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Chronic Pain and Setting the Right Kind of Goals

September 11, 2013

Disclaimer Acute pain may be defined as intense pain of recent onset that usually diminishes and disappears when healing has taken place.  Acute pain is a symptom of some underlying disease or injury.  Chronic pain is that which is ongoing and defies simple causal analysis.  It may be diagnosed in general terms and defies mere biological factors or pharmaceutical therapies.  Chronic pain will be the subject of this blog series.

When forced to confront difficulties or painful situations in life, it is often most helpful to use our God-given minds in order to evaluate our current state of affairs and determine an appropriate, proactive response.  This is especially true for those suffering with chronic pain or debilitating illness.  In the previous posts on chronic pain, I’ve outlined the various physical, social, cognitive and emotional factors that ought to be taken into account before determining a response that may assist with the daily tasks of ordinary life.

Perhaps the most important first step in determining a beneficial response to chronic pain is establishing goals. Goal-oriented behavior is, of course, intrinsic to the Christian life. Saint Paul described this kind of positive behavior when he said, “I press toward the mark for the prize of the high calling of God in Christ Jesus” (Phil. 3:14) and when he advised the Corinthians to run the race to receive the prize (1 Cor. 9:24). And countless fathers underlined this point again and again when speaking of virtue. In Ancient Christian Wisdom, I referred to the following passage from Saint Ambrose of Milan on goals in which the Saint wrote “Deprive the pilot of the hope of reaching port, and he will wander with uncertainty here and there on the waves. Take away the crown from the athlete, and he will fail and lie down on the track….How, then, can someone whose soul is famished with hunger pray more earnestly to God, if he cannot hope to obtain the heavenly food?” And so by extension, those suffering with chronic pain need to establish some active, positive goals in terms of where they want to go defined not just by the experience of pain, but also by who they are as humans who are social, physical, thinking, and feeling beings.

Psychology has much to say about goals. One helpful way to set goals is to follow SMART criteria.  These criteria for goal setting are used in project management, but are also suited for most activities where goals and objectives are important criteria for later evaluation.  They should be Specific, Measurable, Attainable, Relevant, and Time sensitive.  SMART goals help establish criteria by which the pain sufferer can hold themselves accountable to objectives that are measurable and reasonable.

Goals should be Specific.  Such objectives should answer the following questions:  What do I hope to accomplish?  They should establish reasons, purposes and benefits for accomplishing the goal.  It might be helpful to include in this specificity, the time allotted to accomplish the goal and the resources needed to meet the established objective.  For instance, a person who suffers with chronic joint pain may embark on a regimen that includes aquatic exercise in order to become more mobile.  A pool or a safe body of water will be necessary.  Flotation devices or aquatic weight devices might also be necessary.  These items should be included in your checklist to accomplish the specific goal in mind.

Goals should be Measurable.  Using the example of aquatic exercise as a tool to accomplish the goal of mobility, you may set a goal for yourself such as “during the first week I will walk the length of the pool twice.”  You can keep a log of your activity and measure your performance, slowly increasing the length of the pool walk and/or converting to floating or swimming after a period of time.

Goals should be Attainable. Besides a failure to plan, the most certain way to fail is setting unattainable goals for yourself.  If you suffer chronic pain, swimming for an hour at a time may not be attainable.  It would be much more beneficial to start with the objective of walking or swimming for a shorter duration of time or distance than to set yourself up for failure.

Goals should be Relevant. It is important to choose goals or activities that are relevant to your specific situation.  For instance, walking or running on a hard surface may not suit your specific objectives to decrease pain or improve mobility because the activity produces the opposite of the desired effect.

Goals should be Timesensitive.  Set a time period during which you are able to objectively evaluate your goals and the manner in which you hope to accomplish them.  For instance, aqua therapy may be attempted for a period of one month or six weeks.  This length of time may provide you with sufficient performance data to determine if the activity is accomplishing the desired goal.

Once a goal has been established using the SMART criteria, it is important to keep some sort of journal to record your progress to your goal and evaluate your pain before and after each exercise or activity.  Such a journal will assist in evaluating progress and making goal adjustments if they are deemed necessary.

As helpful as SMART goals may be in setting up appropriate goals, they can also become like a body without an enlivening soul. I would also add that for a Christian, SMART goals need to be tied to spiritual goals as well. Increased mobility needs a purpose beyond itself such as going the extra mile (Matthew 5:41), walking “even as He walked,” (1 John 2:6),  walking “after his commandments” (2 John 6), walking “in truth” (3 John 4). Whatever SMART goal one chooses, it is important to link it to the ultimate goals in the Christian life. What are those goals? In Ancient Christian Wisdom, I mention some goals proposed by the fathers: “Saint Gregory of Nyssa considers love [agapë] to be an ideal long-term goal, because it reflects divine perfection, encompasses all the virtues, and can thus guide Christian behavior at every stage in the spiritual life. Elsewhere, he considers the vision of God [ton Theon idein] to be the unsurpassable aspiration for the believer. For Saint John Cassian, the kingdom of heaven [regnum coelorum] is the final prize that the monk strives to attain. When goals such as these underlie daily activities, even the lowliest and least of tasks become precious and meaningful steps in a lifelong pilgrimage to the Jerusalem on high.” With smart goals to be sensible and spiritual goals to be meaningful, goal-setting can be the beginning of movement in a direction that is hopeful, healthful, and even holy. They are useful for everyone, especially those who suffer.

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