Managing Chronic Pain

Pain is one of the main symptoms of a variety of conditions, such as arthritis. It may increase during a flare and then subside at other times, but for most people with chronic pain, it will never entirely disappear.

Pain signals are normally sent from nerve endings in your joints, muscles and other tissues up through the spinal cord to the brain. The brain is the organ that actually perceives pain. Your pain response can be influenced by many factors, like prior painful episodes and your emotional status. Your brain can also send signals to your body that can change the way you experience pain. These signals use chemicals that dampen the pain signals from the body to the brain. They may also reduce your pain perception. The release of these chemicals may be increased by physical activity, as well as by relaxation exercises and techniques.

Acute & Chronic Pain

All pain is not the same. There are two major types of pain: acute and chronic.

Acute pain is usually due to an injury or surgery and serves to protect us. Your brain receives the pain message and sends signals to your body to respond to the pain, such as removing your burning finger from a hot stove or taking weight off a sprained ankle.

Chronic pain is pain that persists for over three months. Chronic pain can be intermittent or persistent (lasting more than 12 hours a day). The most common causes are arthritis, fibromyalgia and low back pain. Another type of chronic pain is called neuropathic pain, which results from disease or injury to the nervous system itself.

According to the Mayo Clinic, chronic pain may be caused by a process called sensitization. When sensitization occurs, your nervous system amplifies and distorts pain, much the way your stereo speakers distort the character of recorded music when you crank up the volume. The pain that is registered is severe and out of proportion to the original cause of your chronic pain. When this occurs, chronic pain may be associated with emotional and psychological problems.

The similarity between both types of pain is that all pain is actually registered in the brain. This does not mean that you are making up the pain. It means that you can use your mind to help manage pain. Changing how our brain functions and responds to pain is a skill that can be learned, which can be very useful in mastering and controlling pain and its effect on our daily lives.

The Pain Cycle

It is important to remember that pain means different things to different people and that not all people experience pain in the same way. What works for one person may not necessarily work for another. Persistent, severe pain requires a combination of strategies; no one pill or management technique is enough to provide non-stop pain relief safely.

Medications are only one part of an overall strategy that will help you reduce and cope with your pain, improve your function and daily-living activities, and learn to deal with the emotional stresses that chronic pain can impose. The first step in managing pain is to understand the pain cycle.

How To Manage Pain

The good thing about understanding the pain cycle is that it helps you see that there are many ways to break it.

There are a number of cognitive techniques you can use to help manage your pain.

Distraction is a technique that can be used during short, painful activities, such as opening a jar or climbing stairs. Our minds have trouble focusing on more than one thing at a time. Therefore, if you can focus your mind on something other than the pain, the pain will be less.

Another way to reduce pain is to relax your muscles. As muscles become less tense, it is easier and less painful to move the joints. In addition to releasing tension throughout the body, relaxation helps you to sleep. Muscle relaxation exercises can help you to do this.

Reducing stress is another way to manage your pain. There are several ways to reduce stress including; deep breathing; guided imagery where you go on a guided 'daydream'; and vivid imagery where you focus your mind on remembering or anticipating a pleasurable event. Like all exercises, you need to practise to obtain the best results.

HANDLING FATIGUE

In chronic or persistent pain, fatigue or feeling more tired than is normal is a very common symptom. It is part of the cycle of pain. Effective fatigue management helps break the pain cycle by rejuvenating both the mind and body. Physical activity is an excellent means of overcoming fatigue, especially if depression or lack of fitness (rather than the disease process) is the source of fatigue.

Effective fatigue management helps break the pain cycle by rejuvenating both the mind and body. Proper body mechanics and relaxation techniques can help manage fatigue.

The Sleep Environment

Getting a good night's sleep is a key factor in breaking the pain cycle. This is still possible, even though you may have chronic pain.

It is completely normal to take up to 1/2 hour to fall asleep. If you are lying awake for longer, get out of bed and leave the room. Go and get a healthy snack, read a book, or listen to calming music. Return to the bedroom when you feel sleepy again.

Sleeping Tips:

• Establish a ritual before going to bed. Always going things in the same order and the same time each night trains your brain to start shutting down.
• Try to go to bed at the same time each night and wake up at the same time each morning. If you have a major sleep problem, you will need to do this, even on weekends, for one month.
• Never sleep with pillows behind your knees as it may restrict the blood flow.

PHYSICAL ACTIVITY

You may want to avoid physical activity because you think it will aggravate your pain. Yet if you establish a regular routine, you can increase your strength, energy and flexibility. It can also help you get back to some of the activities that you couldn't do because of your pain. Current research has shown that physical activity can help with pain management.

If you have chronic pain, more is not necessarily better when it comes to physical activity. 'Slow and steady, consistently without fail' should be your motto. A sensible strategy would be to set your sights on long-term gains in flexibility, strength and endurance.

For more information, refer to The Arthritis Society's Physical Activity & Arthritis Guide [PDF] and Top 10 Exercises [PDF].

COMPLEMENTARY AND ALTERNATIVE THERAPIES

If you are considering using Complementary and Alternative therapies, such as herbal remedies, supplements, acupuncture treatments, etc., you should inform your health-care provider. Your health-care provider can offer valuable advice about these treatments, help you avoid possible interactions with existing therapies and support you to successfully manage your chronic pain.

When looking for information on complementary and alternative therapies, it is critical to verify that the sources are trustworthy and that the findings are based on scientifically proven, solid research. Be sure that treatments have been tested on people who have the same condition as you want to treat. Patient testimonials or product statements that are not backed by evidence cannot be relied upon, as these are often personal opinion or marketing ploys.

For further information, refer to The Arthritis Society's Complementary and Alternative Therapies Guide [PDF].

HEAT AND COLD

Heat helps to relax tight muscles. You can get heat from:

• Hot packs.
• Warm baths or showers.

Cold helps to reduce inflammation. You can get cool using gel packs that you can keep in your freezer.

YOUR PAIN MANAGEMENT TEAM

Learning to manage pain isn't easy. But learning as much as you can about your particular type of pain and actively working with your pain management team are two very effective ways of regaining control over your life. There are a number of individuals and organizations that you may find helpful, including medical specialists, a pharmacist, community organizations, friends and family, and The Arthritis Society.

Take advantage of the help, advice, expertise and experience of the members of your treatment team: ask questions and learn to use every resource available to you. And remember: it is your team; they are there for you.