In this lesson, you will:  - Understand the trade-offs between getting good pain relief, and being able to reach your activity goals - Learn the value of having a "pain action plan" - Learn how to set up your own action plan - Learn how to track your action plan

1. How to set realistic goals
when you have chronic pain
Written by: Joanne Zeis
Reviewed by: Kevin L. Zacharoff, MD, June 2014

2. Learning Goals
➢You have been living with pain for a while, and you’re probably wondering if your
life will ever get better. Will you be able to do any of the activities that you used
to enjoy?
In this lesson, you will:
1. Understand the trade-offs between getting good pain relief, and being able to
reach your activity goals
2. Learn the value of having a "pain action plan"
3. Learn how to set up your own action plan
4. Learn how to track your action plan

3. Balancing pain and activity levels
➢Once you identify your goals, you’ll most likely need to find a good balance between managing
pain, and improving function to achieve them.
Managing pain means using a variety of ways to lower your pain. Some ways are:
❖ Medications prescribed by your health care provider
❖ Injection therapy, such as cortisone shots to joints, or to sensitive “trigger” points on the body
❖ Pain-coping techniques, such as deep breathing, or imagining a trip to a relaxing place
❖ Lowering the stress levels in your life
❖ Changing your lifestyle -- for example, by dieting and losing weight
Improving functioning means finding ways to handle day-to-day tasks and being active, in spite
of your pain. Examples of improving functioning are:
❖ Working
❖ Preparing meals
❖ Doing more of the fun activities that you used to do
❖ Walking farther than you do now
❖ Socializing with friends more often

4. The pain action plan
➢An action plan lists the steps that you can take to reach your goals.
Your health care provider will help you learn how to:
❖Set real goals that you can, and should, be able to reach
❖Put your plan into action
❖Work with other members of your medical team to reach your goals
❖Keep an eye on your progress

5. Action plan goals
➢Your action plan needs to have goals that are good for you – not necessarily goals
that your spouse or family members think would be good to reach.
➢Good goals are:
❖Reasonable: Running five miles a day is not a reasonable goal for many people. However,
working up to walking a mile is sensible.
❖Sustainable: Everyone can start a diet as a New Year’s resolution, but very few people can
keep that diet going over time. Make sure that your goals are ones you can do for the long
haul.
❖Specific and positively stated: A specific and positive goal could be, “I will plant one row of
flowers in my garden.”
❖Measureable: Make sure that your goals can be measured. For example, “I will work for 15
minutes before resting, unless my pain level is at 6 out of 10 or more.”
➢An action plan includes:
❖Starting with goals you can meet, so your success will keep you going
❖An ending goal, like “picking up my grandchild”
❖Breaking long-term goals into smaller, easier to achieve goals

6. Action plan help – working with your
provider
➢Your health care provider wants to work with you, so that you’re able to reach
the goals in your action plan.
➢Talk with your care provider to make your goals as realistic as possible. For
example:
❖If your goal is “to work in the garden,” but you haven’t been outside of your house in six
months…
❖your care provider may suggest that you switch your first goal to “reaching the front porch”
instead.
➢Your care provider may suggest other sources of support for you, such as new
medical or exercise equipment, or a therapist to work with you.
➢Be open to learning to do things in a new or different way. For example, you may
have to find a way to raise a section of your garden to a higher level, so that you
can have less pain by sitting down instead of kneeling.

7. Track your progress
➢It’s important to track how much you’re able to do over time.
Keeping a chart of your progress, or writing it all down in an activity
diary, can do wonders for your self-esteem as you watch yourself
getting stronger.
❖Put your progress chart in a place where you’ll see it, and fill it in, every day
❖Don’t be discouraged if there are some days when you’re not doing as well as
other times. Your chart will track how you’re doing over the long term. Short-
term setbacks are just that – short-term!
❖Bring your progress chart to any appointments with your health care
provider. They will look at the chart and help you to decide whether your
action plan needs to be adjusted
❖Celebrate whenever you reach any of the goals on your action plan. Reaching
a small goal is just as important as getting to a larger one

8. Putting your plan into action
➢Your life may have been difficult up to this point. Be proud of yourself for
moving forward! The small steps that you take may not seem like much at
first, but each step will get you closer to your goal.
❖Start with small steps
❖Each successful step forward should encourage you to take another one
❖Like a cat lying in the warm sun, you should bask in your achievements
❖By moving forward, you’re already accomplishing more than you have in a long time!
❖Once you’ve reached your goal, remind yourself of how long and hard you’ve worked
to get to this stage. Congratulate yourself, and be proud. You, more than your family
or friends, know just how difficult this has been
➢Start now! You know that you can do it. There are always reasons to delay,
but there’s no time like the present to start reaching for your goals.

9. Self Check
➢If you want to start a physical activity that’s harder than usual, and
you think that it might increase your pain, which option is best:
❖Take more pain medication before you start.
❖Get extra sleep the night before.
❖Ask your health care provider for his or her approval before you start. You
may need to increase your activity level slowly, even if it takes a long time to
reach your goal. You might have to deal with more pain.
❖Push yourself as hard as you can, and then give up if you can’t do it.

10. Answer:
➢Ask your health care provider for his or her approval before you
start. You may need to increase your activity level slowly, even if it
takes a long time to reach your goal. You might have to deal with
more pain. You should set realistic activity goals with the okay of your
health care provider. You might have to increase your activity slowly,
though, and deal with some extra pain.

11. Self Check
➢When you set goals in a pain action plan, which of these options is
not important?
❖Action plan goals should be specific and framed in a positive way
❖Action plan goals should be measurable
❖Action plan goals should be reasonable
❖Action plan goals must be hard to reach so that they’re worth it, no pain no
gain

12. Answer
➢Action plan goals must be hard to reach so that they’re worth it, no
pain no gain. An action plan goal should not be too difficult. You
might do more harm than good if you do too much in a short period
of time.

13. Additional Resources:
➢American Pain Foundation. Treatment options: a guide for people
living with pain. (search on
“publications”), http://www.painfoundation.org
➢Bruce, B. & Hooten, W. (2008). Mayo Clinic Guide to Pain Relief.
Rochester, MN: Mayo Clinic Health Solutions.
➢Caudill, M.A. (2002). Managing pain before it manages you (Revised
Version). New York: The Gilford Press.
➢Turk, D.C. & Frits, W. (2005). The Pain Survival Guide: How to Reclaim
Your Life. Washington, D.C.: American Psychological Association.