Living with Chronic Pain
Living with chronic pain can disrupt a person’s personal and work life. Left untreated, it is disabling and it has a negative impact on mental health and self-esteem. But through treatment such as medications, complementary medicine and talk or cognitive behavioral therapy, people with chronic pain can improve quality of life.
The Centers for Disease Control and Prevention estimates that about 50 million Americans live with chronic pain. It’s one of the most common reasons people seek medical care.
People with chronic pain often have problems getting around and doing daily activities. It’s been linked to opioid dependence, depression, anxiety and lack of enjoyment of life.
Most people think of medications when they think of treatment for chronic pain. But successful management of chronic pain requires a mix of different treatment types. In fact, one of the goals of proper pain management is to reduce a person’s dependency on medication.
Treatment focuses on easing pain, restoring normal function, better quality of life and prevention of a relapse of symptoms.
Each plan is tailored to the individual and may have to be adjusted through trial and error, and patients may have a team of specialists to help them.
Complementary Health Treatments
According to the National Center for Complementary and Integrative Health, complementary health approaches may help relieve chronic pain. Complementary health approaches are non-medication practices and products that are not a part of mainstream medicine.
NCCIH looked into complementary approaches that could manage chronic pain without opioids. The 2017 review found evidence that the following complementary techniques helped manage chronic pain. It found several practices could help manage chronic pain but only acupuncture reduced the need for opioids.
- Relaxation techniques
- Tai chi
- Osteopathic or spinal manipulation
- Hypnosis (effectiveness varies from person to person)
- Mindfulness meditation
- Music therapy
Most of these treatments have good safety records, but they may not be for everyone. Make sure you talk to your doctor first.
Psychotherapy for chronic pain helps people understand thoughts, feelings and behaviors that may make pain worse. And because people with chronic pain are more likely to suffer from mental health issues such as depression or anxiety, therapy can help improve mental health and lessen pain.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is the most common psychological intervention for people with chronic pain. It’s a goal-oriented, hands-on psychotherapy that helps people change patterns of thinking and behavior that may be making chronic pain worse.
CBT goals include learning coping skills for pain, reducing the impact of pain on a person’s life and reducing reliance on medication.
Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy focuses on helping people live full lives despite having pain. Its focus is not to decrease pain, but to help people focus on changing their behavior. They learn how to better react to and handle pain. It teaches people how to focus on what matters most in their lives and take action to be fully present.
The type of medication a doctor recommends for chronic pain depends on the patient’s general health and their pain level.
- Tylenol (acetaminophen)
- Tylenol works for arthritis, fevers and minor aches. Don’t exceed more than 4,000 mg a day.
- NSAIDs (non-steroidal anti-inflammatories)
- NSAIDs treat general aches and pains and inflammatory pain like arthritis. Long-term use, especially at higher doses, may lead to stomach problems, heart problems and kidney damage. Examples include: Aleve/Naprosyn (naproxen sodium), aspirin, Advil (ibuprofen), Volatren (diclofenac), Celebrex (celecoxib).
- Steroids treat chronic pain and inflammation from diseases such as lupus and rheumatoid arthritis. They are typically for short-term use. Examples include: prednisone and hydrocortisone.
- These drugs treat neuropathy and fibromyalgia. Examples include: Neurontin (gabapentin), Lyrica (pregabalin), Tegretol (carbamazepine), Depakote (valproate, divaproex sodium)
- Antidepressants treat generalized pain, neuropathy, fibromyalgia and migraines. Examples include: Cymbalta (duloxetine), Effexor (venlafaxine), Pristiq (desvenlafaxine), Tofranil (imipramine)
- Muscle Relaxants
- Muscle relaxants treat cramps and muscle spasms by slowing pains signals that go to the muscles. Examples include: cyclobenzaprine, baclofen, orphenadrine
- Treatment for localized pain, including types of neuropathy. Examples include: Apercreme (trolamine salicylate), Volatren (diclofenac gel), Bengay Ice (menthol), Zostrix (capsacin), lidocaine
Physical and Occupational Therapy
Physical therapy and occupational therapy help patients develop strategies for dealing with chronic pain.
