Managing Your Pain

An A-Z Guide

 

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About 'Managing Your Pain: An A-Z Guide'

'Managing Your Pain: An A-Z Guide' is a resource developed with funding from the Victorian Government, and produced by the team at MOVE muscle, bone & joint health. 

For support and advice from a specialist nurse, contact the MOVE National Help Line. Phone: 1800 263 265 or email  helpline@move.org.au



INTRODUCTION

IF YOU LIVE WITH PERSISTENT (OR CHRONIC) PAIN, YOU’RE NOT ALONE. IT’S A COMMON AND COMPLEX PROBLEM THAT AFFECTS 1 IN 5 AUSTRALIANS.

The good news is there are many things you can do to manage your pain. This A-Z guide will give you new ideas to try and will help you look at things you’re already doing in a fresh light.

It’s important that you don’t rely on just one thing to manage your pain, but have a variety of strategies and tools you can call on when needed. This will give you more control over your pain.

That’s why we’ve provided lots of strategies in this guide for you to sample and practise.

An important note - many of the treatment options in this guide will require you to put in some time and effort before you notice long lasting effects. You’ll need to commit yourself to regular practise, but the rewards are great.


"Do or do not. There is no try."

- Yoda - The Empire Strikes Back


HOW TO USE THIS GUIDE

This guide is not intended to be read from front to back – although you could certainly do that.

We think the most helpful way to use this guide is to dip in, scan the contents and choose where you’d like to start. Each section is its own unique guide with information, hints, tips and links for more information.

Make notes and add your own thoughts, insights and experiences. This is your pain journey and pain guide – make it your own.

And if you have feedback on how we can improve this guide for others, please  let us know.


CONTENTS


A

Acceptance

You have pain - it doesn't have you


"Acceptance doesn't mean resignation; it means understanding that something is

what it is and that there's got to be a way through it"

- Michael J Fox


Accepting that you have persistent pain – or the sort of pain that looks like it’s here to stay - is an important step to managing it more effectively. Acknowledging your pain and how it affects you from day-to-day means you can find practical ways to deal with it. 

Acceptance doesn’t mean ‘thinking positive’. It means understanding that you have pain, but pain doesn’t define who you are. 

By accepting you have pain, you take control. You’re using your energy to manage and control your pain.

Consider this example:

Tomorrow you’re going on a trip with friends and you’ll be a passenger in a car for a few hours. You feel anxious about the trip and start to think about not going. All of your thoughts are focused on your pain - how the trip will make it worse and how you’re sure you won’t be able to enjoy yourself. 

By accepting your pain and taking control you can actively work on ways to manage it and still do the things you want to do. In this example, proactively managing your pain may include allowing extra travel time so you can stop for stretch breaks, using supports (e.g. cushions) in the car to ease your pain, taking pain medication before you set off or distracting yourself from your pain by chatting with your friends. Or it may be a combination of all of these things. 

Whatever you choose to do, the end result is that you can enjoy the trip and have a great time with your friends. Your pain will still be there, but you’ve planned and used strategies to help control it.

This all sounds so easy, right? Well, not really. It can be challenging to accept your pain is a constant in your life. It can be frustrating and it may be a struggle sometimes. You may also go through periods where your pain does dominate your thinking, and may make you anxious and sad. 

That’s okay. Accept that this can happen. It’s completely normal when living with persistent pain to have these ups and downs. 

Speaking with someone - a friend or family member, your GP, a pain specialist, a mental health therapist (e.g. psychiatrist, psychologist) - can help you work through this so you can get back on track. 

Writing it all down in a journal or pain diary is another option. The important thing is to keep working on it.

Personal Perspectives

Chronic pain gives opportunities for the self to grow: as we cultivate awareness and compassion for our own pain, we grow in awareness and compassion for others’ pain – and we do all live with pain, physical or otherwise.

- Matthew

Don’t forget you can also call our National Help Line on 1800 263 265 and speak with a nurse for practical information and advice on living with persistent pain.


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Aids and equipment

Making your life easier


There are a variety of aids, gadgets and other equipment available to help you manage your pain. They can also help reduce stress on your muscles and joints, save energy, prevent fatigue and basically make your life easier.

Aids and equipment can help you with everything from cooking, cleaning, bathing, writing, mobility, technology and driving.

You may be able to modify some objects that you already own – e.g. if you have sore hands, foam tubing can be used to create an easier grip on your pens. Or you may need special equipment for specific situations – e.g. tap turners to help you turn the water tap on or off; pick-up reachers to help you pick items up off the floor; or grab rails beside the bath/shower to help you get in and out of the tub.

Some of these items can be made by a home handyperson or you can buy them from medical suppliers, pharmacies, hardware or other stores.

If installation is required, a competent home handyperson can sometimes do the job, but local tradies and sometimes local councils can also arrange installation. Grab rails, bath seats and other aids must be properly installed or else they’re dangerous!

The range of aids, equipment and other gadgets available is enormous, so you might want to speak with an occupational therapist to get specific information and advice. Occupational therapists work in the public and private sectors. You can access them through public and private hospitals, community health centres, vocational rehabilitation centres, independent living centres and private practice.

Independent Living Centres are also available to help you. They provide information and displays of products and services available to make your life easier.

Personal Perspectives

I love to garden and have discovered thick handled gardening tools. They make pruning much easier.

– Mary

I have a fold-up walking stick that fits perfectly into my bag. I always have it on hand, just in case I need it. And it has a really fun, young design so it doesn’t look like something your Pop would use.

– Natalie


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B

Breathing

Be conscious of each breath


"Breathing in, I calm body and mind. Breathing out, I smile.

Dwelling in the present moment I know this is the only moment."

- Thich Nhat Hanh


For most of us, breathing is something we take for granted. We don’t even think about it. But focused and controlled breathing is a simple and effective pain management technique that can be done anywhere and at any time. You can do it at home, at work, on a train or in a waiting room. It’s useful when you’re trying to sleep or when you’re waiting for your pain medication to kick in. And anyone can do it.

Breathing exercise

Find a comfortable position. This may be in a chair, on a bed or even lying on a blanket outside.

Relax your body, especially your shoulders, chest and stomach.

If you want, close your eyes. This can help you become more focused and block out external distractions.

Clear your mind. Put aside your thoughts, worries and anxieties.

Focus and take this short time out for you.

Slowly take a deep breath. Fill your lungs to a capacity that’s comfortable for you.

Then slowly release this breath. Don’t release it in a sudden exhale, but control it so it’s slow and smooth.

Continue to take slow, even breaths...in and out. You’ll feel your muscles start to relax and your mind will begin to calm.

Continue to breathe deeply in this slow, smooth way for as long as you need.

Variations:

There’s no right or wrong way to practise deep breathing. Find the method that suits you best and makes you feel most relaxed.

Some people prefer to inhale through their nose and exhale through pursed lips; others inhale and exhale through their nose, while others inhale and exhale through their mouth.

Play soft music in the background to help you relax and block out other noise and distractions.

Silently repeat specific words or phrases in time with your breathing ,e.g. ‘I’m inhaling energy, I’m exhaling my pain’ or ‘relax’, or ‘no pain’.

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C

Complementary medicine

Working alongside conventional medicine


Complementary medicine is a wide range of treatments that generally aren’t considered to be mainstream or conventional medical treatments. Complementary medicine includes acupuncture, vitamins and minerals, herbal treatments and naturopathy.

People are often drawn to complementary medicine because the treatments appear natural and safer than conventional medicine. This isn’t necessarily true. As with any treatment, they may cause harm and may make you unwell if they’re not taken correctly, if they interact with one of your other medications, or if the practitioner you see isn’t properly trained or qualified.

It’s important that you’re aware and cautious when you use complementary medicine. Just like conventional medical treatments, they have the potential for harm.

While many people use and get benefit from complementary medicine, there isn’t as much evidence to support its use for persistent pain. More and more research is now focusing on these treatments. But at the moment the evidence is still lacking for many complementary medicines. So it’s wise to proceed carefully and with caution.

Tips about using complementary medicine

  • Be open and honest with your doctor about complementary medicine. Keep them informed about any things you’re taking or considering taking (e.g. supplements, homeopathic treatments, herbal medicines) as well as any other therapies you’re trying (e.g. acupuncture, yoga).

  • Before stopping a conventional medicine in favour of a complementary medicine or treatment, talk with your doctor and let them know what you’re planning to do and why.

  • Talk with your pharmacist and/or complementary therapist (e.g. naturopath) about your other treatments and medications. Do your research and ask lots of questions. Some treatments may help you manage your pain, while others will have no effect. Is there any current evidence that says the treatment is effective and safe for people with persistent pain? Is the treatment affordable? What are the possible side effects? Will the treatment interact with your other treatments or medications?

  • Check the qualifications of the person providing the treatment. Do they receive regular training and updates? Have they treated other people with your condition or health issues? Are they a member of their peak body? Are they accredited?

  • Buy Australian. Australian complementary medicines are subject to strict safety and quality regulations. This may not be the case in other countries. In Australia the Therapeutic Goods Administration (TGA) ensures the safety of medicines and other therapeutic treatments. Look for Australian-made products that are marked:

    • Aust L – these are considered low risk products and are reviewed for safety and quality.

    • Aust R – these are considered higher risk products and are assessed for safety, quality and effectiveness.

At the back of this guide are some links to websites that can help you find out more about complementary medicines and research. You can also contact our National Help Line on 1800 263 265 or helpline@move.org.au to find out more about complementary medicine.

