Movement (Living Beyond Pain Podcast)

Movement (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]
[Amry Capt. Tracy Beegen] Welcome back to the “Living Beyond Pain” podcast. Today we’re going to be talking all about
movement and how engaging in physical activity and enjoyable activities can really impact
the way we experience our pain. We’re excited to have a special guest with
us, [Navy] Capt. Amy Park of the U.S. Public Health Service. Capt. Park is a clinical health psychologist. And she’s currently working out of the Connected
Health branch here at Joint Base Lewis-McChord. Welcome to the show, Capt. Park. [Navy Capt. Park] Glad to be here. [Beegen] So you really have an extensive background
of working with individuals experiencing pain and how it can impact their overall health. [Park] I really enjoy working with patients
with chronic pain because chronic pain really involves the whole gamut of not just biological
or medical issues but psychological and social. And I believe that health psychologists can
really intervene holistically, helping people get better, improve their functioning in their
lives. [Beegen] And oftentimes patients with chronic
pain will engage in guarding behaviors. So there’s really a fear of, “I’m afraid I’m
going to injure myself again. I’m afraid that I’m going to make my pain
worse, or have to deal with another injury,” in a different part of their body. So oftentimes, I find that the patients I
work with are really guarded about engaging in more movement, especially when they experience
pain flare-ups. [Park] It’s a natural human instinct to not
do something that causes pain without really realizing that when we stop moving or brace
ourselves or tense up with pain, here again, another natural physiological response to
pain, that on a long term it reduces functionality and our muscle weakens. Thereby, when we do need to use that parts
of the body, it causes more pain. So it causes that vicious cycle in dealing
with pain. [Beegen] So not only does decreased movement
increase our experience of pain but decreased movement can also lead to increased weight
gain, which puts more stress and strain on our body, which then increases our pain flare-ups
as well. So when we don’t engage in regular physical
activity, we’re really increasing our pain and the experience of our flare-ups. [Park] Exactly. And lot of our service members don’t necessarily
make those connection because I think that we are so driven to really accomplish mission
that oftentimes we have tendency to overdo. And then when pain flares up, then we’ll stop
engaging in that activity because we want to prevent the pain until we get better. And then we overdo again. Here again, sort of engaging in what we call
roller coaster cycle of pain, overdoing on good days and doing less on a bad day. [Beegen] And that’s really the mentality that
our service members and veterans have grown up with and had for so long, of the, “Suck
it up and drive on.” [Park] Exactly. [Beegen] “Just get the mission done.” And now we’re saying, “Hold on. You need to pace yourself.” So can you tell us a little bit about some
strategies that our listeners can use if they want to start engaging in some physical activity? [Park] As we talked about, people with chronic
pain tends to overdo during good days and do less when they have bad days and oftentimes
getting into this roller coaster cycle of pain. So one of the behavioral strategy that’s proven
to be quite effective in managing chronic pain is the concept called pacing, which is
basically helping people reset their level of activity based on time, instead of pain. With pacing, we can encourage service members
or veterans and people struggling with chronic pain to be intentional about picking an activity
or two that they need to engage in or enjoy doing, not based on what they used to be able
to do before injury. [Beegen] So for our listeners who may be unfamiliar
with what pacing is, it’s establishing, just as you said, Capt. Park, a time-based movement
or activity. So say you want to start walking more. Maybe you start walking for three minutes. And then you take a rest for five minutes. And then you walk for another three minutes. So it’s really about being time-bound. And it’s also about the level of pain you’re
experiencing. You don’t want to go above your pain threshold
to where you’re taken out for the rest of the day. So it’s really about monitoring that pain
scale. So again, we talked about the two-point scale
and really incorporating those time-bound movements and activities. [Park] Exactly. So for instance, I would ask people, “What
are some of the activities that you used to really enjoy that you feel like you can’t
do anymore?” So what we can do with pacing strategy is
helping them identify what their sweet spot is, so how long can you engage in an activity
without increasing pain? [Beegen] So oftentimes when we engage in,
say, a new physical activity or exercise regiment, when we first began we’re not so good at it. And it can actually cause us to experience
some soreness and some muscle aches. And that’s really common. And so I find my patients that are experiencing
chronic pain – again, going back to those guarding behaviors – they might start to engage. And they pick that activity. But then there’s some soreness or some discomfort
that comes along, and so they want to stop. What would you recommend for a listener who
has identified some physical activity that they want to engage in but then they’re experiencing
some pain and discomfort? What tips could you give them? [Park] Really normalizing that there may be
some soreness; there may be some discomfort. And helping our service members to identify,
“Is this pain flare or is this a normal part of increasing activity for anyone?” For instance, if we were to go to the gym
and workout and we haven’t worked out in a while, we’re going to experience some soreness. And I think that part of the pain patients
