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Managing Chronic Pain – “Pain is a more terrible lord of mankind than even death itself.”- Albert Schweitzwer

Pain is invariable at one point or the other in our lives.  It warns us that something is amiss, preventing us from further harm, telling us that we should take medicine or see a doctor or avoid what may be the problem.

What is pain?

The International Association for the Study of Pain describes it as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

There are two basic types of pain, acute and chronic.

  • Acute pain, usually, results from damage to tissues, disease, and inflammation. It is typically sudden onset for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated within given period of time.  In some rare instances, it can become chronic.
  • Chronic pain is widely believed to represent disease itself. It is pain that persists for more than 6 weeks. It can be aggravated by environmental and psychological factors and can be resistant to treatments. It can often cause severe problems for patients.

I shall today focus on chronic pain. Managing chronic pain is becoming a serious and expensive public health issue, and a challenge for family, friends, and health care providers who must give support to the individual suffering from the physical as well as the emotional consequences of pain.

Chronic pain if not well managed can be debilitating and reduce the quality of life and well being markedly.

 

How can we manage pain?

World Health Organization devised a step ladder approach to managing cancer pain which has been adapted for other causes of chronic pain.

This involves a stepwise increase or escalation of pain medications. Basically, if the first level does not improve pain then the doctor in consultation with the patient moves up the next level of pain medications which tend to be more potent.

 Mild pain

Paracetamol or a non steroidal anti-inflammatory (NSAID) drug such as ibuprofen usually works at this level.

Mild to moderate pain

Paracetamol combined with an NSAID or either of them is combined with a weak opioid such as hydrocodone, providing greater relief than their individual use.

Moderate to severe pain

Chronic pain medication is used for alleviating long-lasting, ongoing pain and usually involved the mild to moderate drugs plus more potent group of drugs called opiates.

Morphine is the gold standard to which these are compared. While opiates are often used in the management of chronic pain, high doses are associated with an increased risk of opioid overdose. These opiates are prone to abuse of use and guidelines of assessing the patient for the risk of substance abuse, misuse, or addiction must be done.

Other treatment modalities:

Antidepressants and antiepileptic drugs

Some antidepressant and antiepileptic drugs are used in chronic pain management and act primarily within the pain pathways of the central nervous system and peripheral mechanisms. These are in general are more effective in neuropathic pain disorders where the pain is attributed to a nerve pathway rather than musculoskeletal conditions. Drugs such as gabapentin have been widely prescribed for the off-label use of pain control. The list of side effects for these classes of drugs are typically much more than opiate or NSAID treatments for chronic pain, and many antiepileptics cannot be suddenly stopped without the risk of seizure.

Physiotherapy

Physiotherapy and rehabilitation uses therapeutic exercise along with other agents like thermal agents and electrotherapy to treat pain, usually as part of an interdisciplinary or multidisciplinary program.

Acupuncture

Acupuncture involves the insertion and manipulation of needles into specific points on the body to relieve pain or for therapeutic purposes the jury is still out on whether it works.

TENS

Transcutaneous electrical nerve stimulation involves using a small portable machine to stimulate certain nerve path ways that may be involved in the pain process and this however has been found to be ineffective for lower back pain.

Cognitive Behavioral Therapy (CBT).

This helps patients with pain to understand the relationship between pain and muscle tension and ones’ thoughts, emotions, and behaviors. A main goal in treatment is cognitive reorganization to promote helpful thought patterns, engaging in healthy activities such as regular exercise and pacing. Lifestyle changes to improve sleep patterns and to develop better coping skills for pain and other stressors using various techniques such as relaxation, diaphragmatic breathing, and even biofeedback.

Sometimes pain and even medical personnel can make you feel chronic pain is all in your head as it’s so difficult to manage. Though that may not be true you can still use your mind to control pain. Negative emotions can worsen pain and controlling this can help. Coping strategies such as deep breathing, stretching and meditation can control anxiety and your heart rate improving mood and fatigue. Keep doing activities you enjoy and find a pain relieving strategy that works

Let’s get a few tips for managing joint pain depending on what time of the day your pain hits you most.

If you have pain when you wake up:

  • Stretch your muscles before your feet hit the floor: To improve morning stiffness associated with inflammatory joint diseases, start by slowly bending and straightening your legs, then move to your arms, wrists and ankles.
  • Have a dose of your pain medications and or prednisolone on standby if it has been prescribed for you: Take this as soon as possible. Preferably however try to eat something before or soon after you take it to avoid irritation of the stomach.
  • Have a hot shower: A hot shower warms up the fluid in your joints and makes them lubricate the joints better for ease of movement.

Pain in the afternoon:

  • Don’t sit still for too long.: Move your body every half hour to prevent your joints from freezing or stiffening. Stand up often.
  • Desk exercise: Stretch in your seat. March with your feet in place.

If you have pain at night:

  • Keep your bed warm: this helps to keep your joint and muscles relaxed.
  • Sleep promoting foods: Some foods have the amino acid tryptophan which helps promote sleep. Eat these snacks an hour or two before bed. E.g. low fat yoghurt, oat etc
  • Check your medications: some medications interfere with sleep like prednisolone ask your doctor if you can take them at a different time.

If you have pain exercising:

  • Making time to stretch and strengthen your quadriceps and abs that is your thigh and abdominal muscles, this would take the pressure of your knees and ankles the usually site of pain.
  • Take your pain medications before exercise.
  • Get enough sleep
  • Try other forms of exercise such as water based exercises like swimming and water aerobics. Which take pressure off your joints whilst giving you a three dimensional training effect as the water resists your movement in all directions.
  • Talk to an expert, if you can afford to hire a personal trainer he or she can ensure your workout is safe and secure and develope an exercise routine that still works for you.

 

Pain affects our quality of life , let us take some measures so it doesn’t dictate our life.

There is Rheum to Bloom