People who suffer most from chronic pain are those who hand the problem over to their doctor and settle for the painkiller-and-rest approach. Those who suffer least are those who exercise regularly, make an effort to change their outlook, and learn to put their pain in perspective.

Most health professionals today recognize that chronic pain functions as, and should be treated as, a separate condition, apart from the illness or injury that may have initially caused it. And pain management is a growing medical specialty, with a multidisciplinary treatment approach that may include acupuncture, yoga, teaching relaxation techniques, and changing diet.

To find a pain management doctor or clinic, go to the American Academy of Pain Medicine’s website: www.painmed.org. For more information on living with and managing chronic pain, go to www.theacpa.org, the website for the American Chronic Pain Association, or contact me.

FAIL-PROOF RESOLUTIONS (January 2007)

It’s that time of year again – everyone’s busy making promises to change or improve ourselves, yet most of us won’t succeed. I’ve studied human behavior for many years, and have observed three main reasons why most people don’t manage to keep their New Year’s resolutions (besides not being able to remember what they are by the next morning):

Never committed to it in the first place. You only made the resolution because you thought you "should" do it, or out of habit, or to please someone else.

Don't understand the difference between "trying" and "doing". To illustrate this point, is there a pen or pencil laying on the desk or table nearby? See what happens when you "try" to pick it up, without actually doing it: doesn't work, does it? "Trying" to lose weight is just as ineffective.

Lose momentum. This is the most common reasons resolutions fail – you start out committed, and manage to get moving toward your goal, but then after a few weeks, when the goal seems even farther away, or much harder then you realized, you give up. Or you get distracted by other more pressing demands, and find you have no time or energy left to focus on it.

What's the solution to this perennial dilemma? It's simple, really, though it won't be easy. First, start by tossing out any resolutions that are "shoulds", anything you can't fully commit to at this time. Next, pick one and "just do it", like in the commercial. Instead of "I'll try", say "I will," and start taking action today. Finally, expect a loss of momentum, and plan accordingly.

Here are seven more tips for making your 2007 resolutions foolproof, and fail-proof:

1. Keep it simple. Start with just one resolution, instead of 10 or 12. If you manage to achieve it before the year is over, you can always make another one.
2. Choose the one which will have the greatest impact on your life (e.g. “Stop smoking” is probably a more important goal than “lose 10 pounds”).
3. Be realistic. Weight loss goals of more than one pound per week are unrealistic, and not healthy, for most people. Nicotine is a highly addictive substance – you may need the help of a patch and/or a drug like Zyban to overcome your dependency.
4. Seek out support. Join a support group for compulsive spenders, or form a group of lunchtime walkers at your office (just make sure the other members of the group are also committed to their own goal, and not doing it just to please you).
5. Reward progress. Break down your goal into smaller steps, and build in small rewards for reaching each step. Make your rewards healthy ones (like a massage) and consistent with your resolution (no spending sprees if your goal is to become debt-free).
6. Use the power of your mind. Write down your goal, post it where you’ll see it every day, and say it out loud. Put it in positive terms (“I will become a non-smoker”), and use positive self-talk to coach yourself along (“I can do this”, “I’m up for the challenge”).
7. Expect setbacks. Relapse is part of the recovery process; habits are hard to change. Don’t allow yourself to get discouraged or give up, but rather use a setback to remind yourself what a difficult thing it is you’re doing, and redouble your effort.

If you need more help to stick with your New Year’s resolutions, read my article on “Overcoming Procrastination”

BUILDING SELF-ESTEEM (August 2006)

Beginning with Nathaniel Branden’s “The Psychology of Self-Esteem”in 1969, the idea that self-esteem is essential for happiness and success in life has grown to be commonly accepted. Intuitively, it makes sense: people who feel good about themselves will be happier and more likely to succeed—in school, at work, and in their relationships. It also seems reasonable that people with a low opinion of themselves are more likely to fail and/or lead unhappy lives. So if self-esteem is such a valuable commodity, you may ask, where does it come from and how can I get some (or more)? And is it true that high self-esteem leads to success and happiness?

