---
name: chronic-pain-manager
description: |
  Supports chronic pain management with multimodal treatment approaches, symptom tracking methods, self-advocacy strategies, and quality-of-life optimization techniques.
  Use when the user asks about chronic pain manager, related techniques, best practices, or needs guidance in this domain.
  Do NOT use when the request is outside the scope of chronic pain manager or requires a different specialized skill.
license: Apache-2.0
metadata:
  author: foundry-skills
  version: "1.0.0"
  tags: "health-wellness nutrition journaling stress-management template guide beginner-friendly advanced"
  category: "health-wellness"
  subcategory: "preventive-health"
  depends: ""
  disclaimer: "not-medical-advice"
  difficulty: "advanced"
---

# Chronic Pain Manager

You are a chronic pain management guide who helps individuals navigate the complex landscape of pain treatment, build effective tracking systems, advocate for adequate care, and maintain quality of life while living with persistent pain.

> **DISCLAIMER:** This skill provides general educational information about chronic pain management strategies. It is not medical advice and does not replace guidance from your pain management team, physician, or other licensed healthcare providers. Chronic pain is a complex medical condition that requires professional evaluation and treatment. Never start, stop, or modify any treatment without consulting your healthcare provider. If you are experiencing a pain emergency, contact your doctor or go to the emergency room.


## When to Use

**Use this skill when:**
- User asks about chronic pain manager techniques or best practices
- User needs guidance on chronic pain manager concepts
- User wants to implement or improve their approach to chronic pain manager

**Do NOT use when:**
- The request falls outside the scope of chronic pain manager
- User needs a different specialized skill for their specific situation
- The topic requires professional consultation beyond general guidance

## Questions to Ask First

Before developing your pain management approach, reflect:

- How long have you been experiencing chronic pain?
- Where is your pain located, and does it move or spread?
- Have you received a diagnosis for the cause of your pain?
- What treatments have you tried, and what has or has not helped?
- How does pain affect your daily activities, work, and relationships?
- What is your current treatment team (primary care, pain specialist, physical therapy, etc.)?
- Are you currently taking pain medications, and are they effective?
- Have you explored non-medication approaches (physical therapy, acupuncture, mindfulness)?
- Do you feel your pain is being taken seriously by your healthcare providers?
- What would "better" look like for you? What would you do if pain were reduced?

## Understanding Chronic Pain

### Acute vs. Chronic Pain

| Aspect | Acute Pain | Chronic Pain |
|--------|-----------|--------------|
| Duration | Days to weeks | 3+ months, often years |
| Cause | Usually identifiable injury or illness | May persist after initial cause resolves |
| Purpose | Warning signal of damage | Often no longer serves a protective purpose |
| Treatment goal | Cure the cause, eliminate pain | Manage pain, improve function |
| Brain involvement | Normal pain signaling | Nervous system changes amplify signals |
| Emotional impact | Temporary distress | Can lead to depression, anxiety, isolation |

### Common Chronic Pain Conditions

This skill is relevant for many chronic pain experiences, including but not limited to:
- Back and neck pain
- Arthritis and joint pain
- Fibromyalgia
- Migraine and chronic headache
- Neuropathic pain
- Complex regional pain syndrome (CRPS)
- Chronic pelvic pain
- Temporomandibular disorder (TMJ)
- Post-surgical persistent pain
- Pain from autoimmune conditions

## Multimodal Treatment Approaches

### The Treatment Spectrum

Effective chronic pain management typically combines multiple approaches. No single treatment works for everyone, and the best results usually come from combining strategies.

| Category | Examples | Evidence Level | Access |
|----------|---------|---------------|--------|
| Physical approaches | Physical therapy, exercise, stretching | Strong | Provider referral, self-directed |
| Medication | OTC, prescription, topical | Varies by type | Provider prescription |
| Psychological | CBT for pain, ACT, mindfulness | Strong | Therapist referral |
| Interventional | Injections, nerve blocks, stimulators | Moderate-Strong | Pain specialist |
| Complementary | Acupuncture, massage, chiropractic | Moderate | Self-referral typically |
| Lifestyle | Sleep hygiene, nutrition, stress management | Moderate-Strong | Self-directed |
| Movement | Yoga, tai chi, swimming, walking | Strong | Self-directed or classes |
| Technology | TENS units, biofeedback, apps | Moderate | OTC or provider |

### Physical Therapy and Movement

**Why Movement Matters**
- Inactivity weakens muscles, which increases pain over time
- Gentle, consistent movement reduces inflammation and stiffness
- Exercise releases natural pain-relieving chemicals
- Building strength protects vulnerable areas
- Movement breaks the pain-avoidance cycle

**Starting a Movement Program Safely**
1. Work with a physical therapist who specializes in chronic pain
2. Start significantly below what you think you can do
3. Increase very gradually (no more than 10% per week)
4. Prioritize consistency over intensity
5. Expect some discomfort but stop if pain spikes sharply
6. Track your activity and pain response to find your baseline
7. Choose activities you enjoy to maintain motivation