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D

Distraction

Shift your focus


Our minds have problems focusing on more than one thing at a time. Just try the old schoolyard trick of patting your head and rubbing your belly – you may soon find you’ve started rubbing your head and patting your belly and your hair’s become a bird’s nest!

But when you’re in pain you can use distraction to your advantage. By focusing your attention on something other than your pain – something enjoyable, entertaining or distracting – it can help you manage your pain for short periods of time. Distraction can be particularly useful if you have to do something that you know will make your pain worse – e.g. sit for an extended period of time, climb stairs or undergo a medical test or procedure. It can also be helpful for the period of time after you’ve taken pain relieving medication and you’re waiting for it to take effect, or when you’re trying to fall asleep. Distraction can also help you if you’re feeling anxious or stressed.

As with most pain management techniques, distraction takes time and practise. And sometimes you may find that your pain is at a level where distraction isn’t enough. But it’s a great skill to have up your sleeve.

There are a great many ways you can distract yourself from pain.

Here are some simple examples

Simple mind games:

  • Count back from 100 by 3s – e.g. 100, 97, 94, 91 etc.

  • Try to remember all the words to a favourite song.

  • Name a country, animal, plant, town or whatever you like, for each letter of the alphabet – e.g. antelope, bear, cat, dog etc.

  • Name the winners of the last 20 Grand Finals.

  • Work out your Christmas, birthday, holiday shopping lists.

Activities that distract:

  • Reading listening to music/radio/podcast/audio book

  • Watching TV/DVD/online video/movie

  • Playing with your pet

  • Puzzles – e.g. crosswords, jigsaws, Sudoku

  • Art and craft – e.g. drawing, knitting, painting, writing, woodworking

  • Mechanical work – e.g. working on or restoring a car

  • Gardening

  • Talking with someone – in person, on the phone, in an online forum, via social media

  • Going for a walk

  • Visualisation

Personal Perspectives

I’ve become a huge fan of podcasts. When I need distraction, I grab my iPod, plug in my headphones and listen to the latest episodes of ‘Serial’, ‘This American Life’ or ‘Stuff You Should Know’. It takes me away from my pain for a while and I learn something new. 

– Lisa 

I go to the movies. There’s always something on that will take my mind off my pain for a few hours. 

– Michael

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E

Emotions

Let them out


Living with persistent pain can sometimes be a roller-coaster of emotions. It’s perfectly natural that from time-to-time you’ll feel sad, worried, angry, stressed or frustrated. It’s important that you acknowledge these feelings. You may want to write in a journal, talk with a family member or close friend or talk with a counsellor or psychologist. Don’t ignore these feelings or keep them bottled up.

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Environment

Your comfort zone


When you’re in pain, you want to feel comfortable, secure and safe. Your senses can be heightened and you may feel more sensitive to light, smell, noise and touch. Think for a moment about where you are: Is your space comfortable?

Does it provide you with all that you need to live and work without aggravating your pain?

Ask yourself

  • Are there areas or aspects of my home or workspace that make my pain worse?

  • Is the furniture comfortable – at home and work – and does it support my body?

  • Can I adjust the light or temperature to suit how I feel?

  • Are there things around that I bump into or trip over?

  • Is the noise level tolerable?

  • Are my surroundings clean?

Write down any issues that you come across as they may be affecting how you feel and your pain levels.

There may be quick fixes you can do to address some of these problems, e.g. using cushions to help support your body in your chair or using ear plugs to block out loud noises when you’re resting.

Other issues may require more effort and money, e.g. you may need a new mattress, you may want an electrician to install lights that can be dimmed or brightened to suit how you’re feeling, or you may need your employer to get a new chair for you.

If you’re not sure how you can fix these problems, or how you can make your environment more comfortable and less likely to aggravate your pain, you may need to talk with an occupational therapist or physiotherapist. They can provide information and advice to help you.

Personal Perspectives

My bedroom is very bright so I use a lavender eye mask to block out the light while I sleep…and it smells nice too!

– Judy

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F

Fatigue

More than just tiredness


Living with persistent pain can be physically and mentally tiring. This tiredness, or fatigue, can make everyday activities seem overwhelming.

As well as being a result of your pain, fatigue may be caused by lack of sleep, medications, depression or conditions such as rheumatoid arthritis.

Many of the strategies that you use to manage your pain can be used to manage fatigue including exercise, relaxation, saying no, eating a healthy diet, pacing your activities, getting a good night’s sleep and talking with your doctor about your medications.

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Flares

Plan ahead


At times you may go through a period where your pain is worse, or more intense. This is called a ‘flare’ or ‘flare-up’. We don’t always know what causes a flare – they can sometimes appear for no reason. Other times a flare may happen because you’ve been more active than usual, or you’ve pushed yourself way past your usual activity levels. For example, you went for a 5km walk when you normally only do 2kms, or you spring-cleaned your entire house from top to bottom.

A flare may also occur when you change some medications. This may be as a result of stopping one and starting another or changing the dose.

Flares are temporary, but can be frustrating and painful while they last. So it’s important that you have a plan for how you manage a flare when it happens.

Your flare plan

  • Write down what you were doing before the flare. This can help you identify if there was something you did that triggered the flare. If there was a trigger, hopefully you can avoid repeating it.

  • Pace yourself. If the flare is the result of overdoing things, think about getting people to help you, or spread the activity over a greater period of time, e.g. if you want to spring-clean your home, get the family involved and give each person a room or zone that they’re responsible for; or spread the job over a few weekends and assign yourself a room, a zone or a period of time to clean that’s achievable for you. When you’ve cleaned that area, or reached that time limit, stop. You can go back to it later.

  • Prioritise your tasks and activities. This can also reduce the risk of overdoing things.

  • Manage your stress, it can increase your pain levels. Many of the techniques in this guide can help you manage when you’re feeling stressed including: relaxation techniques, meditation, breathing exercises and avoiding caffeine, alcohol and cigarettes.

  • Talk with your doctor or pharmacist before making any changes to your medication (e.g. changing the dosage or stopping).

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    G

    Goals

    Stay focused and motivated


    "When it is obvious that the goals cannot be reached, don't adjust the goals, adjust the action steps"

    - Confucius


    Goals are important in life. Whether it’s a goal involving travel, a new career, financial security or a goal relating to your health and fitness, having a clear goal – or an endpoint – gives you something to aim for.

    Goals motivate you. They give you focus and help you put in place the steps or actions you need to achieve your goal.

    Let’s look at setting a goal. Be as clear as possible about what it is that you want to achieve, and how you’ll do it. A common acronym used for goal setting is SMART: Specific, Measurable, Achievable, Realistic and Timed. Let’s look at an example of a SMART goal that relates to weight loss:

    Specific – be specific. What is it you’re aiming for?

    Ask yourself the 5 W’s – who, what, when, where, why:

    • What do you want to accomplish? Join a weight loss class and lose 5kgs. 

    • Why are you doing this? You have bad knees and the extra kilos makes them more painful. 

    • Who will be involved to help you? Doctor, weight loss class, family and friends. 

    • When will you do this? Attend the weight loss class that meets every Monday at 7pm. 

    • Where will you do this? The class meets in the local hall.

    Measurable – you need to be able to measure your goal so that you know when/if you’ve achieved it. Losing weight is not a measurable goal, but losing 5kgs in 8 weeks is. You’re able to track your weight loss and the timeframe.

    Achievable – your goal needs to be something that’s achievable for you. It should challenge you and stretch you a little, but should be something that’s attainable, e.g. losing 20kgs in 2 weeks isn’t achievable, however, losing 5kgs in 8 weeks is.

    Realistic – your goal needs to be doable - for you and for your own circumstances. Losing 5kgs in 8 weeks is realistic for you because you’ve discussed it with your doctor, you’re committed (you know it’ll help ease your pain), you’ve enrolled in a weight loss class for information and support and you’ve joined a water exercise class so that you can exercise without making your knees more painful.

    Timed – your goal needs to have a timeframe. Losing weight someday is not a timed goal. Having a timeframe, e.g. 8 weeks, gives you motivation and helps keep you on track.

    Now it’s your turn. Think about a goal that’s important to you.

    Using the SMART system, write down your goal and the steps you need to get there. Stick it on your fridge, bathroom mirror or someplace you’ll see it often. Refer to it regularly. Try to stay focused and keep on track. If you have any hiccups along the way, that’s okay, don’t give up. Just refer back to your goal and move on.

    You’ve now taken the first steps towards achieving your goal. Good luck!

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    Guided imagery

    A tranquil daydream


    Guided imagery is a guided daydream that uses the power of your imagination to distract you from your pain.

    This relaxation technique allows you to focus on a favourite place – real or imaginary – that’s safe, calm and pain-free. You’re then guided through positive, detailed imagery that engages all of your senses. A common guided imagery script that’s used is a walk on the beach or a walk in a garden.

    To practise guided imagery you can listen to an instructor, a recorded script (e.g. on a CD or online), or you can create your own scripts. When you’re coming up with your own scripts try to be as detailed as possible – think about the things you see, feel, taste, smell and hear.

    Example script - A walk on the beach

    Find a comfortable position. This may be in a chair, on your bed or lying outside in the garden. Close your eyes and relax your body. Breathe slowly and gently. Take your time and focus on smooth, even breaths.

    Now imagine you’re on a beach. It’s a small, sheltered cove. You have the place to yourself. It’s a beautiful day and perfect for walking – not too hot or too cold. The sky is a remarkable shade of blue. There’s not a cloud in the sky.

    The water sparkles in the sunlight, and the breeze that comes off the water smells salty and fresh. Look out over the water. Inhale the clean air. While you breathe in imagine that the air is filling you with energy. As you breathe out, feel your pain and anxiety go out with your breath and fly away over the water.

