Our psychologists, Dr Bruce Dick and Dr Tula Paul, and their team, offer individual and group sessions to patients who are already under the care of one of the clinic's physicians, at no charge to the patient.
We have called this program Pain 101. Below is a summary of the 10 topics covered in this program.
1. Pain Education
Participants will learn how chronic pain differs from acute pain. The biopsychosocial model of chronic pain is introduced and this model will be reviewed throughout Pain 101. Pain pathways in the body are reviewed including how pain messages are sent from the periphery and received by the brain. The Gate Control Theory of Pain (Wall & Melzak, 1965) is introduced and up-to-date scientific information on our understanding of this theory is discussed. This session sets the stage for the rest of the program and explains the science of pain along with an overview of effective behavioural medicine strategies that can help participants learn to manage their pain.
2. Tension and Relaxation
Participants will learn the science of relaxation and how tension opens pain gates and thereby potentially increases pain. We also review how relaxation strategies close pain gates, which can lead to decreased pain. Relaxation exercises including progressive muscle relaxation, guided imagery and deep breathing are taught and practiced with the group. Click here for audio relaxation and mindfulness exercises.
Participants will learn how unhelpful patterns of activity such as activity cycling can open pain gates and lead to disability in chronic pain. Methods to break this downward cycle are reviewed. This session also focuses on practical goal setting strategies. Participants are expected to complete activity goals for themselves. The goals are broken down from long term goals, to intermediate goals, to mini goals. Activity tolerance times are calculated as a tool for helping participants gently increase their activity levels. Participants are then coached on how to meet their baseline activity goals on a daily basis over subsequent weeks.
4. Dealing with Negative Thoughts
This session deals with the common effects of chronic pain including depression, frustration, and anger. Practical strategies are discussed to challenge and change unhelpful thoughts and behaviours associated with them.
Participants will review the importance of sleep in managing chronic pain and closing pain gates. Sleep hygiene strategies which support restorative sleep are reviewed including bedtime routines, creating a relaxing sleep environment, use of specific relaxation strategies, avoidance of unhelpful behaviours such as technology (television and computer) at bedtime.
6. Stress and Anxiety
In this session we discuss how stress and anxiety lead to biological responses that affect pain gates, mood, and sleep, thereby exacerbating pain. Participants will review stressors such as work, school, homework, dealing with others, chores. Fear of pain and how that fear contributes to disability are reviewed. Recognizing the physical effects of stress and anxiety including physical reactions (fight or flight response) and emotional reactions are discussed. Methods to decrease stress and anxiety such as recognition, coping strategies including relaxation and pacing activities are reviewed.
Pain behaviours and communication are reviewed. Participants will learn about both verbal and non-verbal communication messages and will discuss how the messages may be interpreted by others. Discussion takes place regarding how strategies can be practically applied to teach family, friends, and others about pain.
Participants will learn how to develop their own personal setback plan to be utilized whenever they have a flare in their pain. This plan includes recognizing the flare early, implementing the various strategies reviewed through the course – relaxation, pacing, thoughts, sleep, stress, and communication.
Participants will review the theory of mindfulness of Dr. John Kabat-Zinn. Practice activities for mindfulness are completed in class. Participants are encouraged to practice various daily activities in a mindful way in everyday life.
10. Life with Pain
This final session includes strategies to live life to the fullest despite having pain. Concrete methods include simplifying activities of daily living such as work, chores, social activities, and other activities of daily living. We review how strategies that have previously been covered in Pain 101 can be applied to each of these life activities, structuring activities to allow for breaks while still meeting goals. Individual setback plans are reviewed and participants are asked to provide a copy of their set back plan to the pain clinic staff. Participants who complete the program are provided with a certificate.