Chronic pain management is growing more and more important. Many Americans have to deal with pain every day. According to the Institute of Medicine: 1
From the same study, it was reported that in 2012, the severity of Americans pain was:
There are certain risk factors for people who experience chronic pain. Adults who report chronic pain are more likely to be:2
Aged 60 to 69
In fair or poor health
Overweight or obese
Hospitalized one or more times in the prior year
The brain processes the pain information that is sent by the body. First, a signal is sent out by tissues to the nerve endings. Then, the information is transmitted via the nervous system to the part of the brain that regulates perception. The nervous system also acts to reduce transmission activity. The brain then perceives the pain in its unique (subjective) way.4
Researchers use the nature of pain and its processes to develop methods that can help manage pain.
A comprehensive approach to pain management can be the best option for recovery from chronic pain. Pain medications, mental therapy, as well as physical therapy and relaxation techniques can all help pain sufferers manage chronic pain.
Chronic pain is typically treated with medications. For mild to moderate chronic pain, the initial drug used is a non-opioid pain reliever such as aspirin or ibuprofen. If this does not give the desired relief or if the pain sufferer cannot sleep, an antidepressant with pain-relieving qualities may be added.
If there is nerve pain or pain from fibromyalgia involved, then a trial with one of the gabapentinoids, such as gabapentin and pregabalin, may be introduced. Gabapentinoids were originally used to prevent seizures. Since gabapentinoids have pain-relieving as well as anticonvulsant properties, they are typically used to treat nerve pain with limited side effects. Muscle relaxants and topical ointments may also be prescribed if appropriate.
If these medications are not adequate, then opioid painkillers may be prescribed. For people with moderate to severe pain, long-term opioids may be needed.
Prescription opioid pain medications can be quite effective at relieving pain. Unfortunately, they are also highly addictive and responsible for the epidemic of opiate/opioid addiction, overdose, and death in our nation.
The damage from opioids in the United States happens even when the drug is taken as prescribed. People believe since their doctor gave them opioids, they are safe. In fact, in 2011, opioids were responsible for: 5
of deaths when given prescriptions based on prescribing guidelines
of deaths involved taking low doses of opioids
of deaths involved opioid abuse, doctor shopping, and obtaining opioids on the street
As a result, many people are turning away from opioid painkillers and seeking other forms of chronic pain management.
The key to safely taking pain medication is to talk with your prescribing doctor about the best ways to do so. The general principles for the safe, effective use of opioids for chronic pain management include:
First, try non-opioid pain relievers. Then, follow these steps:
Get a full rundown from your doctor about the risks of taking opioids (including addiction)
Get a schedule from your doctor that states how often you will be able to obtain medications and refills. Understand that you may not get early replacements for any lost or stolen prescriptions.
Provide safe storage for your medications.
Do not share your opioids with anyone.
Make sure you use one source for your prescriptions.
You can request monitoring of your opioid intake through urine tests on a regular schedule.
Keep a log of the severity of pain and impairments you may experience to discuss with your doctor during follow-up visits.
Don’t take a higher dose of opioids without first talking with your doctor.
Ask your doctor if rotating different types of opioids to avoid building (or if you suspect you have) a tolerance to any one opioid.
People with chronic pain can help manage their pain by going to physical therapy (PT). Individuals who have chronic pain that limits their mobility or restricts their participation in everyday activities benefit most from physical therapy. Those who suffer from neck pain, osteoarthritis, back pain, and sports injuries can benefit from PT. Physical therapy can also help manage chronic pain from joint replacement surgery.
Different types of physical therapy include:
The goal of physical therapy regarding pain management is to reduce or eliminate chronic pain. Therapeutic exercises, such as joint and soft tissue mobilization, can help. Manual therapy techniques, such as ultrasound or electrical stimulation, can also help relieve chronic pain. Physical therapy also reduces pain by restoring muscle and joint function. PT can also prevent pain from returning.
The following different types of physical therapies have been proven to reduce chronic pain for many people. Unfortunately, they may also cause pain during the physical therapy sessions. This can cause clients to comply less and have less confidence in their programs.
The three most common pain producers in physical therapy are:
An overworked muscle is a common cause of pain during physical therapy. While working out with the therapist, there is no pain. Once home, you may feel worse than before. Apply ice to sore muscles and rest. Let your therapist know the issues you’re having. Sore muscles may mean you did too much too soon and may have to scale back.
Physical therapy works on your body positions and balance. These types of exercises can irritate the nerves. Work with your therapist to find the position that gives you the most relief from your symptoms. If you feel nerve irritation, put yourself in that position and stay there to allow nerve pressure to decrease. Apply ice to lessen inflammation.
If you are going to therapy to improve your mobility, it’s important to work your joints. This can cause more pain. Find a comfortable position for relief. Ice the area if needed.
The goal of therapy is not to cause more pain. Rather it is to help you manage your pain more effectively. Report all your symptoms to your therapist. This way, your therapist can change your program to make it more comfortable and successful.
