Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain - Michael K. Nicholas, Allan Molloy, Lee Beeston, Lois Tonkin (2012)

Chapter 8. Setting Goals

Before you can start to manage your pain effectively, think about what you’d like to achieve.

What would you like to be doing that you’re not doing now?

This chapter helps you work out these goals.

Goals are important because they provide the motivation for making changes in your lifestyle.

To overcome the effects of pain on your lifestyle it helps to think about what you want to achieve. Another way of putting this is deciding on your goals. If complete pain relief is not on offer, what would you like to achieve? What would you like to be doing that you are not doing now?

While many people may not think about their life in terms of goals, others do find it helpful to work towards specific goals. These goals may be things like saving up to buy a car or to put a deposit on a house. For others it will be to get a certain job or have a family. Goals give all of us motivation. After all, no one will work hard for a goal they don’t really want. Goals also give us direction – they tell us where we are trying to go.

When you have chronic pain the obvious first goal is pain relief, then getting your life back on track. But if pain relief is not really possible at present, chasing it is likely to end up in frustration, wasted effort and, eventually, despair. Coming up with achievable goals can give you a sense of purpose and a feeling that you can control your life once more.

So, to avoid wasting your energy on impossible goals, it’s worth putting some time and thought into working out a few realistic, achievable goals – things you should be able to do despite your pain. We call this process Goal Setting.

What are your goals?

Firstly, you need to work out what changes are important to you. Think of the things you have stopped doing, or don’t do as much as you would like to. Often people have given up hobbies and interests, social activities, the “quality of life” activities, as well as work and daily chores. This can help you identify your long-term goals, or what you would like to achieve in the future. The best sorts of goals are:

1. Realistic

That is, they are within your financial means, appropriate for your age, skills, education, family situation, physical condition, and can be done despite pain.

2. Achievable

That is, they are things you can reach through your own efforts. They do not depend on luck or other people doing things for you. They may not be achievable right now, but should be over time, as your ability to manage your pain improves.

3. Relevant

That is, they are goals that you really want to achieve.

4. Specific or concrete

That is, you will know when you have achieved them. The most effective goals are those you can describe easily. For example, things like taking the family for a holiday at the beach or getting a job or walking to the local shops. Emotional goals, like being happy or relaxed do make life worthwhile, but are usually the result of other things happening (such as achieving your goal of taking the family to the beach or getting job). So it is difficult to make an emotional state your goal by itself. It will usually come from achieving something else. It can help if that ‘something else’ is specified.

Have a number of goals

It can also help if you have a number of goals to work on in different areas of your life. This not only gives you the chance of achieving more, but if one doesn’t work out you still have others to work on.

Long-term and short-term goals

Long term goals are ones you expect to take a while to achieve. Short-term goals should be achieved sooner. Ideally, achieving a short-term goal should help you to achieve a long-term goal.

For example, if your long-term goal is to eat out at a restaurant, but you can’t achieve that until you can sit long enough, then your short-term goal would be to gradually build up your sitting tolerance. This would continue until you could sit long enough to go to a restaurant.

As a guide to working out a balanced range of goals, fill out a LONG-TERM GOAL sheet like the one set out here. This sheet divides goals into different types – Household chores, Family activities, Social activities and so on. Try to think of one or more activities you could use as long-term goals in each section. Remember the points made earlier – make your activity goals realistic, relevant, achievable and specific.

If you are not sure where to start, some examples of activity goals are provided in a list of possible activities at the back of this handbook. Your list doesn’t have to be final – you can add to it as you think of other things you would like to be doing.

Long-term Goals

Household chores

 

Family activities

 

Social activities

 

Recreation/sport

 

Education

 

Hobbies/interests

 

Work

 

Other

 

Next Step

Once you have identified a few goals, you need to think about what is stopping you achieving them at the moment. Is it because you cannot sit or walk for long enough? Do you need to find out some information (important for goals like jobs, courses, etc.)? Or do you just need to get started and not overdo it? Try to work out the steps you will need to take to achieve your goals.

