You have a pesky headache, so you reach for the aspirin. You can ice a bruise to reduce swelling. When you’ve had surgery, painkillers are prescribed. The pain resulting from these situations may be acute but thankfully, it’s usually temporary. Chronic pain, though, lasts for days, months or even years, undermining quality of life. Chronic pain is common, yet managing it successfully can be elusive.
Chronic pain is a complex condition, involving the source and history of the pain how it has been treated, the perception of pain by the individual and the psychological toll it has taken. If you’ve experienced chronic pain, you may have suffered lethargy, fatigue, depression or anxiety. Don’t ignore untreated, persistent pain; it could be symptomatic of a disease or injury that will only get worse without treatment.
How we address chronic pain
We first diagnose the source of chronic pain, and review its history, treatment, if any, and results. This may be difficult, because pain may have no discernable source, such as the widespread pain of fibromyalgia. Pain, with or without a known source is real, and should be taken seriously.
We find that a multidisciplinary treatment program is the best pain management approach, because it takes addresses the whole person, including physiological and psychological aspects of pain. Pain management is not all about medications. With appropriate medications, complementary therapies and lifestyle changes, patients engage in their recovery and gain a renewed sense of control of their lives. While a “cure” may not always be possible, managing pain should be.
Common causes of chronic pain
These include headaches, back pain, arthritis, cancer pain, post-injury and post-operative pain, and neuropathic pain, which result from nerve injury. Treatment is specific to the individual. For example, someone with arthritis may need occasional over the counter medications, while another is prescribed regular aerobic exercise or physical therapy and prescription antiflammatory drugs.
Americans are conditioned to look for the quick fix, the magic pill. In some cases narcotic prescription drugs are appropriate, but the majority of chronic pain cases, there’s a variety of effective and safer therapies, including some exciting new drugs. These therapies usually take more time to work, requiring more patience.
At Hanley Center, hanleycenter.org we treat many patients recovering from addictions to pain and other medications. Addiction is a brain disease with genetic components, so talk to your doctor about appropriate, non-narcotic pain medications if you have a family history of addiction, or if you are in recovery. Narcotics can also significantly change one’s perception of pain, often making it intolerable. The impulse is to over-medicate. This dangerous and probably won’t lesson pain in the long run.
Drugs traditionally used to treat chronic pain are acetaminophens, such as Tylenol, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen, such as Aleve (OTC) or Naprosyn (prescription). These drugs inhibit hormones that stimulate nerve cells the injury site, causing swelling and infection. Opioids such as morphine and codeine can be very effective for treating severe chronic pain. They block pain by locking onto opioid receptors in the brain. But they can be addictive and can cause lack of concentration, drowsiness, dizziness and constipation.
Newer drugs to treat pain have often been developed to treat other conditions such as seizures or depression. Duloxetine (Cymbalta) is an antidepressant, and is effective in treating diabetic neuropathy. Neurantin (brand Lyrica) affects chemicals and nerves in the body that cause seizures, and can treat some types of pain, as in herpes virus or shingles.
Managing pain with narcotics, other prescription medications and OTC drugs can cause serious side effects and interactions. Inform your doctor about all current medications.
The mind/body connection
Why do some people totally recover from injuries and others with similar injuries suffer for years? How a person physiologically responds to pain may determine the development of chronic pain. For example, after the initial trauma, the body’s neurological processes may cause the central nervous system to create a memory of the pain. And if the injured person relies solely on medication and doesn’t carry through with prescribed physical therapy and exercise regime, chronic pain can become crippling.
There are many pain management methods. Some of these include:
Expressive and creative therapies include art, music, movement, and journaling.
Cognitive behavior therapy
Appropriate Exercise is important for almost anyone suffering from chronic pain. Weight bearing exercise is therapeutic for osteopina, the precursor of osteoarthritis. Try aqua-aerobics if walking is difficult. Yoga can be gentle, strenuous, or meditative. Many find Tai Chi and Jin Shin Jitsu healing.
Biofeedback: By using an electronic machine, the patient becomes aware of and gains control of muscle tension, heart rate and skin temperature, then learns to affect changes in her response to pain.
Attitude is key to successfully managing pain. Having a routine, a support system, paying attention to proper nutrition, getting adequate sleep, and not skipping exercise are all effective. Join a walking group, a gentle yoga class, the “Y” for aqua aerobics. Get moving and get involved.
Dr. Barbara Krantz is Chief Medical Officer at Hanley Center. She is a noted addictionologist who is in demand as a speaker around the country. Her work has contributed to the recovery of patients with alcohol and chemical addictions whose health has been severely compromised. Find gender or age-specific treatment and recovery programs as well as prevention and family programs for all ages. http://www.hanleycenter.org
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