Pain is the brain’s perception of a stimulus in the body. This means that we feel pain based on the stimulus and our perception of it. That’s why people who experience the same pain (e.g., a controlled electric shock) report different perceptions of how much pain it is causing.
With this in mind, it is safe to say that the brain plays a large part in how we perceive pain and how it affects us. Mental therapy is help that focuses on the brain, as opposed to physical therapy that focuses on the body.
Depression is a very common condition seen in people who have chronic pain. For people who have both, they need to have their depression and chronic pain treated at the same time. If not, each condition can make the other worse. Cognitive behavioral therapy (CBT) has been shown to help with depression in people suffering from pain.6
CBT for pain helps a pain sufferer in the following ways:
Develop coping skills for managing pain
Learn structured relaxation training where ways to decrease stress and muscle tension are practiced
Behavioral activation where the person schedules pleasurable activity goals and works to meet those goals
Assertive communication where the person believes and affirms that he or she has chronic pain and acknowledges its impacts
Pacing of behavior where the person slows down, moves more slowly, and breaks up activities into smaller steps to avoid prolonged or worsening pain flare-ups
Specifically, CBT addresses thoughts and beliefs and how they impact responses and behaviors in situations regarding chronic pain. For example, a person may feel hand pain when stretching out the hand upon awakening. The person may feel discouraged and frustrated. The individual then thinks, “if I try to use this hand today, I’m just going to hurt more.” This can lead to staying home and avoiding moving for the rest of the day.
CBT helps chronic pain sufferers change their thoughts and behaviors regarding chronic pain. CBT does this by helping individuals develop coping skills. CBT also helps chronic pain sufferers develop a stronger sense of their abilities to tackle tasks and reach goals.
CBT helps participants gain a sense of control over their chronic pain condition. CBT also helps them gain a sense of control over the effects that pain has had on their lives. Behavioral experiences help show clients they may be physically capable of more than they thought. When they do more, they then have rewarding experiences.
Negative thought patterns are also addressed in CBT. Chronic pain sufferers learn how to see their pain experiences in a more balanced manner, which helps improve their moods.7 Taken together, these CBT techniques seek to improve the reactions of pain sufferers to the experience of pain, which minimizes the negative impacts on their lives. While decreasing pain intensity is ideal, the focus is on how to reduce pain-related suffering.
CBT is widely used in the management of chronic pain. CBT is currently regarded as the gold standard mental health treatment for pain.
CBT is considered the gold standard in treating pain because of the strong relationship between the mind and body in therapy. The body’s physical health is connected to its mental health. They can’t be separated, and one affects the other. Research shows that people attending mental health therapy, such as CBT can change their brain structures.8
It’s well-known that too much stress can affect physical health. Uncontrolled anger can lead to heart problems. Studies show that people who cannot control their anger are ten times more at risk for heart problems.
Other studies show that sleep problems may not be a symptom of a mental health problem, but rather is the cause of the mental health issue for some people. Research has shown that lack of sleep can affect mental wellbeing.
The mind and body connection is a strong one. Physical fitness means having mental fitness also.
You can use this mind and body connection to improve your physical and mental health fitness by:
Learning healhty ways to deal with your negative meotions (stress, anger, fear, aggravation)
Learning how to reinforce positive emotions and behaviors
Different ways of doing this include:
Communicating with others. Don’t bottle up feelings and let them fester until you explode
Getting a good night’s rest each and every night
Learning positive ways to relieve stress
Tracking potentially dysfunctional behaviors to nip them in the bud, such as habits that can turn into something more
Some of the relaxation techniques that can help chronic pain sufferers include:
Tense muscles are common responses to worry and pain. Tension causes muscles to feel pain more intensely compared to relaxed muscles. Releasing muscle tension can help and is easy to do. A series of quiet, gentle exercises where you tense and then relax different muscle groups in sequence can help. Begin with the muscles in the head and work your way all the way down to the feet.
Meditation is a mind-body method where you go into a state of deep reflective thought to bring about mental and physical peace. Meditation can reduce anxiety, lower blood pressure, and slow down the metabolism. Meditation can also increase your body’s threshold for pain. While in meditation, the mind and body are distracted and detached from pain. Yoga, chanting, or prayer can help put you in a meditative state.
Hypnosis can help draw away your attention from pain. It can also change your perception of pain. Hypnosis also can help you numb areas of the body where you are experiencing pain.
Biofeedback involves a machine that gives you feedback on how successful you are at changing your body’s functions. You make these changes using imagined images that are peaceful and beautiful. With practice, you can change your heart rate, relax muscles, and distract yourself from Chronic pain.
If you or a loved one is experiencing chronic pain, consult with your doctor or a pain clinic for help. A pain expert can help you design a strategy that combines safe medications, physical therapy, mental therapy, and relaxation techniques for controlling your pain most effectively.
Chronic pain management is an ongoing journey. Managing your chronic pain may seem daunting at times, but don’t give up. Chronic pain sufferers who actively take charge of controlling and managing their pain do better than those who do not.