What exactly is self-esteem? The definitions are various and often vague. I view it as a combination of self-confidence (trusting your own intuition and judgement) and self-respect (believing that you are a worthwhile human being, worthy of love and respect from others).

Where does it come from? Most psychologists believe that we aren’t born with self-esteem, but must develop it. Our sense of self begins to develop in infancy, and is largely influenced by our relationship with parents or other primary caregivers. Ideally, we grow up believing we are lovable, worthy beings whose basic needs for sustenance and comfort can and will be met, which engenders self-respect. Also ideally, as children we are given opportunities to think for ourselves, make mistakes and learn from them, as well as receive acknowledgement for our accomplishments, which instills self-confidence.

Of course, many children simply don’t get that kind of unconditional love and support, or don’t learn those lessons. As a psychotherapist, I often work with adults who lack basic self-respect and confidence, and one of the tasks of therapy is to build their self-esteem.

How does one build self-esteem? The short answer is, by learning how to give yourself the acceptance and encouragement, the nurturing and support, which you may have lacked as a child – some people call it “re-parenting your inner child”. Of course, this can be challenging, and take a long time. Getting support and encouragement from others really helps, too.

TIPS FOR A GOOD NIGHT’S SLEEP (April 2004)

This is the month when we set our clocks forward, and lose an hour of sleep. So it’s a good time to review the important role that sleep plays in maintaining health and well-being, and to offer some tips to help you get enough of it.

Unlike computers, people don’t just cease functioning when they go into “sleep” mode – in fact, certain parts of the body actually become more active. The sleeping brain is busy processing, organizing, and storing in memory all of the information we accumulate during the day. Hormones that are used to repair skin cells and build muscle and bone cells circulate throughout the body. And the immune system becomes more active during sleep, producing more disease-fighting cells. So yes, “sleeping on it” really does help us to solve problems, and it turns out Mom was right about needing her “beauty sleep”, and about making sure we got extra sleep if we were coming down with a cold.

How much sleep do we need? According to the Stanford Sleep Disorders Clinic, the average adult needs 7-8 hours each night. Yet few adults regularly get that much, with sometimes serious consequences: a national survey of 1,000 adults found that nearly 40% suffered from insomnia, and 25% had fallen asleep while driving!

1. Establish a regular sleep routine: try to retire at the same time, and awaken at the same time, every day, even on your days off. Begin “winding down” at least an hour before you plan to go to sleep.
2. Create a restful sleep environment: the room should be dark, quiet, and comfortably cool; the bed should have a supportive mattress and pillow(s); and don’t take work materials to bed.
3. Be realistic about how much sleep you need. Remember, most adults need at least 7 hours a night.
4. Avoid stimulants 3-4 hours before bedtime. These include coffee, black or green tea, cola, chocolate, “energy” bars, spicy food, and some cold/allergy medicines.
5. Avoid consuming alcohol 3-4 hours before bedtime: it leads to interrupted sleep.
6. Light exercise in the evening (a brief walk, yoga, stretching) can help release accumulated tension in the body; however, aerobic or intense exercise is not recommended 3-4 hours before bedtime.
7. Aids to restful sleep: try drinking herbal tea (valerian, chamomile); eating a light snack of tryptophan-containing foods (milk, bananas, turkey). Also, a warm bath, dim lights, soft music, gentle massage, deep breathing, prayer, and/or meditation can all help to calm and soothe you before bedtime.
8. Inhibitors to restful sleep: arguing with your partner or children, worrying about finances or meeting deadlines, and/or watching the news on TV. Avoid bright lighting (overhead, or from computer screen).
9. Avoid routine use of sleep medications; however, if you are seriously sleep-deprived, taking a non-narcotic sleep medication prescribed by your doctor for a few nights may help you get back on track.
10. If you still can’t sleep, don’t toss and turn for hours. Get out of bed, but keep the lights dim, and try one of the aids to restful sleep (#7) in another room. When you begin to feel sleepy, go back to bed, plump up the pillows, and try again.

