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F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 63 ACCEPT It almost seems counterintuitive to think that accepting the condition of chronic pain can be healthy—until we understand what experts mean by "acceptance." "Acceptance of chronic pain entails that an individual reduce unsuccessful attempts to avoid or control pain and focus instead on participation in valued activities and the pursuit of personally relevant goals," writes researcher Lance M. McCracken. 5 There is evidence to support the theory of acceptance. In one study that compared coping (behavior in response to pain and/or behavior that reduces pain) versus accepting chronic pain, the authors concluded "… acceptance of chronic pain was associated with less pain, disability, depression and pain-related anxiety, higher daily uptime, and better work status." 6 Or, more simply stated: quit chasing a cure and get back to living. Simon-Jones's story seems like a textbook case of pain acceptance theory. He stopped unsuccessful attempts to control pain, but didn't avoid situations that may cause more pain. And he focused on what gave him pleasure—climbing. How does a chronic back-pain sufferer get back into climbing? First, he accepted that he couldn't climb the way he used to climb. For example, overhangs now tweaked his back, so he avoided them. He also learned that an easy climb served as a good warm-up for a more challenging one. Through trial and error and some modifi cations, Simon-Jones fi gured out how to do what he loved doing. Determining if a client is nonaccepting can be diffi cult and out of your scope of practice. If you suspect a client is having trouble with acceptance, refer him to a counselor. Lastly, the therapist herself may also struggle with accepting that a client's pain condition isn't curable. Why? Because to the therapist, it may feel like she has failed. But the reality is no one has cured chronic pain. We need to do what is best for our clients, not our egos. That is not to say massage can't be a valuable tool in helping a client manage chronic pain once the client has accepted his pain is chronic. APPLYING THESE LESSONS TO YOUR PRACTICE First, reduce treatment-related stress during intake by providing open- ended questions so the client can tell his story. Next, work to "help" a client feel better, rather than promising to "fi x" a chronic-pain issue. Remember, a good support system and a well-explained treatment plan with realistic expectations can reduce castrophizing. Also, empower the client in the session by providing a means for him to control tactile pressure and provide a therapeutic exit strategy if the treatment isn't helping. Lesson Finally, accepting chronic pain does not necessarily mean the client is giving up. It can actually mean the client is moving on and is creating the best life possible. We cannot cure chronic pain, but by applying Simon-Jones's lessons we can help our clients work toward better pain- management outcomes. Notes 1. Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research," accessed March 2015, www.iom.edu/Reports/2011/Relieving-Pain-in- America-A-Blueprint-for-Transforming-Prevention- Care-Education-Research/Report-Brief.aspx. 2. M. S. Shutty, Jr., D. E. DeGood, and D. H. Tuttle, "Chronic Pain Patients' Beliefs about Their Pain and Treatment Outcomes," Archives of Physical Medicine and Rehabilitation 71, no. 2 (1990): 128–32. 3. I. E. Lamé et al., "Quality of Life in Chronic Pain is More Associated with Beliefs about Pain, than with Pain Intensity," European Journal of Pain 9, no. 1 (February 2005): 15–24. 4. Author interview with David Morris, January 12, 2006. 5. L. M. McCracken, K. E. Vowles, and C. Eccleston, "Acceptance of Chronic Pain: Component Analysis and a Revised Assessment Method," Pain 107, no. 1–2 (January 2004): 159–66. 6. L. M. McCracken and C. Eccleston, "Coping or Acceptance: What to Do About Chronic Pain?" Pain 105, no. 1–2 (September 2003): 197–204. Mark Liskey is a massage therapist specializing in neuromuscular massage. He is a CE provider and co-owner of PressurePerfect (www.pressureperfectmassage.com), a massage company that practices the tenets of conscious capitalism. He can be reached at mark@markliskey.com. Lesson 4