    You hear the cries of seagulls as they fly overhead. Watch as they swoop and dive and perform the most amazing acrobatics. As you watch them, feel their joy and excitement as they play in the air currents.

    Under your feet the soft sand is lovely and warm. Curl your toes and feel the crunch of the grains of sand. The warmth from the sand travels up through your feet, making your whole body feel warm, relaxed and calm.

    You move on and walk slowly along the beach. You notice a small crab making its way along the sand leaving tiny prints as it goes. Shells glitter like jewels in the sand. The trees along the edge of the beach are swaying in the breeze. It all feels so calm and unhurried.

    Ahead of you is a large flat rock jutting out into the water, perfect for sitting. Climb onto it. The surface is slightly rough, but warm and comfortable. From your spot you can see into the water. Small coloured fish are darting about. Take a deep breath. Let it out slowly and smoothly. Notice how your body feels heavy and relaxed. You’re calm and not feeling any pain. Take a few moments to enjoy this sensation.

    Then, when you’re ready, stand up and walk further along the beach. Enjoy all of the sights, sounds and smells that you experience along the way – the gentle lapping of the waves on the sand, the warmth of the sun on your shoulders, the crunch of the sand under your feet, the smell of clean, fresh sea breezes. Think about how relaxed and comforted they make you feel.

    Now as the time comes to leave the beach, remember that you can bring these feelings and sensations along with you. Know that when you need to, you can easily return to your special beach cove.

    Slowly, open your eyes. Continue to breathe smoothly in and out. Take time to notice how your body feels. Relaxed, calm and peaceful.

    The beauty of guided imagery is that it can be done anywhere – at home in bed, at work during a break, on the bus, while sitting in a waiting room – wherever you are and need to distract yourself from pain. It takes time and practise, but it’s a helpful pain management technique to master.

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    H

    Heat and cold

    Simple and effective


    Applying heat or cold to a painful area can help relieve your pain. Some people prefer heat, others prefer cold.

    Generally speaking, heat can relieve muscle spasms and tension. Cold can reduce swelling.

    Depending on where you are – home, work, out and about – there are many different ways you can use heat and cold therapy including:

    Heat

    • warm bath, shower or spa

    • heat packs

    • heat patches

    • heat rubs

    • hot water bottles

    • electric blanket

    • hand warmers

    Cold 

    • ice packs

    • gel cold pack

    • cold gels

    • bag of frozen food

    • ice cubes

    Some of these items are portable (e.g. heat patches, cold packs and rubs) and you can leave them in your car or desk drawer for when you need them. Others require a way to heat or cool them, e.g. a microwave or freezer.

    Cautions 

    • Be aware of the temperature - it should always be comfortable.

    • Wrap heat or cold packs in a towel or cloth to help protect your skin from burns and tissue damage.

    • Check your skin regularly to make sure that you aren’t having any harmful effects from the heat or cold.

    • Be very careful using on areas of your skin with poor sensation to heat or cold.

    • Never use heat or cold over an area of skin where you’re numb, or you can’t feel light touch or the difference between hot and cold – there’s a high risk of burning or damaging your skin.

    • These treatments shouldn’t be used for long periods of time.

    • Heat or cold treatments shouldn’t be used on open wounds or damaged skin. Follow the instructions on the pack of patches, rubs, packs and gels.

    • When using rubs or gels avoid contact with sensitive areas (e.g. your eyes) and wash your hands thoroughly after applying.

    • If you’re using a wheat bag, make sure you allow it to cool completely before you reheat it. Don’t sleep with your wheat bag or smother it behind you in your chair or bed. This can cause them to overheat and catch fire. Always carefully follow the manufacturer’s instructions for use and never overheat them in the microwave.

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    Help

    It's okay to ask


    At times you may need more support, or some help. You might need help with laundry or other household tasks, or a lift to a doctor’s appointment.

    Ask. Most people are very happy to help out, but we’re often too shy to ask.

    There are many help and support services in your local community. You can access them through your doctor, community health service and local council.

    If you need professional help and you can’t get hold of your doctor, contact:

    •  Nurse-on-Call: 1300 60 60 24 for 24 hour health advice and information 

    •  Healthdirect Australia: 1800 022 222 for 24 hour health advice and information 

    • MOVE muscle, bone & joint health National Help Line: 1800 263 265 weekdays

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    Hydration

    More than H20


    More than half of your body is made up of water, so it’s important that you get enough fluids every day to replace the water you lose through normal bodily functions. Water is lost constantly through sweat, urine, faeces and even through your breath.

    Ensuring you’re adequately hydrated every day is important for overall good health.

    Water lubricates and cushions your joints, aids digestion, prevents constipation, keeps your temperature normal and helps maintain your blood pressure. When you’re not getting enough water, your body can’t work as well as it should. This can make it harder for you to deal with other health issues, including persistent pain.

    The amount of water you need each day varies from person to person and from day to day. There’s no ‘one size fits all’. Factors such as your age, gender, health and environment will affect how much water you’ll need. You’ll notice that you drink more in warmer weather, and when you’re physically active, compared to the amount you drink when you’re sitting at home on a winter’s night.

    You can get your daily water requirement by drinking water, but also through other drinks (e.g. fruit juice, milk, herbal tea) and through some of your foods (e.g. soups and watery foods such as celery and melons).

    Alcohol and drinks containing caffeine (e.g. coffee, tea, cola) are diuretics. This means they make you go to the toilet more frequently and lose water through urine. You should try to consume these in moderation. If you’re concerned that you’re not getting enough water, or you’re not sure how much water is right for you, talk with your doctor.

    Personal Perspectives

    I used to find it hard to drink enough water…but I now carry a refillable water bottle with me everywhere I go. You see lots of people doing this – I think we’re now all aware of how important it is to keep hydrated.

    – Ryan

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    I

    Information

    Take an active role


    “Information can bring you choices and choices bring power - educate yourself

    about your options and choices. Never remain in the dark of ignorance."

    - Joy Page


    Knowing as much as possible about your pain and your condition means that you can make informed decisions and play an active role in the management of your healthcare.

    Access good quality, up-to-date information and stay informed. Quality information can be a powerful tool to help you take control of your pain. 

    But there are so many places you can find information these days, it’s very easy to become overwhelmed. It can sometimes be difficult to work out what information is good and helpful, and what information is wrong, misleading and even dangerous.

    As a general rule, libraries, your health professionals, peer support groups, reputable websites/social media sites and peak organisation such as MOVE muscle, bone & joint health can give you great information to help you learn about, and understand, your condition. And the information they provide will help in different situations. 

    For example, your doctor can provide evidence-based information about your condition and treatment options, whereas members of a peer support group can give you practical information about the experience of living with persistent pain. 

    A good practice to get into is to ask lots of questions and be sceptical. The information you get - from any source - could potentially affect your health, so be cautious.

    Ask questions

    •  Who wrote/gave you the information? 

    •  Do they have the proper qualifications? 

    •  Where does the information come from? 

    •  Does it have the scientific evidence to support it? 

    •  Is the information balanced? 

    •  Does it provide you with a variety of options, or provide only one? 

    •  Does the information provide links to scientific evidence? Or does it only use personal anecdotes from satisfied customers or celebrity endorsements? 

    •  Is the information up-to-date? 

    • Is the information regularly reviewed and updated?

    If you get confused about any information you find or you’re given, talk with your doctor. You can also call our National Help Line on 1800 263 265 and speak with our nurse weekdays. Or visit www.move.org.au. Also check out the list of websites and contacts at the end of this guide for more information.

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    J

    Journaling

    Keep track


    Journaling, or recording your pain experiences each day, can be extremely helpful. It’s a real-time record of how you’re going and will help you and your healthcare team track your progress.

    Record any changes in your condition, the effectiveness of medications you’re taking, how you feel physically and mentally, and your pain and fatigue levels. You can record just the basic information – e.g. your daily pain levels and any medications you take. Or you can add more information so that the picture is more complete – e.g. you might also record your diet and exercise program, your daily activities, as well as the quality of your sleep. It’s up to you.

    All of the information you record can help you when you visit your doctor – especially if there’s some time between your appointments. It provides an accurate reflection of how you’ve been, rather than you trying to recall the information when you’re sitting in your doctor’s office.

    Keeping a journal can also help you track any trends in your pain levels. For example, every Friday you may spend 3 hours cleaning your house and on Saturdays you find that your pain levels have increased. By recording this information you can see that this happens every week. So you may need to reduce the amount of time spent cleaning in one session and pace yourself, or get some help. Or you may find that your pain levels decrease after you’ve been using relaxation techniques, so you know that they’re having an impact on how you feel.

    Journaling helps you see the big picture – which can sometimes be hard to see when you go by memory alone.

    To get started, you can use an ordinary notebook to write this information down or there are many apps and templates you can download and use. Some are free, however some do have a fee to access them.

    Personal Perspectives

    I use the Track & React app on my phone to help keep track of my diet, exercise, pain and sleep. Because it’s on my phone I can always access it, and it’s easy for me to update immediately.

    - Steven

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    K

    Keep connected

    Stay in touch


    An important tool for managing pain is to stay connected and involved with the people and world around you.

    It can be very easy to stop doing the things you enjoy when you’re living with pain. You may worry that some activities will make your pain worse, or that you won’t be able to participate as well as you have in the past. On days when your pain is intense, or you’re feeling tired or frustrated, these negative thoughts and worries have the potential to keep you from the things you love. Pain becomes your focus.

