Managing Flare-ups (Living Beyond Pain Podcast)

Managing Flare-ups (Living Beyond Pain Podcast)


[Narrator]
Stay tuned for [Army] Capt. Tracy Beegen, of the “Living Beyond Pain” podcast, produced
by the Defense Health Agency. [music] [Army Capt. Beegen] Welcome back to
the “Living Beyond Pain” podcast. Today, I’m very excited to bring back a special
guest, Dr. Riedmiller, and we’re going to be talking about how do we cope with our pain
flare-ups, and we’re going to be discussing the CAPE method. Welcome, Dr. Riedmiller. [Dr. Douglas Riedmiller] Thank you. It’s good to be with you again. [Beegen] So, Dr. Riedmiller, can you tell
us about the CAPE method that’s utilized in the Living Beyond Pain group? [Riedmiller] Sure. So the CAPE is actually an acronym, C-A-P-E,
and the C in the CAPE is where we consider our ways of coping. The A is where we anticipate and avoid obstacles. P is where we prepare for triggers, and E
is engaging in positive coping. So that comes up to C-A-P-E, which one way
to help ourselves remind that is the acronym, CAPE. I will just start by saying that flare-ups
are actually– in chronic pain, we expect them. We do think that they will happen. No matter how efficient we become at managing
our lives through our emotions and through our behaviors and through our thoughts, it’s
still very much likely that we’re going to have flare-ups. The weather may change which would cause a
flare-up, or we may find ourselves engaged in a particularly stressful event that could
cause a flare-up. So probably the first thing to understand
about flare-ups is that they do happen, and that it’s wise for us to be prepared for them
and to think about what conditions in our life might cause us to have a flare-up. [Beegen] Now, in the group Living Beyond Pain,
we talk about using the CAPE method. Can you tell us a little bit about what CAPE
stands for? [Riedmiller] C-A-P-E. The C is consider your ways of coping, and
that is essentially reviewing, “What are my options? What are the things that I have found to be
beneficial in the past, or what are the things that I’m learning currently,” in regards to
coping with a flare-up? [Beegen] Those methods of coping could look
different for every person. Someone might feel that relaxation is a great
way for them to manage their flare-ups, and they’ll put on some meditation or do some
deep breathing, some relaxation exercises, and someone else might, like you were talking
about earlier, is breaking out their thought log and writing down, “What are my automatic
thoughts right now? Can I distract myself with a puzzle or listening
to calming music? Or maybe I need to go and move my body, or
maybe I need to shift positions.” And maybe there’s a coping card they can use
to remind them of positive things and things that bring them joy. [Riedmiller] Right, absolutely. So, as with many things in life, pain is truly
an individual experience, and we do vary from one another in regards to the intensity of
the pain we feel and how we feel pain. And how we can cope with pain, including flare-ups,
varies from person to person, as well. So one of my favorite things to do with people
is to encourage them to think about, and actually talk out loud or write down, what’s helped
in the past with a flare-up? “What have I done that’s been particularly
helpful?” It can even be helpful, frankly, to write
a couple of those things down on a flash card and carry it so that it’s available if we
happen to go through a flare-up, and we can look at the flash card and see. So that’s one way to do that. Another way to take a look at what ways can
I cope with a flare-up would be to think about, “What am I learning in this class?” for example. [Beegen] Great, and now the A. What does the
A in the CAPE acronym stand for? [Riedmiller] So the A stands for anticipating
and avoiding obstacles, and that is essentially what we’re doing when we’re anticipating and
avoiding obstacles, is we’re sitting down and thinking about, “What obstacles might
I come across today?” Or, let’s say, we’re preparing to do something
that we don’t often do, maybe travel a long distance in a car or maybe get on an airplane
or something like that, and thinking about, “OK, I have this travel planned. What are some potential obstacles that are
going to occur, in regards to this travel?” So being able to anticipate those obstacles
allows us to potentially avoid them, or it could allow us to prepare for them should
they occur. [Beegen] And one of the strategies for the
anticipate and avoiding, in another one of our segments we’re talking about pacing. So that sounds like a great place to put in
pacing. If you know you have a trip coming up or when
you’re having those good days versus those flare-ups, managing the good days in a way
that’s not going to contribute to flaring up and trying to push through and get everything
done you didn’t get done, and so planning that out and pacing is a great strategy to
also implement there. [Riedmiller] Yeah, I agree with you about
that. I think that pacing is one of the skills that
is available to learn in this program that can provide tremendous relief to people, and
I like to refer to it as the two-point rule. I find that my patients, and myself, remember
it a bit better with that. So, essentially, what we do with pacing is
we think about, “What is our common pain level or what pain level am I at currently?” And then as we engage in any kind of activity,
we casually observe that pain level, and at the point at which it gets to two points over
our baseline, our common pain level, we want to stop the activity and take a break, and
take that break from the activity until we’re back down to our baseline. When we’re back down to our baseline, if we
happen to have more that we want to do, in regards to the activity, we can re-engage,
and we’ll do it until we’re two points above our baseline, and then we take a break again
until we’re finished with the activity. And the real nice thing, I think, about using
pacing is it allows us to engage in activity such that we avoid the very high pain experience
and also the recovery period from that pain experience. So, for example, if I apply pacing today to
my activity, it’s much more likely I’m going to be able to engage in activity again tomorrow,
as opposed to just white-knuckling it and pushing through my pain today and then tomorrow
not being able to do anything, and, quite frankly, it won’t be just tomorrow. It’ll be two, three days, if not a week. [Beegen] So the two-point rule. I just want to make sure I’m explaining this
accurately for our listeners, and it’s really a helpful reminder for me, as well. So usually, we use a pain scale of zero, no
pain at all, 10, worst pain you’ve experienced. And so if my baseline is, we’ll say, a three,
and that’s where I operate at, and I’m going up to a five. That’s when I would stop and take a break. Is that correct? [Riedmiller] That’s correct. So you would start the activity and note that
