Strategies for when the pain just doesn’t go away

BY CHERRI STRAUS

We’ve all experienced physical pain—we’ve bumped into tables and it hurt for a while, then the pain went away. But what if the pain never went away? The American Chronic Pain Association (ACPA) describes pain as a normal sensation that serves as a warning system, alerting us to injury or disease. When the injury heals, the pain usually subsides. However, if pain does not subside and continues for long periods of time—several months or longer, and sometimes without any known cause—it is called chronic pain.

Chronic pain affects people of all ages, races, and occupations. To the ACPA, an estimated 86 million Americans suffer from this condition and is the most frequent cause of adult disabilities. The majority of people who suffer from chronic pain are adults between the ages of 24 and 64. Women tend to have more long-lasting and severe pain than men and are more likely to report pain to their doctors.

What Causes Chronic Pain?

Chronic pain is a persistent pain triggered by signals within the brain for weeks, months, even years. It continues beyond the expected time for healing and interferes with everyday activities. The pain may originate from an initial trauma such as a back injury or serious infection. It can also be caused by ongoing conditions such as arthritis, migraine headaches, or cancer. However, some people have chronic pain without the presence of a long-lasting health problem or any evidence of an injury. The most common types of chronic pain are: Headaches, Low back pain, Cancer pain, Arthritis pain, Peripheral nerve damage, Damage to the central nervous system.

Treatment and Management Options

At this time there is no known cure for chronic pain. Treatment options are numerous and varied, and often the nature of the condition can make treatment and management challenging. Identifying the source of the pain is sometimes difficult to do. Prescribing an effective pain-management plan often involves diagnostic testing and trying different treatment options. You and your doctor can consider different therapies and develop a treatment plan that works best for you. Some of the most commonly used treatments are:

Medications: Medication options for pain relief include over-the-counter (OTC) pain relievers such as aspirin, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium. Narcotic pain relievers called opioids, administered through a transdermal (skin) patch, may be prescribed for severe pain that cannot be managed by OTCs or NSAIDs.

Although medication is often found to be an effective treatment, all drugs can pose disadvantages. OTC drugs are rarely effective in relieving chronic pain. Continual use of anti-inflammatory drugs may cause bleeding, ulcers, and other negative health conditions. Long-term use of opioids can result in dependency. You and your doctor can discuss medications that will be safest for you while providing the best possible benefits.

Exercise and Physical Therapy: Exercise and physical therapy can be helpful in alleviating the debilitating effects of chronic pain. Prolonged inactivity results in weakness, loss of muscle mass, and strength. Regular exercise and physical therapy are essential in maintaining or regaining strength. Exercise is believed to increase the body’s levels of endorphins—natural painkillers produced in the brain—which can help relieve pain. Regular exercise can also help to relieve stress and result in a more positive attitude. For those with physical limitations, an exercise program doesn’t have to be strenuous—yoga and tai chi can provide wonderful benefits. Work with your doctor to develop an exercise plan that will be most helpful for you.

Physical therapy may be an option for people whose level of pain prevents them from engaging in regular exercise. Physical therapy can involve massage, spinal manipulation, and applications of heat and cold. Physical therapists may also focus on posture and the way in which a person walks as a means of helping to relieve pain.

Injection Therapies: Injection therapy is a pain management technique involving nerve blocks—injections of an anesthetic around a nerve—that prevents pain messages traveling along that nerve pathway from reaching the brain. Some types of nerve blocks involve injections of specific medications, steroids, or anesthetics directly into the pain sites, or into the spine. Injection therapies may not be appropriate or effective for all types of chronic pain.

An experimental injection therapy called prolotherapy (also called sclerotherapy) involves injecting painful ligaments and tendons with sugar solutions that are intended to stimulate production of connective tissue. The theory is that prolotherapy may strengthen these ligaments and tendons, and reduce pain. So far, studies have shown that prolotherapy alone was ineffective in treating chronic low back pain. However, more research is needed to determine if prolotherapy may help improve chronic low back pain when combined with other treatments such as spinal manipulation and exercise.

Complementary and Alternative Medicine (CAM) Therapies: Transcutaneous Electrical Nerve Stimulation (TENS) is the process of sending electrical impulses to certain parts of the body in order to block pain signals. By placing two electrodes at the location of the pain, a mild electrical current is produced to prevent pain messages from being sent to the brain. The relief from this procedure can last several hours. TENS should only used under supervision of a doctor or physical therapist.

Acupuncture is practiced by thousands of health practitioners for relief of pain throughout the world. Chinese medicine maintains that acupuncture points on the human body connect with “meridians” or channels. Pain and disease are the result of these channels becoming blocked. By placing needles at one end of the channel or the other, healthy energy can be restored. Western medicine’s view is that the placement of acupuncture needles at specific pain points releases endorphins and other natural painkillers.

Yoga is believed to reduce pain by helping the brain's pain center regulate pain triggers and the secretion of natural painkillers in the body. Yoga’s breathing exercises can also reduce pain. Lengthening the time of exhalation can help produce relaxation and reduce tension because muscles tend to relax when you exhale. Awareness of breathing helps to achieve calmer, slower respiration and can aid in relaxation and pain management.

Remember, when it comes to CAM therapies, a safe therapy does no harm when used under defined conditions and as intended. An effective therapy is one that has measurable benefits. Ask your doctor about the safety and effectiveness of the CAM therapy you are interested in.

Dealing With the Emotional Effects of Chronic Pain: According to the National Pain Foundation, chronic pain may often be accompanied by loss of function, employment, money, or relationships. A person who suffers from chronic pain may develop depression, anxiety, stress, and sleep disturbances. Emotions can range from fear, anger, denial, disappointment, guilt, and loneliness to hope and optimism. Every person reacts differently to pain at different times, which can make relationships with others difficult.

Taking care of the emotional aspects of chronic pain is necessary to treat your overall pain condition. Talk to your doctor or a mental health professional about difficulties you may have in coping with stress, or social or emotional problems as a result of your condition. In addition to mental health therapy, the National Institutes of Health lists additional coping strategies for stress and pain management:

Relaxation training involves concentration and slow, deep breathing to release tension from muscles and relieve pain.

Yoga and meditation.

Biofeedback involves the use of special machines to help you learn to control bodily functions, such as heart rate and muscle tension. Biofeedback can be used to reinforce relaxation training.

Visual imagery involves concentrating on mental pictures of pleasant scenes or events, or mentally repeating positive words or phrases to reduce pain. Distraction techniques focus your attention away from negative or painful images to positive mental thoughts.

Hypnosis can be used to reduce the perception of pain. A therapist gives post-hypnotic suggestions that reduce the pain you feel. You can learn self-hypnosis to be able to hypnotize yourself when pain interrupts your ability to function. Self-hypnosis is another form of relaxation training.

Resources

The National Institutes of Health, National Institute of Neurological Disorders and Stroke - www.ninds.nih.gov

The American Chronic Pain Association - www.theacpa.org

The American Pain Society - www.ampainsoc.org

The National Pain Foundation - www.painconnection.org

U.S. Food and Drug Administration - www.fda.gov