    That’s why it’s important to work hard to stay connected to those around you. Focus on doing activities that make you happy such as catching up with friends, participating in sporting and social clubs, working, discovering new hobbies, volunteering, exploring the world or just getting out and about with your family. These connections can help you manage your pain better. They engage your mind and energy and distract you from the pain. Pain is no longer your sole focus. If you find that it’s difficult to do some of the things that you used to do, focus more on a few activities that you really enjoy.

    The important thing is that when you keep doing things you enjoy, you stay connected and involved. This is what makes our lives rich, colourful and exciting. Important noteIf you’re struggling with negative emotions and you’re finding it difficult to stay connected, talk with someone you trust. Whether it’s a close friend or family member, your doctor or a mental health professional (e.g. psychologist or psychiatrist), talking about the problem, and getting support and advice may be what you need to help you move on.

    Important note

    If you’re thinking about suicide or experiencing a personal crisis call Lifeline on 13 11 14.

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    L

    Laughter

    The best medicine


    "Laughter is the tonic, the relief, the surcease for pain."

    - Charlie Chaplin



    You know what it’s like when you have one of those huge, spontaneous belly laughs with your friends. Something was said, a joke was told or you all saw something ridiculous. There’s nothing like it. You snort, you chortle, your eyes water, you gasp for breath, your belly starts to hurt and, when you look at each other, you laugh some more. When you finally do stop, you feel euphoric. Everything seems better, you feel happier and you can’t wait to do it again.

    When you’re in pain, laughing is probably the last thing you feel like doing. But did you know that laughter can actually help you deal with your pain? A good joke, a funny movie or just seeing something silly can all distract you from your pain and make you feel better, at least for a while.

    Laughter causes a variety of chemical responses in your body. The ‘feel good’ hormones - endorphins, serotonin and dopamine – are released into your bloodstream. They boost your mood and make you feel more positive. Endorphins are your body’s natural pain reliever. Releasing them into the body reduces your feelings of pain. Laughter can also help boost your immune system. And, let’s face it, it’s just a lot of fun!

    So next time your pain is getting you down, why not give laughter a go?

    Things to try

    • watch cat/dog/panda videos on YouTube (you know the ones you see pop up on social media regularly!)

    • watch a funny DVD or TV show

    • listen to a funny podcast

    • talk with a friend and reminisce about a funny experience you had together

    • think about the funniest joke you ever heard

    • join a laughter club or group.

    Personal Perspectives

    I watch old episodes of ‘Friends’. I have them all on DVD so I just put one on when I need it…they’re short, funny and distracting.

    – Natalie

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    M

    Massage

    Not just an indulgence


    Massage is a hands-on therapy that involves rubbing and manipulating the soft tissues of your body, especially your muscles. Massage can improve blood circulation, ease muscle tension and help you feel more relaxed.

    A massage is not only useful for helping you deal with your physical pain, it also helps relieve stress and helps you get to sleep.

    You can give yourself a massage or you can see a qualified therapist. You can even ask a family member or good friend to give you a gentle massage.

    While it’s not possible to massage all parts of your body (unless you’re a contortionist) you can still relieve many of your own muscular aches and tension. You may even find that you do it unconsciously – when you’re sitting at the computer and you rub your neck, when you have a headache and you gently rub your temples, or when you’re applying a heat rub to your sore knee.

    Self-massage tips

    • As well as using your hands, you can use a foam roller, massage balls or other massage aids; e.g. use a tennis ball or a golf ball to massage the soles of the feet. Simply place the ball on the floor, place your bare foot on top of it and gently roll the ball along the length of your foot. If you’re unsteady on your feet, sit down while you do this.

    • Before starting, ease some of your muscle tension with a warm shower or applying a heat pack (warm not hot) to the painful area.

    • Use smooth, firm strokes. You’ll feel the difference between strokes that are relieving muscle tension, and those that are adding to it. Adjust the pressure, from hard to gentle, based on your pain.

    • Using an oil or lotion can help your hands move smoothly over the skin, however, they aren’t essential; it’s a personal choice.

    • Try to massage yourself regularly to prevent muscle pain and tension building up.

    • You can also use the shower to provide a massage, especially on your neck, shoulders and back.

    As well as doing your own massage, you can see a qualified therapist. They’ve been trained to know how your body works, how to relieve muscle tension and help relieve your pain. They can also get to the hard to reach places, and give you tips and advice on your self-massage techniques. Massage therapists provide a range of different massage styles from remedial to relaxation to myotherapy.

    Questions to ask a massage therapist

    • What type of massage do you provide? 

    • What are your qualifications? 

    • Are you accredited with the peak massage body in Australia?

    • Have you successfully treated people with my condition?

    • Do I need to take all my clothes off? 

    • How long are the massage sessions? 

    • What is the cost? 

    • Can I claim this on my health insurance?

    Other tips

    • Make sure you’re comfortable before the massage therapist starts.

    • Ask for extra support if you need it.

    • Let your massage therapist know if the pressure is too hard,too soft or if anything hurts.

    • Ask yourself whether you prefer to see a male or female therapist.

    • Try not to feel embarrassed if you fall asleep or pass wind during your massage. It happens – especially when your body relaxes.

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    Medications

    Part of a good management plan


    Along with self-management strategies such as exercise, distraction, healthy eating, managing stress, weight management, and getting a good night’s sleep, medication can help you keep your pain to a level where you can continue to do the things you want, and need, to do.

    There are different types of medication that you and your doctor may use to help you at different times and in different ways. They should be tailored to your pain condition and other health concerns.

    Over-the-counter medications

    Medications that may help with mild to moderate pain include mild analgesic paracetamol (e.g. Panadol), and anti-inflammatories ibuprofen (e.g. Nurofen) and aspirin (e.g. Aspro Clear). These medications may be combined together – e.g. paracetamol and ibuprofen (e.g. Maxigesic). They may also be combined with a low dose of codeine (a weak opioid) such as paracetamol and codeine (e.g. Panadeine, Panadeine Forte).

    All medications have potential side effects (or unwanted effects) and risks. The fact that you can buy these products over-the-counter doesn’t mean they’re without risk or completely safe. Talk with your pharmacist for more information.

    Prescription medications

    Non-steroidal anti-inflammatories (NSAIDs) – there are some over-the-counter NSAIDs available in low dose, however, others need to be prescribed by your doctor (e.g. Celebrex and Naprosyn). NSAIDs work to help provide temporary pain relief, specifically pain associated with inflammation, and to reduce fever.

    Opioids – e.g. codeine, morphine, fentanyl, oxycodone - are used to treat severe pain associated with cancer or acute pain (e.g. following surgery). They may be helpful for some people with severe persistent non-cancer pain, however, their long term benefit is controversial. Opioids can have serious side effects (including constipation, breathing difficulties). They will also produce physical dependence over time and have the potential to produce addiction (although usually in those at risk). Long-term use of strong opioids are used cautiously; before prescribing an opioid you and your doctor will discuss the risks and benefits for you.

    Anti-neuropathic pain medications – medications that act on the nervous system associated with pain may be used where nerve injury or dysfunction produces pain (neuropathic pain) or when the pain system is sensitised (in part due to severity or duration of pain). These include the older type anti-depressants (e.g. amitriptyline, venlafaxine), anti-epilepsy medications (e.g. pregabalin), and some blood pressure medications (e.g. clonidine). These medications typically have significant side effects (e.g. reduced concentration, sleepiness, weight gain), however, sometimes they may be prescribed for these effects (e.g. to improve sleep).

    Medication tips

    • Before buying any over-the-counter medications talk with your doctor or pharmacist about the benefits and harms of these medications and how to use them most effectively as part of your pain management plan.

    • Be aware of the active ingredients in all of your medications to prevent accidentally taking too much, e.g. be careful not to use other medications that contain paracetamol (such as some cold and flu remedies) while you’re taking paracetamol for pain relief. If you’re unsure of the active ingredients, talk with your doctor or pharmacist.

    • Always take your medications as prescribed, and organise regular review appointments with your doctor.

    • If you’re prescribed opioid medications make sure you store them safely.

    • Be aware that your doctor will need to assess their ongoing use, suitability for your situation and may potentially need to obtain a government permit to continue to prescribe them. • If you have difficulty remembering to take your medications, set up a reminder alert on your phone, use a pill dispenser or link your medications to a daily routine (e.g. cleaning your teeth).

    • All medications have side effects. Discuss these with your doctor or pharmacist and read the consumer medicine information that comes with any new medication.

    • Let your doctor know about any other medications or supplements you’re taking. This includes over-the-counter medications, supplements and products you’ve purchased from a supermarket or health food store, or products prescribed by a complementary therapist (e.g. naturopath, homeopath). They may interact with medications you’re taking for your pain or other health conditions.

    • Keep track of your medications. Write down all of the medications, supplements etc that you take. Record them in your pain journal or download one of the many medication apps available. 

    • Don’t stop taking any medications without first discussing it with your doctor. Some medications need to be gradually reduced, rather than simply stopped, to avoid side effects.

    • Consider a Home Medicines Review. They‘re particularly useful if you’re taking many medications, or if you have many health conditions. They help make sure you’re using your medicines effectively and will help you avoid any unwanted side effects. Your doctor or pharmacist can give you more information about a Home Medicines Review.

    For information and advice over the phone contact:

    • MOVE National Help Line: 1800 263 265 - weekdays

    • Medicines Line: 1300 633 424 (1300 MEDICINE) – weekdays

    • Healthdirect Australia: 1800 022 222 – 24 hours

    • Nurse-on-Call: 1300 60 60 24

    Personal perspectives

    Some of my medications need to be taken with food, but I often don’t feel like eating – which isn’t ideal. I’ve found that plain crackers and plenty of water works for me. So I make sure there’s always a box in the pantry. 