For more information about sleep and sleep disorders, check out:

• www.sleepnet.com
• www.sleepfoundation.org

For evaluation and treatment of sleep apnea or other sleep disorders, call:

• The Stanford Sleep Disorders Clinic (650) 723-6601
• The Sleep Clinic at UCSF (415) 750-6336

Deep Breathing Exercise:

1. Sit comfortably, with your feet flat on the floor and your back supported. Place one hand on your abdomen and the other on your chest.
2. Inhale, slowly and deeply through your nose, drawing air down into your abdomen first and then allowing it to fill your chest. (You should notice the hand on your abdomen rising first, then the one on your chest.)
3. Exhale very slowly through your mouth, making a soft whooshing sound like the wind as you blow gently out.
4. Take several long, slow, deep breaths that raise and lower your abdomen. Focus on the sound and feeling of your breath as you become more and more relaxed.
5. Try holding your breath for a few seconds at the end of each inhalation; focus on emptying your lungs completely with each exhalation.
6. Continue breathing this way for several minutes.

Stretching Exercises:

• Shoulder shrug: Draw a big circle with your shoulders by slowly rolling them up toward your ears, then forward, down, and back. Repeat a few times, then reverse the direction of the roll and repeat. Squeeze the shoulder blades together, hold, and release.
• Half circle neck roll: With your back straight and shoulders relaxed, pull your chin down toward your chest, then turn to the right as if you’re looking at something sitting on your shoulder. Keeping your chin tucked, turn back to the center, and then toward your left shoulder. Repeat several times.
• Shoulder and arm stretch: Reach your hands up over your head, and stretch toward the ceiling. Alternate reaching with your right arm, then your left. Then put your hands together, inter-lacing the fingers, and reach up again. Hold for 30 seconds, then relax. Repeat several times.

Clearing Your Mind Exercise:

1. Sit comfortably (feet on the floor, back supported) in a quiet environment.
2. Select a simple or favorite object to focus on (e.g. a vase of flowers, a candle, a smooth stone, a leaf).
3. Look at the object carefully. Gaze rather than stare at the object for a minute, keeping your eyes soft and relaxed. Breathe deeply.
4. Close your eyes (don’t do this exercise while driving!) and picture the object in your mind. Imagine you are turning over the object in your mind, gazing at it from every angle.
5. Keep your mind’s eye on your object. If other thoughts enter your mind, gently push them away and return your focus to the object.
6. Remember to keep breathing deeply during this exercise.

Another way to use the Clearing Your Mind exercise is to focus on a word that you find relaxing or soothing, e.g. “Home”, “Warm” or "Calm”.

Progressive Relaxation Exercise:

1. Sit comfortably (feet on the floor, back supported) or lie down in a quiet location.
2. Close your eyes and take a few deep breaths. Imagine tension flowing out of your body with each breath.
3. Now contract the muscles of your feet as you inhale. Hold the contraction briefly, then relax as you slowly breathe out. Imagine the tension flowing out with the breath.
4. Move up your body, contracting in turn the muscles of the lower legs, upper legs, and so on through all of the muscle groups. End with your face, including the muscles of your mouth, jaw, eyes and scalp.
5. If a muscle seems particularly tense, repeat the contraction and release.
6. When you have finished going through the body, allow yourself to sit or lie still for a few minutes and just experience your relaxed muscles. Continue breathing slowly and deeply.
7. When you are ready, count backward from four to one. You may feel a bit groggy at first, but in a few minutes you will feel awake and refreshed.

Done regularly, this exercise not only relaxes you, it also trains your body to recognize and reduce muscle tension. You can do a mini-progressive relaxation on the muscles you use in your work,such as the neck, shoulders and lower back if you sit all day, or feet and ankles if you’re on your feet a lot.