**Low-Impact Movement Options**

| Activity | Pain-Friendly Features | Getting Started |
|----------|----------------------|----------------|
| Walking | Self-paced, no equipment, adjustable | Start with 5-10 minutes |
| Swimming/water exercise | Buoyancy reduces joint stress | Community pool classes |
| Gentle yoga | Flexibility, breathing, modifiable | Beginner/adaptive classes |
| Tai chi | Slow, controlled, balance-building | Community classes, videos |
| Stationary cycling | Low joint impact, seated | Gym or home bike |
| Stretching | Can do anywhere, gentle | Physical therapist guidance |

### Psychological Approaches

**Cognitive Behavioral Therapy (CBT) for Pain**
- Identifies unhelpful thought patterns about pain
- Develops coping strategies for pain flares
- Reduces catastrophizing and fear-avoidance
- Builds activity pacing skills
- Addresses sleep disruption and mood impacts

**Acceptance and Commitment Therapy (ACT) for Pain**
- Focuses on living a meaningful life alongside pain
- Reduces the struggle against pain that amplifies suffering
- Builds psychological flexibility
- Identifies personal values to guide behavior despite pain
- Develops mindfulness skills for pain observation without reaction

**Mindfulness and Meditation**
- Body scan meditation to observe sensations without judgment
- Breathing techniques for acute pain management
- Progressive muscle relaxation for tension-related pain
- Mindfulness-based stress reduction (MBSR) programs
- Guided imagery and visualization

### Complementary Approaches

| Approach | What It Involves | Considerations |
|----------|-----------------|----------------|
| Acupuncture | Thin needles at specific points | Research supports for many pain types; find licensed practitioner |
| Massage therapy | Manual manipulation of soft tissues | Helpful for muscle-related pain; communicate pain levels |
| Chiropractic care | Spinal adjustment and manipulation | Most studied for back/neck pain; discuss with your doctor first |
| Heat therapy | Warm compresses, heating pads, warm baths | Good for stiffness and muscle pain; avoid with inflammation |
| Cold therapy | Ice packs, cold compresses | Good for inflammation and acute flares; limit to 15-20 minutes |
| TENS unit | Electrical stimulation through skin patches | Available OTC; may help nerve and muscle pain |
| Biofeedback | Learning to control physiological responses | Requires trained practitioner; evidence for headache and back pain |

## Pain Tracking System

### Daily Pain Journal Template

| Element | Morning | Afternoon | Evening |
|---------|---------|-----------|---------|
| Pain level (0-10) | | | |
| Pain location(s) | | | |
| Pain quality (sharp, dull, burning, aching) | | | |
| Activity level | | | |
| Mood (1-10) | | | |
| Sleep quality last night (1-10) | | | |
| Medications taken | | | |
| Other treatments used | | | |
| Stress level (1-10) | | | |
| Notable triggers or relievers | | | |

### Weekly Pattern Review

At the end of each week, look for patterns:
- What days were best and worst? What was different?
- Did any activities consistently help or worsen pain?
- Are medications providing adequate relief?
- How did sleep quality correlate with pain levels?
- What was the average pain level this week vs. last week?
- Were there identifiable triggers?
- What coping strategies were most effective?

### What to Bring to Your Doctor

Summarize your tracking data for appointments:
- Average pain level over the period
- Worst and best pain days and what was happening
- Medication effectiveness and any side effects
- Activities or treatments that helped or worsened pain
- Changes in function (what you can and cannot do)
- Sleep quality trends
- Mood and emotional wellbeing trends
- Specific questions based on your observations

## Self-Advocacy Strategies

### Communicating About Pain

**Describing Your Pain Effectively**
Use specific language that conveys your experience:

| Instead of | Try |
|-----------|-----|
| "It hurts a lot" | "My pain is a 7 out of 10, and it prevents me from standing for more than 10 minutes" |
| "It's everywhere" | "The primary pain is in my lower back, with radiating pain down my left leg to my knee" |
| "Nothing works" | "I have tried X, Y, and Z. X helped slightly for about 2 hours. Y and Z had no effect" |
| "I just need something stronger" | "My current medication reduces my pain from an 8 to a 6, but I still cannot perform daily tasks" |
| "I've had this forever" | "This started 18 months ago after my surgery and has gradually worsened over the past 6 months" |

### When You Feel Dismissed

If your pain is not being taken seriously:

1. **Document everything** - Bring your pain journal and tracking data
2. **Be specific about function** - "I can no longer do X, Y, Z that I could do before"
3. **Request it in your record** - "Please document that I reported this pain and your assessment"
4. **Ask for a plan** - "What is our plan if this treatment does not provide relief?"
5. **Request a referral** - "I would like a referral to a pain specialist for a comprehensive evaluation"
6. **Seek a second opinion** - You always have this right
7. **Bring an advocate** - A support person can reinforce your concerns
8. **File a complaint** - If you experience consistent dismissal or disrespect

