Living with Chronic Pain: One Day at a Time

Written By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II Date: August 5th, 2010. Topic: Life and Recovery Coaching.

Many self-help programs encourage its members to use the slogan “One Day at a Time.” The underlying purpose is to help members focus on what needs their time and attention in the here and now. It encourages people to let go of their obsession with the past and worry about what may or may not happen in the future. The slogan encourages members to get the most out of every moment.

Unfortunately, some people misinterpret this slogan to mean they should forget about the past, and hope the future will take care of itself if they just stay in the present. They refuse to take action; instead they remain on autopilot and just get by. They don’t confront their problems in a proactive way, nor create healthy solutions to address them. They don’t create contingency plans, so when problems demand their attention, they slide into panic mode because they don’t have a plan in place and tend to react, instead of respond. They justify the results by claiming they were just following the “One Day at a Time” slogan.

When someone is living with chronic pain, this slogan could be a blessing or a curse depending on how it is interpreted. My goal is to help people use this slogan to improve their quality of life. However, they also need to realize that using it to deny their problems can sabotage their chronic pain management, resulting in unnecessary pain flare-ups or other problems.
Patients I’ve worked with who have chronic pain often become so hopeless and helpless that they mistakenly believe that they are always going to suffer—they think that the pain they are in today will always be this way, and they lose hope. Because they are not getting the pain relief they want, they convince themselves that life is completely horrible, and that they deserve to do whatever it takes to feel better. Sometimes that “whatever it takes” leads them to abusing their pain medication.

Another misuse of the “One Day at a Time” slogan is when people stop doing what got them feeling better. They forget all the previous work they did to put a good chronic pain management plan in place. For example, they stop exercising, meditating daily, eating well, monitoring their thinking, managing their emotions or using any of the other non-pharmacological interventions they learned. They put themselves at risk for pain flare-ups and the possibility of their condition worsening.

For those in recovery from an addictive disorder who also suffer with chronic pain, staying stuck in the moment could lead to a potential relapse. That is why I work with people undergoing chronic pain management to understand the true meaning of living life one day at a time for a better quality of life.

One of the principles I help people with is a concept called time line competency. This means not getting stuck in the past, present or future. First, I teach them how find a peace-centered place within themselves, which brings their stress (and often distress) down to a manageable level. This is where I explain to patients that those who forget the past are doomed to repeat it—they keep making the same mistakes over and over again. Also, they feel consumed by shame and guilt as the result of past trauma and it destroys their ability to be in a peaceful present.

The past is the first area of focus. My goal is to help patients look at their history from a safe distance in order to see what they can learn from it. I support them to discover what they have done well—what their strengths are. Next we look for the self-defeating patterns of thinking and behaving that caused negative consequences. One of the tools I use to facilitate this learning process is called situation mapping.

Below are the situation mapping directions developed by me and Terence T. Gorski as part of the Addiction-Free Pain Management® Relapse Prevention Counseling High Risk Situation Management process.

A situation map is a description of exactly what you do and how other people react to what you do that makes you want to use medication or alcohol and other drugs in spite of your commitment not to use.

A good situation map describes exactly what you and other people do in a way that lets you clearly see it happening in your mind. When developing a situation map, it is helpful to go visual and see the situation in your own mind as if were the scene of a movie.

Try to see exactly what you or other people are saying and doing in the situation. It is important to put everything that happened into the correct order or sequence. You can do this by thinking about the beginning of the situation and then thinking about the next thing that happened until you reach the end of the situation.

Once you map out the situation, it is easy to look for gaps in the action by asking yourself: “Where in the action sequence is something missing?” Try to notice where you jump from one thing to the next without a logical transition step and then try to fill in the missing step.

Here are some guidelines that will help you to develop situation maps that will give you the most help in learning to manage high-risk situations:

Think of a specific time in the past when you experienced a high-risk situation that was similar to this and managed it in a way that caused you to use ineffective pain management or misuse pain medication, including alcohol or other drugs. Describe that situation as if it were a story with a beginning, middle and an ending. Start with the phrase: “The high-risk situation started when …” Continue to build the story step by step by asking, “What is the next thing that happened?” Keep asking that question until you get to the end of the story. You can end the Story with final statement that starts with the words, “What finally happened was …”

Once the map has been developed and explored, I encourage patients to bring that new understanding into the present so they can explore how to improve their future. Here we continue to use the situation mapping tool, but this time to map a high-risk situation in the future. Below are the future high-risk situation mapping directions.

Since this situation has not occurred, you will use a technique called mental rehearsal to test out different things you could do to manage the situation. When you use mental rehearsal, you think about or imagine what the situation will probably be like and then you think about or imagine different ways of handling the situation in your mind. First, you map out the situation using your old self-defeating ways of handling the situation that caused you to use ineffective pain management or to misuse pain medication, including alcohol or other drugs. Describe that situation as if it were a story with a beginning, middle and an ending. Doing this will help you to see exactly what you thought and did that caused you to mismanage the situation.

Once we have the maps built, we then analyze the high-risk situation by exploring the person’s TFUAR process—Thinking, Feeling, Urges, Actions, and (social) Reactions—that caused pain and problems. Then we move from the problem to the solution by helping them look at a new way of thinking; better ways of managing uncomfortable feelings; ways to manage urges or cravings; new, healthy recovery-prone actions or behaviors; and finding people to help move them out of the problem and into the solution. This new way provides healthy reactions, or positive chronic pain management outcomes, instead of disaster and suffering.

Despite everything we do, some people will continue to stay stuck in the present. They refuse to either look at the past, or plan for the future and then use the slogan “One Day at a Time” to justify their self-defeating mindset. It happens to all of us—we are human—but having a support who can give us honest feedback will allow us to acknowledge the problem and then act upon it in a recovery-oriented way. Our patients can learn to do this, and we must be there to help.

Be Sociable, Share!