    - Paul


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    Mindfulness

    Be in the moment


    "The best way to capture moments is to pay attention. This is how we cultivate mindfulness.

    Mindfulness means being awake. It means knowing what you are doing."

    - Jon Kabat-Zinn



    We live crazy, busy lives with so many distractions, interruptions and things that need to get done. Many times you find yourself doing lots of things at once, and not really focusing on any one thing. You’re at the stove cooking dinner while talking on the phone to your sister and keeping an eye on the kids doing their homework, or you’re at your desk scanning emails, thinking about an upcoming meeting while chatting with a work colleague. You’re so busy doing that you often miss out on connecting with the moments you’re living.

    Mindfulness meditation focuses your mind on the present moment. It trains your mind to be alert and pay attention to the thoughts and the sensations you feel and accept them without judgement. Being mindful is being aware of the moment.

    Regularly practising mindfulness meditation has been shown to improve mood, relieve stress, improve sleep, improve mental health and reduce pain.

    To practise mindfulness meditation you can join a class, listen to a CD, learn a script from a book or play a DVD or online video.

    A simple technique to give you a taste of mindfulness meditation is a body scan. It helps you become aware of your body in this present moment.

    Example script – Simple body scan

    Find a comfortable position. This may be in a chair, on your bed or lying outside in the sun.

    Close your eyes and relax your body. 

    Breathe in and out slowly and gently. 

    Take your time and focus on smooth, even breaths.

    Notice how your body feels. The weight of it as you sit on the chair, or as you’re lying down. 

    Keep breathing in and out, slowly and evenly.

    Now focus on your feet. Notice any feelings or sensations, tension, warmth, coolness, pain, discomfort. Just notice these feelings, they’re not good or bad. They simply exist. 

    Keep breathing smoothly in and out.

    Move up to your legs. Focus on your legs. Notice any feelings or sensations, tension, warmth, coolness, pain, discomfort. These feelings are not good or bad. They simply exist in this moment. 

    Keep breathing smoothly in and out.

    If your mind starts to wander at any time, that’s ok - just gently bring your attention back to your breathing…in and out. Then move back to your body scan.

    Continue scanning your body noticing each body part as you go, and any feelings or sensations you encounter. None of these are good or bad– they’re just there.

    Keep breathing smoothly in and out. After you‘ve reached your head and face, take time to notice the feelings and sensations in your whole body. Focus on your breathing, noticing it going in and out. Open your eyes.

    Practise mindfulness meditation regularly. When you’re trying to sleep, after a busy or stressful day, at your desk before a meeting, when you’re out for a walk. Notice how you feel, the things around you, use all of your senses, be present and pay attention to the moment.

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    N

    Nutrition

    You are what you eat


    Eating a well-balanced diet that includes a variety of foods, such as fruits, vegetables, whole grains, dairy products, proteins and healthy fats, is important for good health. It gives your body the energy and nutrients it needs to work properly, helps you maintain a healthy weight, helps protect you against other health conditions and is vital for a healthy immune system.

    But sometimes pain overrides nutrition. Research shows that during periods of intense pain, most people reported that they ate less. Pain and fatigue may make it difficult for you to shop for healthy food and prepare well-balanced meals. Or you may experience appetite loss because of your pain, or as a side effect of medication.

    If this goes on for a period of time, your health can be affected. You may not get the nutrients that your body needs to function as it should.

    So what can you do? Be prepared. Know that this can happen from time-to-time and plan ahead.

    • Seek advice. If you need help planning meals, or finding simple and easy ways to prepare nutritious meals, talk with a dietitian for information and advice. 

    • Prepare meals in advance. When your pain is under control, take some time to make extra meals that you can freeze and use when necessary. This way you’ll be eating meals that you know are healthy, and not resorting to quick and easy take away foods or store-bought frozen meals – which are often high in fat, salt and/or sugar. 

    • Talk with your doctor about supplements. Supplements may be required for some people who are deficient in specific vitamins or minerals or whose diet is inadequate.

    Other tips

    • For a quick refresher on nutrition and healthy eating, check out the  Australian Guide to Healthy Eating. 

    • A lot of the current research into nutrition and persistent pain is on omega-3 fats. These types of fats are well known for their anti-inflammatory qualities. If your pain is related to inflammation, talk with your doctor or dietitian about adding omega-3 fats to your diet. Omega-3 fats are contained in foods such as oily fish (e.g. salmon and sardines), linseeds and linseed oil, canola oil, walnuts and foods fortified with omega-3 (e.g. margarines and eggs). 

    • Make your meals colourful. Fruit and vegetables fall into five different colour categories: red, purple/blue, orange, green and white/brown. Each colour has unique disease fighting chemicals called phytochemicals. Colourful meals also look appealing and delicious! Find out more at  Nutrition Australia - Eat a Rainbow. 

    • Keep your weight within the normal range. Excess bodyweight increases stress on joints, especially weight-bearing joints such as knees and hips, and will make your pain worse.

    • Be sceptical of the latest fad or celebrity diet. If you need to lose or gain weight, talk with your doctor and get safe, practical advice and support.

    Personal Perspectives

    I’ve never been much of a cook...so when the local community house started running healthy cooking classes a friend and I went along. We learned great new recipes using lots of different ingredients. It’s really inspired me to keep exploring and trying new things.

    – Sue

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      O

      Ointments, creams, sprays, liniments, rubs & gels


      Some quick and temporary forms of pain relief are rubs, gels, ointments, sprays and creams that are applied directly to your skin. There’s a vast array of them available, in many different forms and using different ingredients.

      When you apply these products you’re actually benefiting from two things – the first is the product itself, the second is the mini-massage you enjoy when applying the product. Another benefit of these products is that they’re very portable - you can have some at home, in your desk drawer, in your handbag or in your gym locker and use them as needed.

      The different ingredients used in these topical products include

      • Counterirritants. These products have ingredients such as menthol, methyl salicylate, eucalyptus oil and camphor. They’re called counterirritants because they create a burning or cooling sensation that distracts you from your pain. You may know some of these by their distinctive smell, however, you can now get some that have little or no smell.

      • Medicated products. Many of the topical products contain non-steroidal anti-inflammatory drugs (NSAIDs). It’s important to be aware of this, especially if you’re taking other NSAIDs. If you’re unsure, talk with your doctor or pharmacist before using a medicated topical pain reliever.

      • Capsaicin. This is the main ingredient of chili peppers and is effective for topical pain relief.

      Cautions

      As with any medication, there are things you need to be aware of to prevent any problems occurring:

      • Always read the consumer medicine information carefully and follow the instructions.

      • Wash your hands thoroughly after applying.

      • Be careful to avoid contact with your eyes or other sensitive areas.

      • Don’t use these products on wounds or damaged skin.

      • Don’t use with heat packs as this may cause burns.

      • Check the use-by-date and discard any out-of-date products.

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      P

      Pacing

      Know your limits


      It’s an easy trap to fall into when you live with persistent pain. The days when you feel great you do as much as possible – you push on and on and overdo it. Other days you avoid doing things because it hurts. Both of these things – overdoing and avoidance – aren’t helpful for managing persistent pain and they can actually make your pain worse.

      Pacing can be an effective strategy to help you do the things you want to do by finding the right balance between rest and activity (both physical and mental). This will help reduce your risk of pain flares and fatigue.

      It requires that you listen to your body and understand what you can do on a good day (when you’re pain is under control) and on a bad day (when your pain is more intense).

      Pacing is ‘time contingent’. That means it relates to the amount of time you can do things before your pain or fatigue worsens. For example, if you know that you can walk the dog for 20 minutes before your pain becomes worse, then that’s your current limit. Then you need to take a rest break. A rest break means switching from the active thing you’re doing (e.g. walking the dog) to doing something more passive (e.g. reading a book, paying your bills online, creating a meal plan for the coming week).

      Working out your current limits can take some trial and error. Recording your activities and pain levels in a pain journal or pain diary will help you keep track. It will also help you see clearly the activities, or the time spent on activities, that may be causing you problems.

      If you find that from day-to-day your limit changes quite a bit, try this – but hold on to your hat we’re about to do some maths! Over a week or two record the amount of time you can do an activity (e.g. walk the dog) before your pain becomes worse. Add these up and then divide by the number of measurements you’ve taken, this will give you an average limit. For example, if you’ve recorded the times of five walks, add all the times up and then divide by five. Now work out 80% of this limit – e.g. if the average was 20 minutes, 80% will be 16 minutes. This will be your new current limit for walking the dog.

      By understanding your limits, and what you can do at this point in time, you can plan and take control of your day and the things you do. You can plan activities and rest breaks so that by the end of the day you’ve done all the things you wanted or needed to do, and you haven’t made your pain or fatigue worse.

      Pacing will also help you gradually increase the amount of time you spend being active and performing certain activities. For example, if your current limit for walking the dog is 20 minutes, do this regularly for a week. In the second week, try increasing the amount of time by 10% - so instead of 20 minutes, walk for 22 minutes. Record how you’re going in your pain journal. If you’re able to tolerate this increase, try adding another 10% in week 3. And so on. Keep recording your progress. Set milestones (e.g. able to walk for 30 minutes) and reward yourself when reach them. Don’t be hard on yourself if this takes time.

      Tips for pacing

      • Plan your day.

      • Prioritise the things you want/need to do – what really needs to be done?

      • Can you do some things tomorrow?

