I use this graphic to explain to clients that nothing happens in isolation. And of course when it comes to pain, the philosophy is doubly appropriate. I use various names for this graphic including wheel of death, wheel of pain, pain wheel, and pain cycle. I like the wheel analogy because I explain to patients that discomfort and pain can lessen the more air (energy) is put into the tire.
Starting at 6:00 on the wheel, medicine is what patients hope will cure their pain. I ask my clients to explain what they know about their particular medicine. Usually, it isn’t much more than the number of pills and frequency. I challenge them to learn how to take the medicine…with food, without food, with a meal, with water, etc. We know that medicine is more effective IF taken properly. Also, I encourage my clients to talk with their PCP or pharmacist about their entire medicinal regimen and make sure they thoroughly understand interactions, proper dosage, and again, how/when to take for maximum effectiveness.
I start with medicine because most clients focus on it ahead of everything else. By turning the tables and getting them to focus on what the medicine is supposed to do and how, I can then use this discussion to move around the rest of the wheel.
At 5:00, nutrition and its opposing hydration at 10:00, tie in nicely to the medicine discussion. Particularly with pain medication, if my clients are dehydrated or not eating enough real food and fiber, elimination and energy (2:00) become a problem. When these become problems, then the medicine is not as effective. Clients start to get it and see these connections leading to success and interest in other parts of the wheel.
Next, I tie sleep (8:00) and activity (12:00) together. Often clients come to me with low activity levels and sleep problems. I explain that if their bodies are not expending some energy during the day, restful sleep will be a problem and if they aren’t resting they won’t have the energy to do any activity. We start with functional activity and movement and build time and reps every 5-7 days.
With the exception of medicine (I want my clients to learn this completely and quickly), I ask that my clients start small, but make changes to all parts of this wheel or cycle. I work with them to identify small changes that can be added, subtracted, or tweaked for each of the Pain Wheel spokes and get the wheel turning. In a short time, momentum starts to keep the wheel turning, and then gains help keep it turning faster and faster while at the same time minimizing pain/discomfort.
