Living with Chronic Pain
How to manage pain, improve your daily life, and work with
your healthcare team.
3
Whats
Inside
INTRODUCTION TO CHRONIC PAIN3
What Is Chronic Pain?4
Pain Is Usually a Warning Sign5
Breaking Your Pain Cycle7
SOLUTIONS TO DEALING WITH YOUR PAIN8
Talking about My Pain10
My Pain and My Life12
WORKING WITH YOUR HEALTHCARE TEAM14
My Healthcare Team17
Pain Medicines18
Other Treatments for Pain20
Questions about Treatments21
OTHER TREATMENTS FOR CHRONIC PAIN 22
Things You Can Do to Help Yourself24
My Daily Pain Diary26
My Daily Summary28
Where to Find More Help29
Your health plan and
healthcare team know how
chronic pain can wear you
down. This workbook can
help you manage your pain
and keep it from getting in
the way of your life.
You can read through the whole workbook, or you can start with the
sections that interest you right now. This workbook can help you:
Understand your
pain and how it
affects your life.
Work with your
healthcare team
and case manager
to find the best
treatments for you.
Do things at
home to help
make your pain better.
4 5
What Is
Chronic Pain?
Chronic pain is pain that will not go away. It can last for months or even
years. It affects millions of people, and it is the most common reason for
going to the doctor.
Chronic pain can start
in many ways:
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Sometimes the pain starts
with an injury, an infection, or
surgery, but then it does not
go away after you heal.
Sometimes the pain comes
with age or with a disease,
such as diabetes, heart
disease, shingles, or cancer.
Severe stress can also cause
chronic pain.
Sometimes the cause of
chronic pain cannot be found.
Each persons chronic
pain is different:
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The pain may be mild or
severe.
It may hurt all the time, or it
may come and go.
It may just be annoying, or it
may keep you from living your
normal life.
It may leave you depressed,
angry, or afraid.
Common kinds of
chronic pain:
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Back pain
Headaches and migraines
Arthritis pain
Neck pain
Fibromyalgia
Chronic pain varies a lot,
but it is real and it changes
your life.
Back pain
Arthritis
Neck pain
Headaches
and migraines
Fibromyalgia
Pain Is Usually a
Warning Sign
Pain tells you that something is wrong, and that you need to act. That's
why it is important to get treatment. The sooner you get treatment, the
more likely that you will feel better.
5
16
 out of 
patients
say they feel less
pain after seeing
a doctor
Pain and your body
These things can make your
pain better or worse:
The illness or injury that
is causing your pain
Other illnesses and your
general health
How well you sleep and
how tired you are
The exercises and
activities you do
Pain and your mind
These feelings and thoughts
can make your pain worse:
Feeling depressed,
angry, anxious, or helpless
about your pain
Feeling guilty about
being in pain
Avoiding your
normal activities
Worrying about the
cause of your pain
Pain and your daily life
These things can affect how
you react to pain and how you
care for yourself:
The demands of work
and home life
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How family and friends
respond to your pain
How easy it is to get
medical care
How much you have to pay
for medical care
6 7
Chronic
pain can
become an
endless
cycle.
You
become
less active.
You avoid
daily activities.
Your muscles
get weaker, your joints
get stiffer.
You avoid
daily
activities.
You have
trouble
sleeping.
You feel more angry,
depressed, anxious,
or helpless.
Your body
makes fewer natural
painkillers.
You feel
more pain.
Breaking Your
Pain Cycle
The goals of pain
management
» Feeling less pain
or no pain
» Having an increased
sense of well-being
» Returning to work or
leisure activities
Learn about pain
treatments.
Pain treatments can help
you stop the pain cycle.
This guide will tell you about
treatments, such as:
» Over-the-counter and
prescription medicines.
Physical therapy, counseling,
and relaxation.
Changes to your daily life,
such as being active and
doing things you enjoy.
»
»
Keep pain from
taking over your life.
» Ask for treatment early.
Accept help from
family and friends.
Speak up. Ask for
what you need.
Work with your
healthcare team.
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»
»
Keep a positive,
hopeful attitude.
Doing the thing
s listed below
can help reduce your pain and
improve your quality of life.
» Accept that your pain is real.
» Take one day at a time.
Follow your treatment plan.
Tell yourself that you will get
through this.
The way to break the pain cycle is
to get treatment and learn ways to
help manage your pain.
My Goals:
»
»
Solutions
to Dealing
with
Your Pain
Learn about your pain and
how your daily life affects
pain. This is important
information for you to share
with your healthcare team.
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10 11
Talking about
My Pain
Where do I feel pain?
When do I feel pain?
What is the pain like? (For example, sharp, throbbing, achy, shooting, dull, pinching)
How long have I had the pain?
What makes the pain worse?
What makes it better?