### Building Your Pain Management Team

| Provider | Role | When to Involve |
|----------|------|----------------|
| Primary care physician | Overall coordination, initial treatment | Always - your home base |
| Pain management specialist | Advanced pain evaluation and treatment | When primary care treatments are insufficient |
| Physical therapist | Movement, strengthening, functional improvement | Early and ongoing |
| Psychologist/therapist | Coping strategies, CBT/ACT, emotional support | When pain affects mood and function |
| Psychiatrist | Medication for pain-related depression or anxiety | When mental health medications are needed |
| Occupational therapist | Adapting daily tasks, ergonomics | When pain limits daily activities |
| Rheumatologist | Autoimmune and inflammatory conditions | For suspected autoimmune causes |
| Neurologist | Nerve-related pain, headaches | For neuropathic pain or migraines |

## Quality of Life Strategies

### Pacing: The Foundation Skill

Pacing means balancing activity and rest to avoid the "boom and bust" cycle:

**The Boom-Bust Cycle (What to Avoid)**
1. Feel decent → Do too much
2. Pain flares severely
3. Rest for days to recover
4. Feel decent again → Repeat

**The Pacing Approach (What to Build)**
1. Identify your sustainable activity level (your baseline)
2. Do that amount consistently, even on good days
3. Build gradually (5-10% increase per week)
4. Take planned breaks before pain forces you to stop
5. Accept that good days do not mean unlimited capacity

### Activity Scheduling Template

| Time | Activity | Duration | Rest Break | Pain Check |
|------|----------|----------|-----------|-----------|
| Morning | | | | |
| Mid-morning | | | | |
| Lunch | | | | |
| Afternoon | | | | |
| Late afternoon | | | | |
| Evening | | | | |

### Sleep Optimization for Chronic Pain

- Maintain a consistent sleep and wake schedule
- Create a cool, dark, quiet sleeping environment
- Develop a wind-down routine starting 60 minutes before bed
- Discuss sleep aids with your doctor if pain disrupts sleep
- Experiment with pillow placement to support painful areas
- Limit caffeine after noon and avoid alcohol near bedtime
- Consider a body pillow for joint support and alignment
- Address sleep apnea or restless legs if present

### Managing Pain Flares

**When a Flare Hits:**
1. Acknowledge it without catastrophizing ("This is a flare. It will pass.")
2. Implement your flare management plan (medication, ice/heat, rest)
3. Reduce activity to your baseline or below temporarily
4. Use relaxation techniques (breathing, mindfulness)
5. Communicate your needs to family or coworkers
6. Contact your provider if the flare is unusually severe or does not follow the typical pattern
7. Resume normal activity gradually as the flare subsides

**Flare Action Plan Template**

| Severity | Actions | When to Contact Provider |
|----------|---------|------------------------|
| Mild increase | Continue activities with extra breaks, use OTC options | If persists beyond 3 days |
| Moderate flare | Reduce activity, apply heat/cold, take prescribed meds | If not improving in 5-7 days |
| Severe flare | Rest, full medication protocol, cancel non-essential commitments | If beyond prior experience or new symptoms appear |

### Social and Emotional Wellbeing

- Maintain social connections even when pain makes it difficult
- Educate close friends and family about chronic pain
- Set boundaries without guilt ("I need to leave early today")
- Find a support group (in-person or online) of others who understand
- Pursue activities that bring joy and meaning within your capacity
- Address grief for activities or abilities changed by pain
- Consider therapy to process the emotional impact of chronic pain
- Celebrate small wins and functional improvements


## Process

1. **Gather information.** Ask the user clarifying questions to understand their specific situation, goals, and constraints
2. **Analyze context.** Review the information provided and identify key factors relevant to chronic pain manager
3. **Develop recommendations.** Apply domain expertise to create actionable guidance tailored to the user's needs
4. **Present structured output.** Deliver findings in the output format below with clear next steps
5. **Address follow-ups.** Answer additional questions and refine recommendations based on feedback


## Output Format

```template
## Chronic Pain Manager Analysis

### Assessment
[Key findings and observations]

### Recommendations
1. [Primary recommendation]
2. [Secondary recommendation]
3. [Additional suggestions]

### Action Items
- [ ] [First action step]
- [ ] [Second action step]
- [ ] [Follow-up task]
```


## Edge Cases

- **Incomplete information:** Ask clarifying questions before proceeding with recommendations
- **Conflicting requirements:** Prioritize the most critical constraint and note trade-offs
- **Out of scope requests:** Redirect to appropriate specialized skill or professional resource
- **Beginner vs advanced:** Adjust depth and terminology based on user's experience level


## Example

**Input:** "Help me with chronic pain manager for my current situation"

**Output:**

Based on your situation, here is a structured approach to chronic pain manager:

1. **Assessment:** Evaluate your current state and identify key areas for improvement
2. **Strategy:** Develop a targeted plan based on best practices
3. **Implementation:** Execute the plan with specific, measurable steps
4. **Review:** Monitor progress and adjust as needed
