These steps summarize the experience of others who have learned to cope, and to live well despite suffering with chronic pain. You should plan to work on all of the steps at the same time. This is not a sequence, in which you work at step one, and when you finish you go to step two, etc. Rather, each step represents improving a different area of your life and your pain problem, and you must work at all areas at the same time in order to make progress.

By the time you have read and absorbed these 12 steps, you should understand more about coping mechanisms, and have the necessary skills and ability to put these strategies in place to help you to begin to cope.

Other steps you can take to help you cope include:-

• Take simple over the counter pain killers (pain drugs, analgesics, medications, medicines).
• Start using the part that hurts by doing gentle exercises and stretches. Your local physiotherapist could assist in this area.
• Think about trying the Pain Gone Pen - a simple low-cost non-drug self-help pain relief device for home use.
• Ask your GP for a referral to your local hospital Pain Clinic, where there may also be a pain management program available.
• Consider holistic alternative medicine technques or alternative therapies such as Pilates, Osteopathy, Acupuncture, Reflexology, Aromatherapy, Hypnotherapy, Massage Therapy, Reiki.
• Seek out professional help and support for associated stress, anxiety and depression, including relaxation and meditation.
• The American Chronic Pain Association "10 Steps from Patient to Person" leaflet.

Step 1 - Accept the fact of having chronic pain

• If you have had appropriate and adequate medical evaluations, and the cause of your chronic pain is understood, and nothing can be done about it, then you must accept the fact that you have this problem and make the best of life despite it.
• You should neither give in to pain and just lie around feeling sorry for yourself, nor waste your time chasing some impossible cure. There is much that you can do for yourself, and the more you do, the less pain will dominate your life.

Step 2 - Set specific goals for your life

• Set specific goals for work, recreation or hobbies and social activities towards which you will work. These goals, things you actually want to accomplish, are those which will keep you busy and bring you satisfaction and occupy your mind.
• If you want to have a job or need an occupation, then you must work at getting and keeping one. If you do not need an actual paying job, then you should have some work like activity instead that gives you a sense of accomplishment, whether as a volunteer or in some other capacity.
• For fun and a change of pace, you also need some regular hobby or recreational activity. And you need social activities and interaction with family and friends for needed emotional support. You need to be very specific in just exactly what you want to accomplish in these three areas, and you need to work towards these goals in a deliberate, step-by-step manner.

Step 3 - Let yourself get angry at your pain

• Let yourself get angry at your pain if it seems to be getting the best of you. Do not take your anger and frustration out on your family or others around you. And do not take it out on yourself, blaming yourself or making yourself depressed. Rather, it is the pain which is the source of your misery, and you should allow yourself to get angry at it and resolve to overcome it.
• Use your anger at the pain as a source of motivation to pursue the goals you want to accomplish, and to use the other steps as a means of achieving these goals. By doing so, you will turn your anger into an effective means of conquering the pain, in that the pain may still be there, but you will have managed to live a satisfying life despite it.

Step 4 - Adjust your analgesics

• Take your analgesics on a strict time schedule, and then taper them off. Long term use of narcotic analgesics leads to tolerance, physical dependence and addiction, and also has unpleasant side effects.
• Narcotics taken "as needed" in chronic pain states tends to have the paradoxical effect of maintaining pain at an abnormally high level, as well as keeping you more mentally dull and irritable than you want. Most chronic pain patients function much better when they withdraw in a gradual and systematic way from narcotics.
• Non prescription (over the counter) analgesics, when consumed in large amounts for long periods, can have serious effects on the liver and kidneys. If you do not get some pain relief from the small amounts recommended in the directions for their use, then stop taking them as well.

Step 5 - Get in the best physical shape possible

• Get in the best physical shape possible, then keep fit. In order to work at and achieve your goals for work or work like activity, recreation and social activities, you need to be in sufficiently good condition that pursuing these will not increase your pain.
• You need to begin a gradual, progressive conditioning program, ideally one that is prescribed just for you and which takes you medical situation into account. This conditioning will include some aerobic component, not only to improve your endurance, but because of its beneficial effect on raising your pain tolerance while helping to discharge the tensions which develop each day from having to cope with pain as well as the routine daily hassles.
• As part of this conditioning you will also need to stop using stimulants such as caffeine and nicotine because they contribute to muscle irritability and tightness and thus make pain worse.

