FAMILY HEALTH MAGAZINE - SPECIAL CHRONIC PAIN SECTION Although chronic pain may emerge from acute pain, in many cases there is no obvious reason why it does not go away. Pain often acts as a protection or control system, warning that something can or will do harm. Touch a finger to flame, and almost instantly your body's nervous system sends a signal to move it before damage occurs. First, a signal is sent through special nerve cells called nociceptors. Once stimulated, nociceptors respond by sending a message to the spinal cord. This in turn signals to the body's reflex centre, starting an instant action like pulling your hand from the flame. From the spinal cord, the message is transmitted through different parts of the brain, where additional information is gathered. Once the message reaches the cerebral cortex, the message is interpreted. The brain gives the message meaning, creating a conscious experience that involves both feelings and emotion. It very quickly evaluates what the incoming messages mean. An instant decision is made on the best course of action. Your brain decides whether you feel high pain, some pain, or no pain. In some cases, it may limit the usual pain response. After a serious car crash, your brain will first focus on the immediate priority. Getting out of a burning car comes before transmitting the pain of a broken limb. As a result, you may not feel pain or realize you are injured until your brain tells you that you are safe. The brain can also lessen the pain response by releasing the body's natural painkiller – endorphins. These help block the sending of pain messages. Some people produce more endorphins than others. They are better able to tolerate pain. If the spinal cord and brain are bombarded with persistent pain messages, as in chronic pain, the nociceptors become increasingly sensitive. The pathways remain open, even though damage has stopped. In time, nerve cells along the pathway and in the brain become overly sensitive to the messages. The pain cannot be switched off. Each person's sense of pain varies greatly. This response depends on many factors including cultural beliefs, past experience, age, and general state of health. Chronic pain can hugely affect a person's life. Continuing pain may physically weaken the body. If there is less activity, both muscle strength and mobility can be lost. Focusing on pain leaves little room in life for much else. Depression and anxiety often go along with chronic pain. Since pain is invisible, those experiencing it can feel misunderstood or alone in their suffering. If it seems that others cannot understand, this frustration can make the pain worse. Feelings of depression increase. Depression and irritability can be socially isolating, breaking down personal and work relationships. An inability to work can threaten financial security. Chronic pain also influences sleep. Persistent chronic pain often leads to problems falling asleep. Continually waking with pain in the night does not allow restorative or refreshing sleep. Feelings of hopelessness, anxiety, and fatigue further reduce the ability to cope with daily life. Remember, it is unlikely that chronic pain will go away completely. However, there are ways to manage it. This kind of pain affects many different aspects of life. You may feel forced to give up things you enjoy because you are afraid they will make you feel worse. It can seem like your dreams and aspirations have been lost. Still, there is hope. It is possible to carve a new path. While it may not be the one you first dreamed of, it can be just as fulfilling and meaningful. It can be frightening to start something new, but using goal setting as a planning tool can help you gradually increase activities. You can take control of pain and not allow it to control you. A goal is something that you would like to achieve. It can be as simple as playing with your grandchildren, walking your dog, or being able to go to the grocery store. If you follow some basic planning rules, goals can help you significantly improve the way you deal with chronic pain. Keep in mind that a goal must be:|time-bound (have a time frame).|The first step is to decide on your goal. Think about everything involved with achieving that goal. It is vital that you set a goal that you can reach. Start small – you can always move your 'goal post'. For instance, let's assume that you would like to be able to walk your dog. To change this into a SMART goal, you could decide to walk the dog around the yard for 15 minutes every day. This goal is specific, measurable, achievable, realistic, and has a time frame. You can measure your progress and make adjustments as you go. Be aware of barriers in thinking that may get in your way. Barrier 1 Reasoning: "I can't walk the dog today because of the snowstorm."Better thinking: "I'll walk inside the house instead, and throw a toy for the dog so he's moving too." Barrier 2 Excuses: "The dog is sleeping. I shouldn't wake him."Better thinking: "He enjoys walking with me, so it's worth waking him up." Barrier 3 Rationalization:"I shouldn't go out in case the doctor calls."Better thinking: "I promised myself I'd walk the dog every day, no matter what. It's only 15 minutes - the machine can take the call. "Barrier 4 Learned behaviour: "My high school coach said exercise should hurt. "Better thinking: 'Walking the dog counts as exercise. It's a small step towards feeling better. "Once you set a goal, keep reviewing your progress. Make changes if it is not working for you. If you fail, blaming yourself will not help. Instead, revisit the goal and ask yourself if it was realistic. Were you asking too much of yourself? Can you break the goal down to achieve it over a longer period of time? Remember, small achievable steps can eventually add up to big leaps! By understanding chronic pain and setting realistic goals, it is possible to improve your quality of life.