1. Managing pain and fatigue Zoe McGavock Arthritis Educator

2. A sensation Any unpleasant sensory or emotional experience A sign of actual or potential damage A subjective experience – both for the person and the observer Very real Pain is …

3. Individual experience therefore individual response Response not just physical -physiological -emotional -behavioural -social -activity -sleep The Pain Response

4. Psychological - stress, attitude, understanding etc Physical - age, health, fatigue etc Social - supports, role models etc Cultural - treatment, religious beliefs etc Situation – control, duration, environment etc Factors that influence pain

5. Acute pain Chronic pain Types of pain

6. Pain Cycle • Pain • Nerve endings pick fatigue • Up and send messages • tight muscles • Pain messages go • Through spinal cord stress response • pain messages pass feelings of fear, • through hypothalamus anger etc. • emotional thought response

7. What can YOU do to take care of yourself & relieve the pain?

8. Using heat • Keep joints warm (gloves & socks) • Direct heat: wheat-bag / hot water bottle / heat pads – caution with Raynaud’s • Hot shower / bath / sauna

9. Capsaicin Anti-flamme Rheumon Gel Voltaren Creams / Gels & Massage

10. Have a go: Topical rubs & heat

11. The ‘F’ Word… There is definitely a relationship between pain & fatigue!

12. The Four Ps • Pacing • Activity – rest – activity – rest • Build activity levels up slowly • Be aware of the BOOM-BUST! • Prioritising • What tasks are my priority today? • What is the worst thing that can happen?

13. The Four Ps • Planning • Spread the ‘heavy’ tasks throughout the day • Plan rest periods • Be flexible: allow for changes due to pain • Posture • Good posture conserves energy • Adapt activities: e.g., sitting to garden • Keep things within reach

14. Stress is a response to any demand made on the body A stressor is anything which causes the response or wear and tear on our body Stress is an individual reaction We experience stress from 3 sources: - our environment, body and mind What is Stress?

15. Stress is normal and we need it to survive The key to managing stress is to know what our individual stress levels and stressors are By being aware of our stresses, we are more likely to be able to cope with them All change is stressful whether it is positive or negative What is Stress? Continued …

16. When something stressful happens to you, it is registered in your brain Then your brain sends instructions to other parts of your body This triggers a chain of reactions This reaction is known as the stress response or fight and flight response Stress Response

17. Short term stress Adrenalin Cortisol Fight or flight Chronic stress Adrenalin Cortisol Decrease serotonin Depression Mood disorders Increased pain perception

18. In order to manage stress effectively we need to be aware of the sources of stress in our life Some stress is caused by major life events However, most is affected by day to day happenings We all have physical, psychological and behavioural responses to stress Stress Awareness

19. What strategies do you use to cope with stress? Do these strategies always work? Are they cost-effective strategies? What other strategies or techniques could you try? Coping Strategies

20. Exercise: finding ways to reduce YOUR stress

21. A way of reducing chronic physical tension It will help you to cope with stress and pain It is a skill that is learned and requires practise Long-term benefits for our physical functioning, our health in general and our feelings, thoughts and behaviour What is Relaxation?

22. Relaxation for pain/stress/fatigue Acupuncture Tai Chi Massage The Alexander Technique Yoga Meditation Deep breathing Distraction Relaxation Sleep Psychotherapy Counseling

23. Breathe in through the nose, and out through the mouth, if this is comfortable This is to encourage deep, slow, regular breathing, from the abdomen rather than the chest Deep Breathing

24. Breathing exercises 1 & 2

25. Guided imagery is a relaxation technique that uses a narrative to “take you” someplace in your mind. Physiological effects of guided imagery: Decreased blood pressure lower heart rate increased production of endorphins All of these factors are known to help with pain control!!! Guided Imagery

26. Exercise: water guided imagery

27. To wake us up again… • Disability Information & Equipment Centre 0800 69 33 42 • Mobility Centre 0800 243 866

28. Further useful information Arthritis New Zealand www.arthritis.org.nz Arthritis Research UK http://www.arthritisresearchuk.org NIAMS http://www.niams.nih.gov Every Body NZ http://www.everybody.co.nz How to cope with Pain http://www.howtocopewithpain.org Explanation of Pain http://faculty.washington.edu/chudler/pain.html

29. Questions?