      • Break jobs into smaller tasks. Break jobs like cleaning into smaller tasks, and rest in between. The job will still get done, and you should have more energy for other things. For example, if you know your current limit for cleaning your house is 30 minutes, then do 30 minutes. Then take a rest break – even if you feel ok. 

      • Alternate physical jobs with less active ones. For example, vacuum the lounge, then sit and sort through your mail or your pile of old magazines. You’re still cleaning, but you’re not overdoing it.

      • Don’t overdo things on your good days.

      • Ask for help when you need it.

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        Posture

        Strike a pose


        When someone mentions the word ‘posture’ it’s seems like we all instinctively straighten our spine. But posture is more than just how straight you sit or stand.

        Posture refers to the correct alignment and positioning of your body. Good posture means that your body is arranged so that no structure is overstressed, that the pressures on your body are evenly distributed and that your muscles aren’t strained or tense.

        When you think about good posture, you may think about the stereotypical image of a soldier at attention. Eyes straight ahead, shoulders back, stomach in. But this military stance isn’t good posture as the muscles are likely rigid and tight. For good posture, your body should be in correct alignment but also loose and flexible. Bad posture can cause, or aggravate, existing pain. It can also cause general aches and pains, muscle fatigue and other health problems.

        Bad posture can sneak up on us. Working away at a computer, sitting on the couch watching TV, standing around at a football game, lifting a suitcase out of the boot of your car - if you’re not paying attention to your posture, it’s easy to slouch, hunch over, or strain.

        Tips for good posture

        • Stand in front of a mirror and check your normal posture. Your spine should be straight when you look front on, but when you look sideways, you should have a natural S shaped curve. If you’re slouched or hunched, make a conscious effort to adjust your posture. When you do this you should notice that your position feels more natural and comfortable. 

        • Use a cushion or a lumbar roll for support when sitting in a chair or in the car. 

        • Avoid squishy chairs that don’t provide your body with adequate support.

        • Get a mattress that supports your body correctly when you’re sleeping.

        • When lifting and putting down heavy things, use your hips, knees and thighs - not your back. And keep the object close to your body when you’re carrying it.

        • Exercise and strengthen the muscles around your torso and pelvis (your core muscles).

        • Use prompts - eg. a post-it note, a pop-up reminder - on your computer or your phone to remind you to think about your posture. This can help you correct youself if you start slouching or hunching.

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          Progressive muscle relaxation

          A whole body experience


          When you’re in pain, often your muscles become tense and sore, adding to your overall pain. Progressive muscle relaxation helps you ease this muscle tension. It’s also a useful technique to use if you’re having problems getting to sleep.

          Example script

          First you need to find a comfortable place to sit or lie down. Make the environment as relaxing as possible – turn the lights down if you can and put some soothing music on to block out any distracting noises. If you’re comfortable to do so, close your eyes. It can help you focus.

          Relax your body. Breathe slowly and gently. Take your time and focus on smooth, even breaths.

          Starting at your feet, point the toes of your right foot, slowly flexing and tightening the muscles. Notice the tension. Hold this for a few seconds. Then relax.

          Now slowly point the toes of your left foot, flexing and tightening the muscles. Notice the tension. Hold this for a few seconds. Then relax.

          Move on to your calves. Slowly curl the toes of your right foot towards your right calf, tightening the muscles. Notice the tension. Hold for a few seconds. And relax. Repeat for your left calf.

          Continue to work your way through your muscle groups, tensing the muscles as you go, noticing the tension and holding for a few seconds, then relax.

          Right foot – point your toes, relax

          Left foot – point your toes, relax

          Right calf – curl your toes towards your calf, relax

          Left calf – curl your toes towards your calf, relax

          Right thigh – tighten the muscles, relax

          Left thigh – tighten the muscles, relax

          Buttocks – squeeze the muscles, relax

          Stomach – suck it in, relax

          Chest – breathe in deeply filling your lungs and chest, then breathe out

          Back – pull your shoulder blades together, relax

          Shoulders – shrug your shoulders up to your ears, relax

          Neck – pull your head back slowly as if you’re looking at the ceiling, relax

          Forehead – raise your eyebrows as far as possible, relax

          Eyes – squeeze your eyes closed, relax

          Jaw – open your mouth wide, relax

          Tips

          • Don’t tense your muscles so hard that they cramp or make you feel additional pain.

          • Don’t tense and relax areas where you’re having intense pain. You might want to try an alternative form of relaxation, or skip that muscle group. 

          • This relaxation technique can be done anywhere and can be done while sitting or lying down.

          Personal perspectives

          I learned this in primary school and have used it ever since. It’s second nature now.

          – Lisa

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          Q

          Quit smoking

          And feel better


          Smoking is bad for your health. There’s no denying it. But did you know it can also make it more difficult to manage your pain and can also cause pain?

          As well as the obvious links to cancer and lung disease, smoking has also been linked to back pain, neck pain and rheumatoid arthritis. Smoking also causes fatigue and slower healing, which can make your pain worse. And it can make some of your medications less effective.

          So quitting smoking has many health benefits. Within weeks of quitting you’ll breathe easier and have more energy, making it easier to exercise and do day-to-day activities.

          Quitting can be difficult, but there’s a lot of help available to support you.

          Tips for quitting

          • Get help. Talk to your doctor and the Quitline (137 848).

          • Decide on a strategy. Are you going to use medication, nicotine replacement, coaching or a combination of strategies? Or are you going to just go it alone?

          • Talk to your family and friends. Let them know what you’re doing and ask for their support.

          • Write down the reasons you want to quit and put this list in prominent places to encourage and motivate you.

          • Have some strategies in place for when you want to smoke, e.g. what will you do if you’re around other smokers? 

          • Be kind to yourself. Quitting can be difficult and you may have a slip-up to two. It’s not the end of the world, or the end of quitting. Get back on track.

          • Use some of the money you save and treat yourself to something special, such as a massage or gold class movie tickets .

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          R 

          Reduce

          Don't stop


          You know what it’s like. You come home from work and your pain is all you can think about. All you want to do is curl up on the couch and do nothing. Your usual habit when you get home is to walk your dog in the park for 1 hour. But you know you just can’t do an hour.

          What do you do? Reduce the activity. Do something that’s manageable for the level of pain you have. Take your dog for a 20 minute walk instead. You’ll get the exercise you need, you’ll get some fresh air, and your dog will stop giving you the looks that make you feel so guilty!

          By reducing your activities rather than stopping, you can still enjoy the benefits of being active and involved.

          Make a plan to gradually increase your activity levels by a small amount each week. Get advice from your doctor or physiotherapist about how to increase your activity levels safely.

          Keep your family and friends involved by discussing your pain management plan with them. They can be a great source of support and encouragement.

          Take small steps and pace yourself. Waiting until you feel 100% before returning to activities or to work isn’t a good approach. Small, gradual steps allow you to stay connected and mean that you can continue to do the things that are important to you, sooner rather than later.


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          Relaxation

          More ways than you think


          "It sounds so geeky, but I really do like studying and reading, and if I'm not working on 'Harry Potter',

          then my greatest relaxation is to sit with a book"

          - Emma Watson


          Living with persistent pain can be stressful. Unfortunately stress can make your pain worse by causing the muscles throughout your body to become tense or to spasm.

          Relaxing – easing your stress and muscle tension – can help reduce your pain levels. There are so many things you can try to help you relax.

          Ways you can relax:

          • Focused and controlled breathing

          • Meditation and mindfulness

          • Gardening

          • Visualisation

          • Listen to music

          • Progressive muscle relaxation

          • Catch up with friends

          • Get a massage

          • Laughter

          • Get back to nature - a stroll by the sea, a walk in a park

          Personal perspectives

          For me it’s a bubble bath and a book. The water is warm and soothing, the bubbles smell lovely, and the book takes me away.

          – Mary

          My own strategies encompass meditation, various forms of exercise, including swimming and walking, as many coffee-dates with smart and caring friends as I can manage, and at least an hour of downtime every day with my music and my books.

           – Matthew

          My partner gives me a head massage. It’s so relaxing I often fall asleep mid-massage!

          - Karen

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                        S 

                        Stress

                        A manageable part of life


                        "I have a drum set in my dressing room. I play drums to relax and have some fun."

                        - Queen Latifah


                        Stress is a part of life. You can feel stressed when there's a deadline looming, or you're caught in traffic, or you're having trouble sleeping. These are the everyday stresses we all live. We can generally handle these small amounts of stress.

                        But if you're constantly stressed, this can have an impact on your health and wellbeing. It will also make your pain worse.

                        So it's important to be aware of your stress levels, and deal with your stress effectively before things get out of control.

                        Many of the strategies that you use to manage your pain can be used to manage stress, including: breathing, exercising, pacing, talking with a friend, meditating, guided imagery, progressive muscle relaxation and doing something you enjoy (e.g. reading, gardening, walking your dog, playing music).

                        Talk with a professional, such as your doctor of psychologist, if you're regularly finding it difficult to keep your stress under control.

                         

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                        Support

                        Everyone needs it


                        The support of your family, friends and those around you is important. Research has shown that people who have positive social support cope better with their pain.

                        Whether it’s knowing that you have people around who love and care for you, or are happy to help when you need it, or are there to encourage and support you through the good days and bad, support from the people closest to you is invaluable.

                        As well as this inner circle of family and friends, having the support of your healthcare team is essential. Being able to discuss your pain and your treatment plan openly with them will lead to better outcomes for you.

                        Finally, there’s nothing like talking with someone who knows what living with pain is like. Sometimes you might need to talk with a friend who also lives with pain. Or you might want to look into joining a peer support group. They’re available all over the country. Some meet face-to-face, while others connect via social media and websites.

