Goals | Right Decisions

Goals can help people living with chronic pain to regain the confidence to move towards doing more of their valued activities.

Relationship between pain and goals

Goals provide milestones on the journey which can help with motivation and achievement
Some people may struggle to set goals as they can initially be difficult to identify

Potential strategies:

Person-centred: Goals need to be person-centred to be more effective and should be generated by the person working towards the goal
Values based: Choose goals or targets related to what is important to the person
SMART (IES): Specific, Measurable, Achievable, Realistic and Timed (Independent, Enjoyable/or Satisfying)
Action: Goals should target an action rather than a result e.g. being fitter is a result, walking to the shop and back is an action
Create an action plan: A series of goals put together to reach a longer term/ bigger goal
Break down: Break down goals into achievable steps
Easy start : Start with the easiest step
Reward: Identify meaningful rewards that can be used
Reassess : Regular reassessment of goals to modify when required to make more achievable or more of a challenge

Resources:

Re-engaging with meaningful activity

Martin, a 50-year-old male, presented with widespread pain. He was prescribed liquid morphine, co-codamol and amitriptyline with limited benefit. A recent MRI scan of the whole spine and pelvis was normal for age. On assessment, he presented with significant health anxiety on a background of previous trauma. He was experiencing significant social stress including past bereavement, terminal illness within the family and job insecurity. Pain had a significant impact on quality of life, sleep and relationships with family and friends.

Discussion and guided reflection (through pain education) helped develop an understanding of the connection between current life experiences, stress, distress and heightened sensitivity of the pain system. This reduced the belief that pain meant injury to the body thus reducing health related anxiety.

Support focussed on activities that mattered to him, including time with his children and re-engaging in hobbies, in combination with pacing, self-care, sleep hygiene and relaxation.

To address the significant psychological distress and anxiety, an interdisciplinary team approach was implemented. A review of his case with the Psychological Therapies team, resulted in mental health support being tailored to his individual needs. Face-to-face sessions were arranged as he did not feel comfortable with group or telephone consultations. Third sector social support was also offered.

The outcome was that he re-engaged with valued activities and had greater understanding of the multifactorial nature of his pain. He was no longer seeking a medical diagnosis, and felt a significant reduction in health anxiety. Over time, he stopped his pain medication and engaged with mental health services.

Practitioner reflection:

In individuals experiencing nociplastic pain, who have high psychological distress or previous trauma and low support/resilience, then caution is advised when prescribing opioids and other dependence forming medications, due to the risk of tolerance, dependency and addiction.