Step 6 - Learn how to relax

• Learn how to relax, and practice relaxation regularly. Use whatever relaxation technique works best for you, and get really good at it. Then you will be able to avoid muscle tension, which makes pain worse and tends to tire you quickly.
• When you take breaks to pace yourself, these relaxation techniques can be very refreshing and helpful in restoring your energy levels. With some of them, such as self hypnosis and imagery, you can block out pain and learn to split your awareness in such a way that you don't feel the pain, although it is still there, somewhere.
• As with the physical conditioning exercises, you will have to practice relaxation daily in order to maintain your proficiency and get the benefits.

Step 7 - Keep yourself busy

• The reasons for having specific goals for work or work like activities, recreation or hobbies and social activities is not just to bring you satisfaction, although that is very important. It is also to have plenty to do.
• You need to keep busy so as to be involved in what you are doing and not in your pain. When you are absorbed in these activities, you are not dwelling on the pain, and it cannot bother you as much. You are keeping your attention focused on things outside yourself, and so are not noticing the pain.
• Whenever the pain ( or feeling discouraged) seems to start getting the upper hand, immediately change what you are doing and thinking about. "Move your muscles, change your thoughts", and switch from one activity to another.

Step 8 - Pace your activities

• Learn what your time limits are for each activity, stop before the pain increases. Take relaxation breaks, listening to your tapes and letting yourself relax completely at least twice daily.
• At other times, switch from one activity to another so that different muscles and different kinds of mental activities are involved.
• At still other times, you may repeat certain of your other exercises, such as back exercises. The principle here is that remaining in one position or repeating one particular activity too long can result in increased awareness of pain.
• Following a schedule to change activities regularly will allow you to pace yourself better, and you will be able to accomplish a lot, and be absorbed in what you are doing and yet not have any worsening of the pain.

Step 9 - Get the right support from friends and family

• Persuade your friends and family to support only healthy behaviour, not your invalidism. You need to talk to them about not asking about your pain or offering to do things for you that you can do yourself.
• You should not use your pain as a way of bullying others, making them feel guilty or getting out of things you should be doing.
• You need to have your friends and family give you emotional support and pats on the back for acting normal, not for being disabled and in pain.
• When people fuss over you for being in pain, it keeps you involved in your pain and disability, and both seem worse than they need to. It is more satisfying and a better distraction from the pain to have the attention and praise for all you're accomplishing despite the pain.

Step 10 - Be open and reasonable with your doctor

• Your doctor would be very pleased to be able to eliminate your pain if that were possible, but if it were possible then you wouldn't have chronic pain. Don't insist on relief when none is to be had, nor on prescriptions for narcotics, which will only make the problems worse in the long run.
• What you should expect is a periodic re-evaluation of the pain problem to make sure nothing is being overlooked, and that the pain is not part of a progressive disease.
• And you can expect to be be kept up to date on new developments in pain treatments that might help you. Remember that chronic pain is not an emergency and pain flare ups can be kept to a minimum better by following these 12 principles than by your frantic phone calls to the doctor.

Step 11 - Practice empathy with others in pain

• Misery loves company, if that company knows what it's like to be miserable. You should join with other pain patients for sharing techniques for overcoming pain (not talk about the pain) and for emotional support.
• Groups of patients can lobby for more government support of pain research and can support private organisations which are engaged in research and educational activities.

Step 12 - Remain hopeful

• From time to time you may feel worn out and discouraged, and this is to be expected. But the feelings will pass, especially as you change your activities and your thoughts.
• It also helps to remember the wide range of ongoing pain research, which will undoubtedly continue to yield new understanding and breakthroughs. There may have been many great advances in the last 15 years and some pain conditions which had previously been untreatable are now routinely treated with great success.
• There is every reason to hope that more and more answers and new techniques will be forthcoming. There is every reason to remain optimistic !!