                        Contact MOVE muscle, bone & joint health on 1800 263 265 for group details.

                        And with online support, you’re not just limited to Australian groups. There are some very interesting forums, social media pages and blogs all around the world. If you find some you like, don’t forget to bookmark them or join them so that you can get back in touch when you need support.

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                                                                T 

                                                                Teamwork

                                                                There's strength in numbers


                                                                "Alone we can do so little; together we can do so much."

                                                                - Helen Keller


                                                                When you live with persistent pain, you may sometimes feel overwhelmed, upset or alone. But it’s useful to know there’s a lot of help available to get you through these periods and to help you live well.

                                                                First it’s important to remember that pain can be managed.

                                                                And the best way to manage pain is to have a team of people around you. This team of health professionals, family, friends and support groups will treat, support, encourage, motivate, inspire and help you along the way.

                                                                At the heart of the team is you. You’re the central player. You know how your body is feeling and what problems you’re having.

                                                                Your team will include people who share your day-to-day struggles and triumphs. This includes your family and close friends. Talk to them openly and honestly about your pain and ask for help when you need it. This may be as simple as a lift to your doctor’s appointment or doing a load of laundry, to being available to chat when you’re feeling sad or anxious. Most people are very happy to help out – they just need to be asked.

                                                                Your general practitioner (GP) will also be a key team member and will likely be the health professional you see the most. They can help you manage day-to-day and help you access other health professionals and services.

                                                                Other health professionals will play large and small roles in your support team. You’ll see some of them regularly and others only as needed. Depending on your pain and any other health issues you have, you may see a variety of health professionals including: pain specialist, physiotherapist, occupational therapist, psychologist, pharmacist, dietitian, podiatrist and surgeon.

                                                                Meeting with people who know what you’re going through, who have similar conditions and experiences, can help. If you’re not already part of a support group, you might be interested in finding a group of people that you can share with and learn from. Many groups meet face-to-face, but there are others that you can access via websites or social media.

                                                                People in your neighbourhood who provide services such as massage, healthy foods, and other things that assist you (e.g. help with chores around the house and garden) may also have a role in your team.

                                                                As you can see, there’s a lot of support and people wanting to help you manage your pain. If you feel like your team is missing some key players, talk with your GP about how you can access them.

                                                                Other sources for information and advice

                                                                Call the MOVE muscle, bone & joint health National Help Line on 1800 263 265 weekdays or visit our website – www.move.org.au.

                                                                If you need professional help, and you can’t get hold of your doctor contact:

                                                                • Nurse-on-Call on 1300 60 60 24 for 24 hour health advice and information

                                                                • Healthdirect Australia on 1800 022 222 for 24 hour health advice and information

                                                                • If you’re thinking about suicide or experiencing a personal crisis call Lifeline on 13 11 14.


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                                                                U 

                                                                Understand

                                                                Your pain and your condition


                                                                What do you know about your pain? Do you know what’s causing it? Do you know what makes it better, and what makes it worse? Do you know the things that trigger a flare? What are your treatment options? What can you expect in the future? 

                                                                Knowing as much as possible about your pain means that you can make informed decisions and play an active role in the management of your condition. Ask questions, talk with your healthcare team and access good quality information.

                                                                Listen to your body and understand your pain and you’ll be able to take control and get more out of life. 

                                                                Personal Perspectives:

                                                                 I’ve lived with [my condition] and pain for most of my life so I know how important it is to understand as much about it as possible - and to keep learning because things change as [my condition] changes.

                                                                – Lisa 

                                                                “The Routine”- the unique routine I have negotiated with my body - is my authentic daily dialogue with my own body. It’s not always a friendly conversation, but it’s my key to living with chronic pain; accepting that pain as an integral part of my life – of ME.

                                                                 – Matthew


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                                                                V 

                                                                Visualisation

                                                                Use your imagination


                                                                Visualisation is another technique that uses the power of your mind to reduce pain and stress. It’s similar to guided imagery, however, instead of being told what you see, hear and feel, visualisation is up to you and your imagination. As with guided imagery, it’s a chance to distract your mind from your pain, and take some time out.

                                                                Visualisation won’t take your pain away, but it can help you deal with it better when you’re having a flare, when you’re feeling stressed or tense or when you’re having problems sleeping.

                                                                Below are some visualisation exercises for you to try.

                                                                Before you begin, get in a comfortable position – this may be sitting or lying down – and relax your muscles.

                                                                Breathe slowly and evenly and listen to the sound of your breath. Try to clear your mind of other thoughts, worries and concerns. If you’re comfortable to do so, close your eyes. And now begin your visualisation.

                                                                Visualisation exercises

                                                                Remember a past event

                                                                Think back to a happy time and place from your past, e.g. your wedding day, a family holiday, a wonderful day at the beach. Now try to remember that day in as much detail as possible. Imagine the sights, smells, tastes and feelings.

                                                                Imagine a future event

                                                                If you have something exciting coming up, or an event you’re really looking forward to, try and picture it in as much detail as possible, e.g. you may be planning a trip to Cairns - visualise the places you want to see and the things you want to experience. Picture the Great Barrier Reef, smell the warm, salty sea breeze, taste the seafood and cocktails. Or imagine a trip to Paris - visualise the Eiffel Tower, smell the bakery with the buttery smells of croissants and other pastries. Get all of your senses involved.

                                                                Fantasy

                                                                What have you always fantasised about doing? Climbing Everest? Singing onstage to an adoring audience? Travelling through Middle Earth with elves, hobbits and dwarves? Whatever the fantasy, imagine yourself doing it – again, involve all your senses and include lots of details.

                                                                Visualise your pain

                                                                Use colours to visualise your pain and then imagine the colour changing as your pain lessens, e.g. if you have hip pain, visualise the pain as a bright red glowing spot. Now see the spot gradually changing colour from an intense, throbbing red, to a cool, relaxing blue. As the colour gradually changes from red, to pink, to purple, to blue, imagine the pain becoming less and less intense, and the spot becoming smaller and smaller.

                                                                When you finish your visualisation, continue breathing evenly and smoothly in and out. Notice how relaxed and comfortable you feel. Enjoy this moment and know that you can use this technique next time you feel pain, stress or are having difficulty relaxing.


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                                                                W 

                                                                Weight management

                                                                For a healthy life


                                                                Food. We love it. There’s nothing better than getting together with family and friends for a delicious meal.

                                                                But sometimes our pain interferes with our desire to eat and can affect our weight. Pain may make you lose your appetite or you resort to quick and easy take away meals because you’re hungry but shopping or cooking feels beyond you at the moment.

                                                                The occasional missed meal or take away food is generally not so bad. But if it happens regularly you won’t get the necessary nutrients your body needs. And you could start to lose or gain weight. You need a healthy, nutritious diet to help you manage your health in general, but also your pain.

                                                                Overweight

                                                                Apart from the many other health issues related to being overweight or obese (e.g. heart disease, diabetes) being overweight is also linked to increased pain. Extra weight on painful joints will increase the pain you experience. Being in pain may affect your ability to be as active as you’d like – which makes your pain worse and may lead to more weight gain. It can also be difficult to be more active when you’re overweight or obese, which can lead to increased pain and weight gain.

                                                                Underweight

                                                                Being underweight also has many health issues. It can affect your immune system (meaning you’re more at risk of getting sick or an infection) and you may feel more tired than usual. Feeling tired and run down will affect your ability to be active, which will affect your pain levels.

                                                                Tips for managing your weight

                                                                • If you’re concerned about your weight, see your doctor or dietitian for information and advice.

                                                                • Find out more about nutrition and healthy eating.

                                                                • Keep a food diary to help you track what you’re eating.

                                                                • Have a goal and work towards it, e.g. if you’re trying to lose weight, set a realistic goal and plan the steps that will help you reach that goal.

                                                                • Maintain your weight and try not to gain any additional weight.

                                                                • Exercise – even small amounts can boost your health and will also help you control your pain.

                                                                • Get a good night’s sleep. Not getting enough sleep is linked to weight gain.

                                                                • Involve your family and friends. Let them know what you’re doing so they can help support and motivate you.

                                                                • Don’t deny yourself something you enjoy - if you love chocolate, allow yourself a small treat occasionally, but not too often.


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                                                                X 

                                                                Exercise

                                                                Let's get physical


                                                                "I will always have pain. But I exercise as much as I can, and I find that makes a huge difference."

                                                                – Jennifer Grey


                                                                Exercise and being active might seem like the last thing you want to do when you’re in pain. Curling up on the couch or your bed sounds so much better. Right?

                                                                Well not really. While in the short term it might make you feel better to sit and just take it easy, not exercising regularly and being inactive can cause many health issues.

                                                                Exercise is essential for your overall good health and wellbeing. It helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as heart disease, osteoporosis, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, aids weight control and improves sleep.

                                                                If you aren’t sold on exercise by now, think about this: when you exercise your body releases chemicals such as endorphins, serotonin and dopamine into your bloodstream. They’re sometimes called ‘feel-good’ chemicals because they boost your mood and make you feel good. They also interact with receptors in your brain and ‘turn down the volume’ on your pain system.

                                                                So exercise can help you feel better, reduce your risk of many health issues and can help you manage your pain.

