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During the process of change, lapses and relapses can happen. When they do, they affect chronic pain self-management. Especially during a flare-up. So, what do we do to get back on track?  

The 5 Stages of Change

There are several theories and models of health related behavioral change. The most common one is the Transtheoretical model (TTM) which was developed in the early 1980s by Prochaska and DiClemente. This model helps health care professionals to assess where the patient or client is at in their readiness and journey of behavioral change.

Prochaska Chart – by Aaron Design

People move through five stages: Precontemplation, Contemplation, Preparation, Action, Maintenance. They can experience lapses and relapses, usually in the Action and Maintenance phase.

Lapse vs. Relapse

Lapses tend to be shorter in duration. They are times when you revisit old behavior, or depart from new behavior that you’re trying to incorporate into your life. A relapse lasts longer than a lapse. Typically, people who experience a full relapse are not very motivated to get back to where they were prior to the relapse. Many times catastrophic and all or nothing thinking occurs during this phase.

Maintenance phase

Looking back over the past year, I would consider myself in maintenance phase for the stages of change with many areas of my life and overall wellness. I had minor flare-ups here and there, but nothing that was too disruptive. They were like little bumps in the road and I would move on. I was managing my pain well, continuing exercises, going to the gym, working, eating healthy. Basically, I was thriving, not striving.

My lapse

Then I had a flare-up that became very disruptive. It was triggered by an activity that I did in physical therapy with my physical therapist. I call the flare-up disruptive because I reverted to my pre-chronic pain rehab days. I catastrophized and had increased expressive pain behaviors. I avoided doing some of my physical therapy exercises, and skipped going to the gym for a couple of weeks.

I regressed in some of my healthy eating habits. I started going to bed later and waking up later. The tendency to isolate from people came back, and I started slacking off on many work related projects. I stopped intentionally praying and reading my daily meditations. My mood even changed. The biggest thing that I noticed was the fear of my pain, and of making it worse. This flare-up affected my entire self: mind, body, and spirit.

I say that I was in a lapse vs. an actual relapse because despite the fact that this lasted an entire month, I still had the motivation to improve and stay on track. I was still doing what I could to the best of my ability given the state of my central nervous system.

Getting back on track

Physical therapy: I have had a long history (over 25 years) of being in and out of physical therapy, so I know what approach works well for me, and what doesn’t. I’m compliant with the exercises (except see above), and I am very blessed to have the best physical therapist that I’ve ever worked with.

Coming out of the lapse, I realized that even though by scaling back during the acute flare (and even after that during avoidance), I could still get back to where I was when I was in maintenance phase. Not all hope or ground was lost. I continued to use my heating pad and other tools as well.

Healthy eating: I have a lot of issues with food (methylation issue, allergies, sensitivities, being picky). I am grain free, dairy free, sugar free, and follow a ketogenic diet, along with avoiding sulfur rich foods and foods that are high in histamines.

During the lapse, I went off my ketogenic diet by increasing my carb intake. I got back on track and fought the temptation to purchase packaged food at the grocery store. I also got back on track with crockpot cooking and prepping healthy food for a few days at a time.

Gym time: I resumed going to the gym during the tail end of the flare-up. I was reminded by my physical therapist that movement within my ability was not going to be harmful. I didn’t need to be scared of walking on the treadmill or using the recumbent bike. I didn’t need to be afraid of my pain. I could start off slow and work my way back to where I was prior to the lapse.

Social support: I got back to at least one friend date a week. Sometimes it is with a friend who I’ve met along this chronic pain journey, and they struggle too. Sometimes it is with a colleague. We usually get together and have “healing time” and catch up over tea. Sometimes we meet up for acupuncture. It is time spent ministering to each other.

Spirituality: I started reading my daily meditation books and resumed my bible study again. I resumed praying and spending time with God. Being connected spiritually to a higher power grounds me, and helps me stay peaceful in the midst of chaos.

Work: I went ahead and set times in my calendar for when I needed to work on various projects. For the most part, my work schedules and projects are adaptable and flexible. This helped me to get back on track to complete tasks that needed to be completed.

Emotional health: There are times when I view the world with an “all or nothing” lens. This gets magnified when I am in a lapse or a flare-up. With the help of others and self re-direction, I was able to pull myself out by utilizing cognitive behavioral techniques that I’ve learned over the years.

I reminded myself that the lapse is only temporary. I was gentle and kind with myself. I needed to stick with the basics until I could resume full baseline functioning again. I re-read some pieces of some very instrumental books in my chronic pain recovery journey. I continued to write my daily gratitude note for the gratitude jar and focus on the positive. I started posting on instagram so keep myself accountable. I briefly looked back on the past and could see how far I had come.

With these tools, I was able to move from the Action stage back into the Maintenance stage, and I expect that this will continue to be a progressive “practice makes permanent” journey.

References:

Iserman, M., Walker, K. (2014). The Fitness Professional’s Manual. Minneapolis, MN: National Exercise Trainers Association (NETA).

Gavin, J., Mcbrearty, M. (2013). Lifestyle Wellness Coaching (2nd ed.). Champaign, IL: Human Kinetics Inc.    

Miller, W., Rollnick, S. (2013). Motivational interviewing: helping people change (3rd ed.). New York, NY: The Guilford Press.

Prochaska, J., Di Clemente, C. (1982). Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice(19, 3). Retrieved from http://www.hbftpartnership.com/documents/uploadResources/TranstheoreticalT-Prochaska1982.pdf

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