Chronic Pain Management

Screen Shot 2015 05 23 at 7.41.16 PMBy Dr. Nina Radcliff

I recently read an estimate by health economists at John Hopkins University that puts the annual economic costs linked to chronic pain at $635 billion annually–far greater than for cancer, heart disease, or diabetes. This includes direct costs such as health care and indirect costs resulting from lost work days and daily productivity. What eclipses these staggering numbers arthe very lives (and those who care for them) of the millions upon millions of people suffering with chronic pain today, which is estimated at well over 100 million Americans. The heart of the issue is that these folks are friends, family members, colleagues, associates or, perhaps, you, experiencing the anguish physically, emotionally and mentally from chronic pain.

This is Part 2 of a 3-Part series on pain management. And whether mild or excruciating, how we approach our physical suffering can change how we approach any discomfort in our lives. The goal of pain management is to minimize suffering from pain while improving the level of function and quality of life. While it may not be possible to completely eliminate pain from diseases such as osteoarthritis, there are steps we can take in order to helpgain control.

Dr. Nina’s What You Need to Know:  About Some Options for Chronic Pain  

Resilience and CourageBoth, are key attributes that are called upon when we manage pain. A recent research study in the journal Traumatology examines “how resilient” pain patients cope with chronic pain and its impact on long-term recovery. Results showed that patient resilience typically focused on some common themes:

• Developing a sense of control over their pain by seeking out information as well as cross-checking the medical advice they received using other sources (collaborating with their doctors makes them feel less like patients and more like co-therapists)
• Becoming actively engaged in medical or alternative healing techniques which can make a difference in the ability to cope – from controlling their pain through therapy, active exercise, or changing their diet to eliminating potentially harmful substances that could be aggravating their pain.
• Establishing social connections to develop support networks to help with coping

As well, underscored are some additional techniques and information that has been reported to be helpful in managing chronic pain – but some may not be aware.

Harness Distractions:  Distractions cannot make your pain go away, but they can make your brain change its focus. Doing two things well at the same time is quite a challenge. Have you ever tried to cook dinner while helping the children do their history homework? How about counting backwards from a hundred while writing letters of the alphabet? When it comes to chronic pain, a distraction means shifting or moving your attention away from it. Some techniques that have been identified by experts include: counting, blowing bubbles, listening to music or audio books, reading, drawing, doing puzzles or utilizing apps like Pinterest. These are just some—there are many, many more!!

Deep BreathingThere is a Chinese adage that states: “If you know the art of breathing you have the strength, wisdom, and courage of ten tigers.” Deep breathing has been shown to calm the mind and relax the body. And, fortunately, there are a number of breathing techniques that have been shown to help divert pain. By focusing on the breath (feeling the air go in and out of our bodies), quieting our mind, and focusing on a word, phrase or positive mental image, we relax. After all, tense muscles feel more pain. Breathing techniques can be as simple as inhaling and exhaling deep breathes, s-l-o-w-l-y, repeatedly (e.g., three times) – and repeat again. An added bonus is that it can been done anywhere, anytime

Keep it Moving: Physical activity and exercise can be adapted for an individual who is suffering from chronic pain, and is something people can do for themselves—they have control over it. Additionally, it is likely to have minimal adverse effects, and maximal benefits (exercise is beneficial to the heart and blood vessels, and helps us stay at a healthy body weight). For those with chronic pain, the discomfort may tempt you to curl up in bed. However, inactivity can cause your muscles, tendons, and ligaments to deteriorate and worsen our pain condition.

In addition, mounds of research show that staying active, within realistic limits, can help you remain flexible and strong; decrease re-injury; and ease your sense of suffering. And, too, exercising releases endorphins—our body’s natural painkiller and mood enhancer. Make sure to discuss with your healthcare provider what physical activities are safe and feasible and work towards creating an individualized plan that incorporates pacing or gradual progression.

Biofeedback:  This technique teaches us how to gain a greater awareness of your body’s stress responses—tensed muscles; increased heart rate, blood pressure, and breathing—and learn how to control them. A trained professional utilizes different monitoring devices and sensors that are attached to our bodies and connected to a computer. This allows someone to literally “see” their bodily functions on a screen. For example, an electromyography (EMG) can measure muscle activity and a blood pressure cuff can determine your blood pressure. By becoming aware of what is going on inside our bodies, we can then implement relaxation techniques and get immediate feedback to help us figure out how to control our stress responses. While biofeedback has been most often used in the management of headaches, it is also used to treat a variety of chronic pain disorders.

Physical and Occupational Therapy

The fear of pain or re-injury is not uncommon in those who suffer from chronic pain—and this fear can result in decreased bodily movement with resultant physical deconditioning. Physical therapy teaches exercises and provides treatments to help increase mobility and build strength, that are individualized. Some activities include stretching exercises; strengthening exercises; graded exercise techniques (activities that start slowly andgradually increase over time); massage; and mobilization and manipulation of joints.

In occupational therapy, trained professionals teach you how to perform activities of daily living, also known as occupations. This can include bathing, cooking, and dressing ourselves. In other words, they help you acquire techniques to work around your pain—to adapt.

Talk Therapy: Cognitive-behavioral therapy (CBT) is a method used to help cope with a health problem by changing how we think; much like the saying “mind over matter.” CBT involves a structured approach that focuses on relationships among thoughts (cognition), emotions, and behaviors. The goal is to adopt an active, problem-solving method to cope with the many challenges associated with chronic pain. This includes cognitive restructuring (identifying unhelpful thoughts and increasing balanced thinking); behavioral activation (increasing engagement in rewarding and meaningful activities); and relaxation techniques (to decrease stress and muscle tension).

These are only a few options and understanding what is best for chronic pain can be challenging. And while having underscored this before, it bears repeating that the first step is to speak to your doctor. After discussing your pain and conducting an examination, they can provide treatment recommendations. It is important to follow-up in a timely manner if the pain does not subside or symptoms worsen. 

Also, you may (or be advised to) seek help from a doctor specializing in pain medicine. As chronic pain has become recognized as a primary problem, rather than always being a symptom of a disease, the medical specialty of pain management has grown. When taking this tact, look for doctors who are board-certified in pain medicine or who did a fellowship in something pain-related. Chronic pain management is dynamic and it is important for sufferers to know they are not alone – and too, to have courage in making informed actions with positive support, professionally and personally.

Dr. Nina Radcliff is dedicated to her profession, her patients and her community, at large. She is passionate about sharing truths for healthy, balanced living as well as wise preventive health measures. 

She completed medical school and residency training at UCLA and has served on the medical faculty at The University of Pennsylvania. She is a Board Certified Anesthesiologist. Author of more than 200 textbook chapters, research articles, medical opinions and reviews; she is often called upon by media to speak on medical, fitness, nutrition, and healthy lifestyle topics impacting our lives, today.