– is the fear that any kind of discomfort could equate to worsening of pain symptoms. And so really helping them understand that
just because it’s sore and uncomfortable, doesn’t necessarily mean that this is a pain
flare. And helping them really stick to their time
and increasing slowly. Another barriers that I find with our service
members and veteran is that during good days they tend to overdo it, thinking, “Oh, I just
have a little more dishes to do,” or, “I can just vacuum through this. Why stop?” Even though they know that their time is up. And so they push through and get into sort
of their old habit of, “Let me just push through and finish the job,” and, at times, leading
them to have the next pain flares. So that has been another area where it’s a
barrier. [Beegen] And it sounds like it’s about self-awareness
too, about understanding the difference of how your body experiences hurt when you engage
in a new physical activity or an exercise regimen versus harm, where there’s a new injury. [Park] Exactly. [Beegen] If I’m understanding you correctly,
because of the circumstances of the injury and the chronic pain, we kind of have to shift
what resources we’re using. And I kind of think about some of our service
members, maybe before they had a family, and they had this great sports car that was a
two-seater, and they drove really fast. And then they got married and had a couple
kids. They’re not going to use the same driving
habits or the same vehicle to get their family where they need to go because they’re all
not going to fit. Pretty sure we can’t put kids in the trunk. I think the law enforcement frowns on that,
right? So if we’re looking at how we can shift what
we need now, with our current situation and what we’re currently experiencing in our bodies,
and readjust. And we are great at readjusting and adapting
in the military and that is really one strength that I know all of our veterans and military
members have is we’re taught to adapt and overcome, but really adapting in a way that’s
helpful for us in how we experience our chronic pain. [Park] Capt. Beegen that’s a really great
example. Many times when I try to explain the concept
of pacing, service members get really stuck by, “What do you mean I have to plan an activity? What do you mean I have to not finish a task
because my time is up?” And explaining to them in terms of, let’s
say, If you were planning a trip and you have to go from one place to another, what do you
need to do? “Oh, I need to make sure that I have all the
ID [identification] cards. And I need to make sure I have gas in the
car. And I have to make sure that I’ve got food
and schedules and itineraries.” Helping people to really translate that into
managing their chronic pain in terms of being thoughtful about what activity do you want
to engage in. “If we can engage in ten activities without
any pain prior to the injury, here and now, with injury and chronic pain, what two activities,
or three activities, could you engage in that is intentional, that is meaningful, that is
going to give back and increase your quality of life? And then, how would you strategize it and
slowly increasing it without increasing pain?” [Beegen] That’s a really great example of
how resilient our service members are and our veterans are. And a great example of utilizing pacing is
a patient I worked with. And she allowed me to share this story, hoping
it would encourage other people experiencing chronic pain. And so it was around the holidays. And she really enjoyed putting up decorations
but she hadn’t been able to do it for several years because of her pain. So one of the things that she wanted to do,
and one of her physical activities, was to engage in decorating her house. She wasn’t able to do it all in one day. So we looked at using that SMART [Specific,
Measurable, Agreed Upon, Realistic, Time-Based] goal strategy of breaking down, “OK. I want to decorate my house. OK. Today I’m going to start with this window
sill, right here.” And it took her about a week and a half to
get all of her decorations out. And she said, “I’m so thankful I did because
now I can enjoy them, and I haven’t been able to enjoy them in several years. So maybe I can’t do it as fast as I used to,
but I was able to do it. And I wasn’t in pain.” [Park] That is such a great example. Utilizing the SMART goal – that’s an activity
that’s specific and measurable and achievable – can really give back to our pain patients
some of their quality of life back that it can help them shift their frame of mind from
what all the things that they cannot do to strategizing to identify ways to be able to
do the activities that they once were able to do. I always tell patients no doctor can tell
you in the future what they are able to or not able to do. But we can certainly engage in all the strategies
that are proven effective, here and now, to really work on slowly increasing their functionality
so that they are able to get the quality of life and meaning back in their life. [Beegen] I want to encourage our listeners. Hopefully, you’re gleaning some good information. And even if you’re just starting to think
about, “Maybe I could do something different,” we want to encourage you to look over the
resources that we’re going to have in our show notes. And Capt. Park, I just want to thank you so
much for being on our show today and talking to us about the importance of movement and
how it can really help us reduce how we’re experiencing our chronic pain, and sharing
with us about pacing and, really, the importance of engaging in those physical activities. And again, we want to remind our listeners
if you start a new exercise regimen, please check with your primary care provider to make
sure that it’s a safe activity for you to engage in. [Park] Thank you for having me. [Beegen] Thank you to our listeners. We’re really excited that you’ve joined us
today and we hope you’ll tune in next time for our next segment of “Living Beyond Pain”. Until next time, be well. [music]

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