your pain level was a three. That’s your baseline pain level. And, as I said, you just kind of casually
observe your pain level, and when you notice that it gets to a five – because that’s two
points over your three – that’s where you want to take a break. And then you’ll take a break until your pain
scale score comes down two points from the five to the three, which is your baseline,
and then you would continue the activity if you wanted to, at that point. And, again, you’d wait until you went up two
points. So in your case, we’d be going from a three
to a five, and we’d take another break, and we would continue to approach it that way. [Beegen] Great. Well thank you so much for that strategy,
and I know it’s been really helpful for a number of my patients. So I would really encourage our listeners
out there, if that’s something you’ve been really struggling with or something that’s
really impacting you, that crash and burn cycle where you have a good day– and like
you said, if you white-knuckle it and push through, that’s when we’re seeing patients
and individuals crash for the next couple days. And I’ve had a number of patients say, “I’m
just flat on my back, and I can’t get out of bed because I pushed so hard on the day
I was feeling good.” [Riedmiller] Yeah. I’ll share with you that I, just today, had
a patient tell me happily that he completed painting his house, and he used the two-point
rule in doing that. And he kind of chuckled and said, “It took
me five months, but my house is painted.” And then he paused and said, “If I hadn’t
done it that way, it wouldn’t be painted now.” So it was actually quite nice to see how happy
he was that he was able to accomplish this desired goal by using the pacing, the two-point
rule skill, in his life. [Beegen] And that’s a really great point,
especially for our veterans and active duty where very much given the message of, “Push
through, drive on, suck it up,” and to keep going. So this really does require a change in our
thinking and our perception about even our own abilities. There’s kind of this, “I should be able to
do this kind of work. I used to be able to do it this way or this
quickly or work for this long,” and so there is a level of frustration that most of my
patients experience because there’s also a loss of identity that’s associated with having
chronic pain versus the service member and military member they used to be, and that
can be really challenging for folks. But here you’re sharing a success story where
your patient might not have been able to do it as quickly as they would have before, but
they were still able to engage in it and still able to do the painting themselves, even though
it’s not quite what it would have looked like prior to their chronic pain condition. [Riedmiller] Yeah. I think that what you touch on there is very,
very true for my patients, as well. I find that many of my patients struggle with
the idea that just simply their body will not allow them to do what their will or their
brain, their desire would like them to do. I find that talking with patients about looking
at these different life activities as missions can be very helpful, and thinking about, “What
supplies do I have for the mission? How well am I prepared for the mission?” The fact is, when we have chronic pain, that
we have to be aware that our supplies or our preparation is affected by the limitations
that pain puts on us so our approach to the mission may be different but the outcome remains
the same. We will be successful. And if we do it this way, it’s much, much
less likely that we’re going to experience those extreme pain days and then be laid up,
and we have no hope of achieving the mission if we’re laid up. [Beegen] And that brings us to preparing for
our triggers, and that’s a great way to explain how we prepare for those is really taking
stock of what our resources are and what some of our limitations are in our physical bodies
because of our chronic pain. [Riedmiller] Yes, that is the P, the preparing
for triggers. And, again, that’s a lot of what we learn
in this program is to slow this process down, this living with pain process down so that
we can understand it well. Like most things, when we understand it well,
we’re much more able to impact it so that it’s less of a problem. So when we understand what our triggers are
for flare-ups and we prepare for those triggers, it’s kind of like packing our backpack. We’re ready for it. If we need to deal with it, we have what we
need to deal with it. [Beegen] And now for the E in the CAPE acronym,
what does the E stand for? [Riedmiller] So the E stands for engaging
in positive coping, and there are a number of different ways to do this. We might do things like purposefully and intentionally
noticing things in our life that we are pleased with, or that we like or that we’re thankful
for or grateful for. It might be, also, noticing when we’re talking
to people how we’re talking and trying to use words that are more positive in nature,
if you will. Not denying the chronic pain experience – we
don’t want to do that – but we do want to focus on what’s positive. So, for example, again, this fellow I spoke
about who was able to paint his house. He wasn’t focused on how long it took him
to paint his house. He was focused on the fact that he did and
that he achieved what he wanted to do. [Beegen] So really, again, it’s that being
intentional about what we’re thinking about. Being aware of what we’re thinking about can
really have a significant impact on how we’re experiencing our pain. [Riedmiller] Yeah. One of the ways that helps me to think about
this is, I recall what it was like to be in high school and college and working on algebra
and how hard it was for me to solve algebra problems and how much easier it was for me
to solve simple addition problems. The way that you get to that is that you learn
about the problem. In learning about our chronic pain, we turn
this situation that’s very difficult for us to come up with a resolution to, or a solution
to, into an easier equation for us to solve. Now, it doesn’t take our pain away, but it
certainly gives us an ability to act so that we are more in control of what happens, as
opposed to the pain being in control. [Beegen] And that really is the focus of this
podcast is giving people back more control of their lives so that they can have decreased
flare-ups, decreased intensity, and really increasing the ability to engage in those
enjoyable activities, getting control back of their lives. I want to thank you so much for joining us
today on our podcast, Dr. Riedmiller. [Riedmiller] It’s been my pleasure. [Beegen] Well thank you so much to our listeners,
and we hope you’ll join us again. Until next time, be well. [music]

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