What has it kept me from doing?
What treatments have I tried?
Questions and notes for my healthcare team:
Use this form to tell
your healthcare team
as much as you can
about your pain.
Mark the pictures
below to show wher
e
your pain is.
FRONT BACK
My Pain
and My Life
This form can help you see the
things that affect your pain and
how your pain affects your life.
Check what best describes your
pain and your life today.
12 13
Name:
Date:
MY PAIN
None Annoying Uncomfort-
able
Bad Very Bad
MY STRESS
None Low Medium High Very High
MY SLEEP
Very rested Rested Somewhat
rested
Little rest No rest
MY MOOD
Very cheerful Somewhat
cheerful
Not cheerful
but not
depressed
Somewhat
depressed
Very
depressed
MY LEVEL OF ACTIVITY
High Medium-high Medium
Low None
MY SOCIAL TIME
A lot Plenty
Some, but
not enough
Little
None
-
MY DAILY EXERCISE
Over  hour
 hour
/ hour  minutes None
MY APPETITE
Excellent
Good
Fair
Poor
Don’t want
food
MY DRINKING
I don’t drink  to  drinks
a week
 to  drinks
a day
 to  drinks
a day
More than 
drinks a day
MY SEXUAL ACTIVITY
Very satisfied Mostly
satisfied
Somewhat
satisfied
Not
satisfied
Very
unsatisfied
MY CONCERNS ABOUT MONEY
None
Not very
concerned
Somewhat
concerned
Concerned Very
concerned
MY CONCERNS ABOUT MY PAIN
I don't worry
at all because
I know it will
go away
I worry a
little
I worry
some
I'm afraid
I may
always have
pain
I'm very
afraid that I
will always
be in pain
MY LIFE ON A SCALE OF 1 TO 5
Very good
Good
OK
Not very
good
Poor
Working
with Your
Healthcare
Team
You now know your pain
symptoms and activities
that affect this pain. You
should work with your
healthcare team to find
treatment options.
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16 17
Working with Your
Healthcare Team
5
16
Your healthcare
team includes you!
You are the expert
on your pain.
Speak up and ask
for the treatment
you need.
Your healthcare team
includes all the people
who help you manage
your pain:
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Your primary care doctor
Specialists, such as a
neurologist or a psychologist
Nurses
A psychologist or mental
health counselor
A physical therapist or
rehabilitation specialist
Use the form on page  to
keep track of your team.
Your treatment plan
A treatment plan may include
medicine, physical therapy,
counseling, and other steps to
help you manage and reduce
your pain. You will work closely
with your healthcare team to
decide what’s in your plan.
To make a treatment plan that
works for you, your healthcare
team needs to know everything
you can tell them about you,
your pain, and your life.
The tools on the next pages can
help you and your healthcare
providers understand your pain
and create a good treatment
plan for you.
Your rights as a
patient with pain
Your doctors and other
healthcare providers should:
» Take your pain seriously,
study it carefully, and treat it
right away.
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Treat you with respect and
give you clear answers to all
your questions.
Include you in making
decisions about your care.
Explain all your possible
treatments, including the
benefits, risks, and side
effects of each treatment.
Tell you what your insurance
will pay for and what you will
have to pay.
Review your pain, and change
your treatment plan if your
pain does not get better.
Refer you to a pain
specialist if your pain
does not get better.
List the names, phone
numbers, and email
addresses of everyone on
your healthcare team.
My Healthcare
Team
Primary care doctor:
Phone:
Email:
Case manager:
Phone: Email:
Physical therapist:
Phone: Email:
Counselor:
Phone: Email:
Pharmacy:
Phone: Email:
Other healthcare provider:
Phone: Email:
Notes:
18 19
Pain Medicines
Pain medicines can help you feel better and be more active. Some
medicines are over-the-counter and some need a doctors prescription.
You can get most medicines as both brand names and generics. Generics
usually cost less. Generic names are listed below in italics and brand
names are listed in parentheses.
Acetaminophen
(Tylenol)
Acetaminophen helps with
pain, but it does not reduce
the swelling that often comes
with pain.
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You can buy it without a
doctor’s prescription.
It should not be taken with
certain other medicines,
such as the heart drug
warfarin (Coumadin).
However, it can be taken
with some stronger drugs,
such as opioids.
NSAIDs
ibuprofen
and
naproxen
(Advil,
Motrin, Aleve)
NSAIDs ease pain and swelling
(inflammation). They work
better for some people than
acetaminophen.
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»
NSAIDs are Non-Steroidal
Anti-Inflammatory Drugs.
You can buy them without
a prescription. You can
get higher strengths by
prescription. One kind,
celecoxib (Celebrex) comes
only by prescription.
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»
»
They can be taken with
some stronger drugs, such
as opioids.
You should take the
lowest dose that relieves
your pain.