BASELINE (where to start) and PACING (step by step).

As was mentioned in the previous section on pacing, it often helps if you work out how much you are capable of doing at the moment – your baseline. It is often more realistic to work out how much you can do on two or three occasions, rather than just once. Then you can work out where you are now more accurately. Your baseline should be within the limits of your present pain tolerance – so don’t push things to the maximum.

For example, if your long-term goal is to be able to drive your car for 3 or 4 hours, you would set your baseline by seeing how long you could drive comfortably now. Try to work out your baseline over 2 or 3 trips, not just on one good day. In this way you might find that on one trip you drove for an hour before the pain got too bad. On the next trip you may have only managed to drive for 10 minutes, and on the next trip it may have been 15 minutes. In this case it would be more realistic to set your baseline at something closer to 10 minutes than to an hour.

Once your baseline is established, you can set your first target, or short-term goal. Short-term goals, as mentioned earlier, are the stepping stones along the way to your long-term goals. You should not expect to get to your long-term goals in one day! The targets (or short-term goals) need to be stated in terms of how much you will do. To start with, we recommend that you start well within your capabilities. This makes it much more likely that you will achieve your early goals. Achieving your target will encourage you to try again. You can use the Short-Term Goals sheet provided as a guide to drawing up your own one. By checking off your achievements each day you can monitor your progress. Remember, this is often a good way to reinforce your efforts. 

Short-term Goals (Example sheet)

ACTIVITY

Mon

Tues

Weds

Thurs

Fri

1. Sitting

5 min

5 min

6 min

6 min

7 min

2. Standing

10 min

11 min

12 min

13 min

14 min

3. Lifting (floor to bench)

1 kg

1 kg

1.5 kg

1.5 kg

2 kg

4. Walking (in street)

15 min

16 min

17 min

18 min

19 min

Now draw up your own plan (make a number of copies as it will change with time):

Short-term Goals

ACTIVITY

Mon

Tues

Weds

Thurs

Fri

Sat

Sun

1.

             

2.

             

3.

             

4.

             

5.

             

Using the driving example given above, you might set your starting point or first short-term goal just below 10 minutes – say, 8 minutes. Using the pacing method described earlier you would start driving for short distances but stopping regularly every 8 minutes. Each time you stop, get out of the car, do some stretching or walk around the car for a few minutes, then drive for another 8 minutes. Then stop again. And so on. You should continue this for 2 or 3 days, then increase the driving time and distance a little. To, say, 9 minutes, and repeat the process. After another two or three days you should increase the time and distance again. And so on, until you gradually work your way up to driving for 1–2 hours.

By increasing your driving time by a minute or two every few days it will obviously take some time to reach your goal, but you will succeed – if you keep at it.

Keeping it up

Your progress needs to be reviewed regularly. Your rate of pacing may need to be adjusted, depending on your progress. If you are having real difficulty reaching your targets, the rate of pacing may need to be reduced, or changed. For example, doing it a little at a time and more often may be easier. If you are achieving your targets easily, the rate of pacing can be increased so you reach your long-term goal more quickly.

Achieving your goals will be rewarding in itself. However, using small rewards along the way can help you to stick to your programme, irrespective of how you feel (whether it is a good day or a bad day). The harder a goal is to achieve, the more you probably need to reinforce yourself to keep up your progress. So, remember tell yourself how well you are doing (and doing it despite pain). Think of those tennis players, golfers and footballers you see on TV – when they make a good shot or a good kick you will often see them recognizing it by shouting or punching the air. You can do the same, but you may need to be quieter about it.

Finally, stick with it! Most goals can be achieved by working at them slowly and steadily (providing they were realistic in the first place). If you have continuing problems getting started or sticking to it, despite trying the above ideas, perhaps the goal is not really what you want. Or you’re not ready to work on it just yet. That’s OK, your goals are only there to help you achieve the changes you want to make when you are ready. You can always come back to them. In the meantime, why don’t you concentrate on ones you can work on?