Physical therapists perform tests to see any physical issues could be contributing to pain. These tests include strength, posture, balance endurance and range of motion. Based on the results of this test, the therapist will develop an individual treatment plan.
Therapists use exercise, massage, transcutaneous electrical nerve stimulation (TENS) and heat or ice to help treat pain. They may also give a patient exercises to do at home.
Occupational therapists teach clients how to move differently to accomplish daily tasks while managing pain. They can also help chronic pain sufferers make changes in their living environment to make it easier to get around or use assistive devices such as canes.
If medications and therapy aren’t helping, doctors may suggest some procedures for pain relief. These include deep brain stimulation, spinal cord stimulation or injections called nerve blocks.
Deep Brain Stimulation (DBS)
Surgeons perform deep brain stimulation by placing a fine electrode (wire) into certain parts of the brain. The electrode delivers a continuous electrical pulse the part of the brain that processes pain signals. Up to 80 percent of patients treated with DBR find relief, according to the American Association of Neurological Surgeons. It’s particularly effective for chronic back pain.
Spinal Cord Stimulation
Spinal cord stimulation blocks the sensation of pain by delivering a low-voltage electrical current delivered to the spinal cord. It blocks pain by stopping pain signals from reaching the brain. Types of pain it may treat include prior back surgery pain, nerve damage, chronic sciatica and peripheral vascular disease. About 60 percent of people who received spinal cord stimulation have relief or pain reduction when surveyed one to two years after the procedure.
Doctors perform radiofrequency rhizotomy by inserting a heated needle into the body to stop a nerve from sending pain messages to the brain. It’s also called radiofrequency ablation or neuroablation.
Many patients experience pain relief for six to 12 months.
Injections provide temporary pain relief. Also called nerve blocks, these injections deliver powerful medications, such as opioids or steroids, to nerves or around nerves to relieve pain. An epidural steroid injection into the lower back is one of the most common types of injections.
Patients typically need two or three injections to get the maximum benefit. Patients shouldn’t exceed this limit because of side effects from steroids.
What Makes Pain Worse?
Healthcare providers are there to help people manage their pain. But some lifestyle habits influence how long pain lasts, how patients perceive pain and how intense the pain is.
If you have chronic pain, you have control over these factors. Reducing or eliminating them will improve your pain and overall health.
Research shows that about 28 percent of people with chronic pain use alcohol to help manage pain, but it’s only a short-term solution, according to Practical Pain Management. Alcohol has negative impacts on mental health, physical health and can be dangerous when mixed with pain medications. Long-term heavy drinking can even lead to peripheral neuropathy, a type of burning pain that typically affects the legs.
People with chronic pain are more likely to smoke than people without chronic pain. But heavy smokers report higher pain scores than people who don’t smoke. They are also three times more likely to develop chronic back pain, according to Practical Pain Management.
People with chronic pain may find it uncomfortable to move or exercise, but research shows exercise can reduce the severity of chronic pain. It also helps people with pain move better. For example, research shows exercise is effective at treating pain from osteoarthritis, chronic neck pain, chronic low back pain and fibromyalgia, according to Practical Pain Management.
Make sure you check with your doctor before starting an exercise program.
Focusing on Negative Thoughts and Feelings
The way people think about their pain can actually make it worse. Negative thought patterns that could intensify pain include rumination, magnification and helplessness.
People who ruminate repeatedly think about a problem with no solution. For example, repeatedly thinking about how much pain they are in. People who magnify a thought may think about how much worse the pain can get. People with helpless thoughts think that a situation is out of their control and may think about how they cannot reduce their pain.
Cognitive behavioral therapy can help people manage their thoughts and help them better manage pain.
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