NSAIDs can cause stomach
bleeding, and they can
damage the kidneys.
They can also interfere with
some medicines, including
diuretics (water pills),
ACE inhibitors, and ARBs.
Opioids
Opioids are strong prescription
pain medicines. They work well
to reduce pain. People may
respond to one opioid better
than another.
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»
Opioid pain medicines include
oxycodone (OxyContin and
Percocet), hydrocodone
(Vicodin), and morphine
(MS Contin and Avinza).
Side effects from opioids
include constipation,
dizziness, sleepiness,
sweating, nausea or vomiting,
and trouble brea
thing.
» You can become physically
dependent on opioids. You
must go off them slowly.
Other prescription
medicines
Sometimes doctors prescribe
other kinds of medicines to
help control pain.
These include antidepressants,
muscle relaxants, and sedatives.
Talk with your doctor
about the best pain
medicines for you
»
»
»
Ask how much to take and
how often to take it.
Ask about the side effects.
Tell your doctor all the other
medicines you take, including
vitamins and herbs. Pain
medicines can interfere with
some other medicines.
Questions and notes for my healthcare team:
20 21
Other Treatments
for Pain
Pain medicine is usually part of the treatment plan for chronic pain. But
pain medicine often works best when used with other treatments. These
treatments may help your body feel better or help you ignore the pain. Your
healthcare team may suggest one or more of the treatments listed below.
Physical therapy
Physical therapy can help
reduce pain and swelling and
increase strength and range of
movement. It can relieve chronic
pain caused by back and joint
problems, headaches, arthritis,
fibromyalgia, and nerve damage.
Physical therapy usually includes
strength and flexibility exercises.
It can also include massage, ice,
heat, or ultrasound.
If chronic pain makes it hard
for you to move and do daily
tasks, ask your healthcare team
about physical therapy. Physical
therapists must be licensed by
the state.
Counseling
Counseling can help you keep
pain from taking over your
life. It can help you relax and
sleep better. It can help you
stop smoking, drinking, and
overeating in response to pain.
And it can help you manage
feelings like anger or depression.
Talk to your doctor or your
case manager if you want a
referral to a counselor.
Relaxation
Relaxation therapy includes
activities like meditation,
deep breathing, and muscle
relaxation. These activities can
help slow down the body and
calm the mind. They can lower
your blood pressure, slow your
heart rate and breathing, and
reduce muscle tension. This can
help relieve chronic pain.
Check with your health plan to
find out what relaxation therapy
is covered.
Chiropractic care
Chiropractors use massage,
pressure, and physical
adjustment to straighten the
bones and joints in the spine.
This can help relieve pain and
make movement easier. It
can be especially helpful for
relieving chronic back and
neck pain, joint problems, and
headache pain.
Check with your health plan
to find out if chiropractic care
is covered.
Acupuncture
This technique involves pricking
the skin with very thin needles
to treat physical, mental, and/or
emotional issues. This practice is
done around the world.
Questions and notes for my healthcare team:
Questions about
Treatments
This workbook has information on medicines and other treatments. Your
healthcare team will suggest treatments, but you should also tell them
what you want. Make sure you understand all your treatment options. Ask
the questions below about each treatment.
Questions to ask your healthcare team:
How can this treatment help me?
What are the benefits?
What are the risks and side effects?
What does the treatment cost?
Does my insurance pay for it?
How long will it take to work?
What should I do if it does not work?
My other questions:
Other
Treatments
for Chronic
Pain
Many everyday activities
can help you deal with your
chronic pain. Talk to your
healthcare team about the
ideas on the following pages.
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24 25
Things You Can Do
to Help Yourself
Pain medicine is usually part of the treatment plan for chronic pain. But
pain medicine often works best when used with other treatments. These
treatments may help your body feel better or help you ignore the pain. Your
healthcare team may suggest one or more of the treatments listed below.
Exercise in your
everyday life
Many people are afraid that
being physically active will
make their pain worse. In fact,
exercise is one of the best
treatments for chronic pain.
In most cases, an exercise
program should be part of
your treatment plan.
»
»
Exercise releases a natural
chemical in the brain that lifts
your mood and helps block
pain signals.
Exercise also strengthens
your muscles, and this helps
prevent future injuries.
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»
You may do one-on-one work
with a therapist or trainer,
a class, a group activity, or
something on your own.
Walking is one of the best
exercises. It doesn’t cost
anything, and you can do it
almost anywhere.
Check with your healthcare
team before starting an exercise
program to see if it is the best one
for you and your pain.
Reduce stress to
relieve your pain
Stress can make your body
more sensitive to pain. Finding
ways to reduce stress can
help relieve chronic pain. Try
listening to calming music,
reading, or meditating. Or
download a relaxation or guided
imagery program that leads you
through relaxation exercises.
