1. Acceptance of the pain. The ACPA states that at some stage many patients with chronic pain will have to accept that they ‘learn to live with it’. After initially looking to the medical community to take away the pain you will realise that you are living with the chronic pain. Learning to live with pain does not mean that you will abandon medical treatment.

2. Getting involved. Once you accept that you have chronic pain you must become actively involved in your own recovery. Attending ACPA meetings or following the excellent manuals provided by ACPA can assist you in this.

3. Priorities. What is the most important thing to you today? Ask yourself this question each day and list those things you feel important in your life. This list should not only contain your problems, but also those things that make you happy and those things that you always wanted to do if only you had the time.

Realise that certain issues cannot be avoided and must be addressed. When you set priorities you accept that nothing is absolutely black or white, including your life. You must try to be flexible and

learn to focus on your life instead of your pain. Setting your priorities is the first step in moving back into the mainstream of life.

4. Realistic goals. Once you recognise your capabilities and limitations and set your priorities you can begin to set specific goals for yourself. How many of your activities have you allowed to fall away because of your pain? How many social activities have you shut yourself from? Setting goals will give you a reason for getting out of bed each morning.

Your goals need not be centred on work but on activities that you enjoy. Simply setting aside time for relaxation can be one of your goals. Accomplishing even one of your goals can be a powerful force in helping you to generate a positive attitude and helping you to learn with chronic pain. After several successes you may find that anything is possible.

5. Your basic rights. No matter who you are, what you look like, or what you do, you have certain basic rights. These rights establish the fundamental principles of your actions and reactions. It is important that you study these basic rights, understand them and use them in your daily life. These rights will give you freedom to explore the vast opportunities that you may not have believed possible before. They will allow you to be you without feeling guilty. Briefly your rights as listed by ACPA are:

• The right to act in a way that promotes your dignity and self-respect.

• The right to be treated with respect.

• The right to make mistakes.

• The right to do less than you are humanly capable of doing.

• The right to change your mind.

• The right to ask for what you want.

• The right to take time to slow down and think before you respond.

• The right to feel you don’t have to explain everything you do and think.

• The right to say no and not feel guilty, and

• The right to ask for information.

*195\37\8*

She already had major surgery some years previously and, by the time she was first seen, she was suffering from a terminal cancer of one of her breasts. This particular tumour was painfully ulcerating through the skin, and required daily dressings which was extremely painful and unpleasant and the constant nursing and pain it caused resulted in her being readmitted to hospital. All she wanted for the remaining days of her life was to be with her family, and to be as alert as possible. She wanted to be able to contribute in any way to the care of her husband and young children.

As is often the case with cancer sufferers, she proved to be an extremely good hypnotic subject and, within one or two sessions of hypnosis, she was able to put herself into a deep trance whenever she wished.

In hypnosis, she was taught how to use the techniques of ‘glove anaesthesia’ in which she could visualise her hand becoming cold, numb and dull.

Simply by holding that hand above the affected breast, she could cause that numbness, that dullness, that painlessness, to transfer from her hand into her breast and upper left chest.

She could also by using hypnotically-based imagery, fantasize herself leaving her body and going into the room next door whenever the district nurse came to change her dressing — or whenever she felt too bad to cope with her current existence.

By using these techniques, she was able to stay at home until three days before her death when she lapsed into a coma. Her consumption of narcotic analgesia had decreased to almost nothing, and her consumption of anti-depressants and tranquillisers guaranteed that she remained calm, relaxed, and able

to use the self-help imagery techniques. She never came out of the coma and died peacefully in hospital. Later, her husband expressed appreciation that the family had been able to share the last few days with their mother and wife.

*168\37\8*

She was told under hypnosis to:

‘Imagine that you are lying on warm sand on a beach and that a layer of sand is gently being blown over your leg. This sand has special properties and, as your leg absorbs the sand’s warmth, the pain in your leg is draining into the sand so that, when you return to a normal waking state, your pain will be gone.’

Mary was able to use this technique even standing in crowded buses to get to work and home again. She was eventually able to cease taking the high dosages of anti-depressants prescribed by previous practitioners.

*142\37\8*

It consists of treating tender points in the soft issues which often accompany, or cause, chronic pain.

The trigger point is a small, well-defined area of tenderness, sensitive to pressure or stretching. Usually less than a centimetre in size, it is located in muscle, connective tissue or skin. When stimulated, or excited, it reacts by causing pain and spasm in a rather explosive way. Hence the comparison with pulling the trigger of a gun! And pain is not only caused at the site but far beyond the point. For example, a trigger point in the neck may produce headaches. One in the back may produce leg pain. A trigger point in the shoulder blade can produce pain down the inside of the arm.

Predisposing causes There is a range of conditions that tend to make tissues develop a trigger point. These include:

• Chronic muscular strain produced by poor posture or repetitive movements.

• General tiredness, nerve irritation and chronic pain.

• Poor sleep patterns are believed to be increasingly important because these can lead to chronic muscle spasm when a person is asleep. The poor sleep pattern condition is now a popular illness, given the name ‘fibromyositis syndrome’. This has all the hallmarks of being a twentieth century disease due to continuing muscle spasm aggravated by anxiety and strain.

It can be summarised as an ‘uptight syndrome’ during waking and sleeping.

Immediate causes These include sudden injury due to strain, temperature changes and serious illness — thus putting a strain on the whole body, and acute nerve pressure.

*117\37\8*