                                                                For exercise to be most effective it needs to be regular and should include the following:

                                                                • flexibility exercises – stretching and range of movement exercises help maintain or improve the flexibility of your joints and nearby muscles and will help keep you moving properly and ease joint stiffness

                                                                • strengthening exercises – build muscle strength, provide stability to your joints and improve your ability to perform daily tasks

                                                                • cardiovascular or aerobic exercises – exercise that gets you moving and increases your heart rate will help improve the health of your heart and lungs (cardiovascular system) and can also help with endurance, weight control and prevention of other health problems (e.g. diabetes).

                                                                Many types of exercise and activities can help with flexibility, strength and cardiovascular health at the same time including:

                                                                • swimming or water exercise classes

                                                                • tai chi, yoga, pilates

                                                                • walking

                                                                • chair exercises

                                                                • low-impact aerobics

                                                                • strength training

                                                                • dancing

                                                                Exercise tips

                                                                • Talk with your doctor, physiotherapist or exercise physiologist for information and advice before starting an exercise program.

                                                                • Start slowly and gradually increase the amount of exercise you do.

                                                                • Set yourself goals - they’ll help keep you focused and motivated.

                                                                • Remember that time may have passed since you last had an exercise routine, so set goals that are appropriate for the new you, not the old you! Be SMART with your goal setting.

                                                                • Choose exercises and activities that you enjoy.

                                                                • Be active on most, preferably all, days of the week.

                                                                • Be consistent and exercise regularly.

                                                                • Exercise with friends, in a group or a team environment – this will make it more enjoyable and will also help motivate you.

                                                                • Warm up and cool down properly before and after exercising.

                                                                • Know the difference between the muscle pain you feel after exercise, and the pain you may feel as a result of overdoing it. When starting a new exercise program, it’s natural to feel some muscle aches and pains. Your body is adjusting and adapting to new movement and activity. If the pain feels intense or unusual, talk with your doctor or exercise professional. You might be overdoing it.Wear comfortable, appropriate clothes and footwear when exercising.

                                                                • Write down all of the possible barriers, challenges or excuses that you can think of that may get in the way of your exercising. Then come up with possible solutions. For example: Problem - It’s raining, so I can’t do my usual walk. Solution - Go to the shopping centre and do your walk inside. Problem – I want to try tai chi but there are no classes near me. Solution – Borrow a tai chi DVD from your library.

                                                                • Try something new. It’s easy to get into an exercise rut. Check out new exercise classes and DVDs to keep things fresh and fun.

                                                                • Balance rest and exercise - sometimes it can be difficult to exercise due to pain. An inflamed, hot or painful joint needs rest, but too little exercise can cause muscle weakness, pain and stiffness. It’s important to find the right balance of rest and exercise. If you’re not sure what the right balance is for you, talk with your doctor, physiotherapist or exercise physiologist for some advice.

                                                                • Check out Australia’s Physical Activity and Sedentary Behaviour Guidelines 


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                                                                Y 

                                                                Your inner voice

                                                                Self talk


                                                                We all talk to ourselves. From the time you wake up to the time you go to bed, that voice inside your head can influence how you feel, how you act and how you manage your pain.

                                                                This self-talk can be helpful and positive – ‘it’s a beautiful day and a gentle walk in the park will help me loosen up after sitting all day’; or negative and unhelpful – ‘everything hurts and if I go for a walk it’ll make things worse’.

                                                                Negative self-talk can affect how you see yourself, your life and your future. It’s that pessimistic, critical voice that focuses on the bad.

                                                                Paying attention to your self-talk and changing negative thoughts to be more positive will help you deal with your pain more effectively.

                                                                When you hear yourself say something negative ask yourself: Is there any evidence for what I’m thinking? Am I keeping things in perspective? What can I do to change the thing I’m feeling negative about? Try and turn the negative around and put a positive and optimistic spin on it. It can be difficult, but it’s definitely worth the effort.

                                                                Examples – Changing negative self-talk to positive

                                                                Negative – I’ve tried everything for my pain and nothing works.

                                                                Positive – Mindfulness seemed to help a bit, I should give it another go and practise more often.

                                                                Negative – I’m fat and my pain makes it impossible to lose weight.

                                                                Positive – I want to lose weight so that I feel better. I’ll talk with my doctor about ways I can do this.

                                                                Negative – My pain means I’ll never be able to travel like I’ve always wanted.

                                                                Positive – Travelling is more of a challenge, but with the help of my doctor and my pain management tools I can still see the world.

                                                                Negative – I’m a burden to my family.

                                                                Positive – My family loves and supports me.

                                                                Practise your self-talk regularly and you’ll find you feel more positive, confident and able to deal with your pain better.

                                                                Tips

                                                                • Stick post-it notes around you with positive, upbeat messages – e.g. ‘I look great today!’; ‘I control my pain, it doesn’t control me’; ’exercise is fun and makes me feel good’.

                                                                • When you have a negative thought about yourself – e.g. ‘I’m a burden to my family’ - ask yourself what you would say to a friend if they told you they thought that of themselves? We’re often kinder and have better perspective when we’re thinking of others.

                                                                • If you wouldn’t say it to another person, don’t say it to yourself.

                                                                • Surround yourself with positive, happy people. If you have friends or acquaintances who are constantly negative or critical, that can affect how you feel. Talk with them about how their attitude makes you feel, or limit the time you spend with them.


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                                                                Z 

                                                                Zzzzzz...

                                                                Sleep


                                                                Persistent pain can sometimes get in the way of a good night’s sleep. Pain, muscle tension, anxiety and other factors can interfere with your ability to get to sleep, stay asleep or the quality of your sleep. Not getting enough good quality sleep can affect your pain levels, your muscle tension and your anxiety levels. This can become a vicious cycle. But there are many things you can do to break this cycle and get back to having a good night’s sleep.

                                                                Sleep tips

                                                                • Try not to put too much pressure on yourself to go to sleep. This leads to anxiety and stress if you don’t fall asleep quickly. Feeling anxious or stressed will affect your ability to sleep. Get out of bed. Don’t lie in bed tossing and turning. Have a warm drink (e.g. milk, no caffeine), do some gentle stretches or breathing exercises and go back to bed when you feel more comfortable.

                                                                • Develop a sleep routine. Try to go to bed and get up at the same time each day.

                                                                • Try some relaxation techniques. Consider mindfulness, visualisation, deep breathing or a warm bath before bed. These techniques will help you become more relaxed and may help you manage your pain better so that you go to sleep, and sleep well.

                                                                • Write it down. Thoughts, worries and anxiety can prevent good sleep. Don’t take them to bed. Write them down and then put them away. You can deal with them tomorrow. Be active during the day. As well as the many other benefits of regular exercise, it will help you fall asleep and stay asleep longer. Keep a sleep journal. This will help you and your doctor work out what may be causing your sleep problems because it tracks the things that may affect your sleep.

                                                                • Keep a water bottle by your bedside.

                                                                • Avoid caffeine and alcohol for several hours before going to bed.

                                                                • Don’t look at the clock. Constantly checking the time can make you anxious and anxiety makes it hard to sleep. Try removing your clock from the bedside, or cover it up at night.

                                                                • Avoid using technology in bed. The blue light from laptops and tablets suppresses the hormone – melatonin – that makes us sleepy at night, so be sure to stop screen use at least one hour before bed.

                                                                • Light. Is your room dark enough to allow you to sleep well? If not, look at solutions such as window coverings or a dim switch on your alarm clock. You might also try using an eye mask. 

                                                                • Noise. If you have no control over the noise in your environment (e.g. a barking dog, loud party, your partner’s snoring), ear plugs may be an option. Or playing soothing, gentle music softly in the background can also be helpful at cancelling out other noises. 

                                                                • Seek help. If pain is constantly keeping you awake at night, discuss it with your doctor for information and advice.

                                                                Personal Perspectives

                                                                When I have problems sleeping, I do some visualisation exercises. I also add a small dab of lavender oil to my temples – which is really soothing

                                                                – Sarah.


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                                                                  More to Explore

                                                                  Links


                                                                                  HELP LINES

                                                                                  MOVE  National Help Line: 1800 263 265

                                                                                  Nurse-on-Call (For 24 hour health advice and information): 1300 60 60 24

                                                                                  Healthdirect Australia (For 24 hour health advice and information): 1800 022 222 

                                                                                  Lifeline Australia (For 24 hour crisis support and suicide prevention): 13 11 14 

                                                                                  Quitline: 137 848


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                                                                                  FEEDBACK

                                                                                  Let us know what you think about our pain guide.

                                                                                  Contact  MOVE muscle, bone & joint health on 1800 263 265 or email  info@move.org.au if you would like to provide feedback.


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                                                                                  PRODUCERS & CONTRIBUTORS

                                                                                  Odoo CMS- Sample image floating

                                                                                  Resource developed with funding from the Victorian Government and produced by the team at MOVE muscle, bone & joint health:

                                                                                  Lisa Bywaters | Information Coordinator

                                                                                  Ornella Clavisi | Research & Knowledge Manager

                                                                                  Ben Harris | General Manager, Policy, Information and Programs

                                                                                  Helen Koutsimanis | Health Promotion Project Officer


                                                                                  MOVE muscle, bone & joint health would like to thank the following people for their contributions to this A-Z guide:

                                                                                  Professor Flavia Cicuttini | Head, Musculoskeletal Unit DEPM & Head Rheumatology Unit, Alfred Hospital

                                                                                  Dr Anne Daly | Transport Accident Commission, WorkSafe Victoria, Pain Services Austin Health

                                                                                  Dr Malcolm Hogg | Department of Anaesthesia and Pain Management, Royal Melbourne Hospital

                                                                                  Eve Caplan, Jane Cheong, Lesley Hunter, Annie McPherson, Elizabeth Peck, Judy Pullar, Matthew Sutherland


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