Avoid alcohol
while on medication
Alcohol can change the way
many pain medicines work.
For example, drinking alcohol
while taking acetaminophen
(Tylenol) can damage your liver.
Taking alcohol with NSAIDs can
increase the risk of stomach
bleeding and sleep problems.
Talk with your healthcare team
about how much alcohol you
drink and ways to cut back,
if needed.
Stop smoking to
improve health
It is easier to manage pain if
you stop smoking. Smoking can
increase inflammation—pain,
redness, heat, and swelling. This
makes chronic pain worse.
Smoking damages your blood
vessels, so less blood circulates
in your body. This can lead to
heart disease and stroke. And
it slows healing after an injury
or surgery.
There are programs and
medicines to help you stop
smoking (like the patch). Talk
to your doctor or your case
manager for help.
Plan fun activities
for mental relief
Sometimes you just need to
get your mind off your pain.
Try to do something you
enjoy so that you don’t focus
so much on your pain. Try
different activities, such as
cooking, reading, watching
movies, meeting friends for
a meal, gardening, working in
the garage, playing cards,
and knitting.
Get support from
other patients
Getting support is a big part of
feeling better physically and
mentally. You can join a support
group with others who have
chronic pain. They know what
you feel, and they may have
good ideas for managing pain.
Family and friends can also give
you support by helping you and
keeping you company.
Things I would like to do to feel better:
26 27
My Daily
Pain Diary
A daily pain diary can help you and
your healthcare team figure out how
well your treatment plan is working and
what changes you may need to make.
Day & Time Where pain was
Pain level
(0-10)
Kind of pain What I was doing
Example:
Mon. 1PM
lower back 8 sharp washing dishes
Medicine & dose
When I took
medicine
Other treatments
(heat, ice, exercise, etc.)
How long
pain lasted
What made it better
Tylenol, 20 mg 1:15 PM Stretching, heat 4 hrs. heat (warm bath)
28 29
My Daily
Summary
You can use this daily summary to track your treatment and any
breakthrough pain you had between taking pain medicines.
Breakthrough pain is pain that happens even when you take pain
medicine. The pain may happen when you do certain things, like cough.
It may mean that you need to change your treatment plan.
Date:
Did I take all my pain medicine as directed?
P
Yes
P
No
If not, what did I skip and why?
Did I have breakthrough pain?
P
Yes
P
No
How many times?
P
1-3
P
4-5
P
6-8
P
9-10
P
>10
What else did I try to ease the pain?
(such as medicine, rest, walking, heat, or physical therapy)
Did I exercise today?
P
Yes
P
No
What exercise? For how long?
How often did I wake up during the night and have trouble getting back to sleep?
How many hours did I sleep?
Where to Find
More Help
You’re on Your Way!
Congratulations! You have
taken big steps to help manage
your chronic pain. To keep
feeling better:
» Take your pain medicines
as directed.
Follow your other treatments
as directed.
Tell your healthcare team if
your pain changes or if it does
not change.
Report any side effects from
your medicines.
»
»
»
You may have setbacks along
the way, like breakthrough pain
or depression. But working
with your healthcare team and
keeping up with your treatment
plan will help you get through
the setbacks.
Where to Find More Help
These groups can help you
find more information and
useful tools.
» Pain associations (ACPA)
Online pain diaries
Pain diary phone apps
»
»
Suggested Resources
The American Chronic Pain
Association
http://theacpa.org
---
Email: ACPA@theacpa.org
ACPA Resource Guide to Chronic
Pain Medication & Treatment:
 Edition
http://theacpa.org/consumer
The Food and Drug
Administration (FDA)
a. The U.S. Food and
Drug Administration
http://www.fda.gov/default.htm
b. A Guide to Safe Use of Pain
Medicine. http://www.fda.gov/
c. A variety of drug
safety information.
http://www.fda.gov/Cder/
d. Food and Drug
Administration (FDA)
Center for Drug Evaluation
and Research Educational
materials on topics related
to buying and using
medicine safely.
http://www.fda.gov/Drugs/
e. Food and Drug
Administration (FDA).
Over-the-Counter Medicines:
What’s Right for You?
http://www.fda.gov/
National Center for
Complementary and
Alternative Medicine
(NCCAM). (). What is CAM?
http://www.nccam.nih.gov/
NIH
http://www.nlm.nih.gov/
http://www.ninds.nih.gov/
http://newsinhealth.nih.gov/
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Notes
This Page Is Intentionally
Left Blank
Working with your
healthcare team to
manage chronic pain.
This guide was developed with consumer
testing and other assistance from
the health literacy program at Health
Research for Action, the University of
California, Berkeley.
ISBN: 978-0-9850898-0-1
MADE IN THE USA | PRINTED ON RECYCLED PAPER