Managing Chronic Pain
“He has but half lived who has not been to the House of Pain,” wrote Ralph Waldo Emerson. Pain is a common experience, shared by all humans. Up to 50% of community-dwelling older adults suffer from a condition that leads to chronic pain. Among these conditions are arthritis, nerve degeneration and shingles.
Types of pain
Acute Pain usually results from traumatic injuries such as a broken bone, infections, and inflammation as occurs with a toothache or appendicitis, metabolic changes as with soreness after exercise, surgery and others. Acute pain persists for relatively short periods of time and eventually disappears by itself or with an intervention, such as extracting a bad tooth, treating an infection with an antibiotic or using pain medication until an injury is healed.
Chronic pain continues after the original injury has been treated and can be present even in the absence of physical findings. It can go on for months or years or for the remainder of the person’s life. Another type of pain shares features of acute and chronic pain and that is recurrent pain, which alternates with periods of no pain, or lesser pain, as may be the case with migraine headaches. While chronic pain can feel the same as acute pain, the treatment approaches are generally quite different.
The pain response in the body is complex and is not completely understood. With acute pain, there is most often a clear cause and effect relationship; this may not be the case with chronic pain. In some cases, the causative factor may be healed, but the pain continues. We are conditioned to think about things in a cause and effect way. For example if we have a leaking pipe in our living room, we find the source of the leak, get it fixed, patch the ceiling and move on. This type of approach works well for acute pain, but not for chronic pain.
For example, a person who suffers a back injury may undergo treatment such as medication, rehabilitation and even surgery and still be left with pain. When doctors tell the person that there are no more physical problems to treat, this can lead to frustration, anger and/or sadness-sometimes progressing to depression. Physical pain combined with emotional pain may cause a person to limit their usual activities with friends and family, leading to social isolation and even relationship difficulties.
Pain Management
The first step in a treatment regimen is recognition of the problem. Pain that lasts several weeks or longer should be brought to the attention of a health care professional. If your family physician determines that your pain is chronic, consult a specialist
All chronic pain should be thoroughly evaluated by a multidisciplinary team. Typically, the first encounter is with the pain doctor who obtains a history and performs a physical exam. Some diagnostic tests may be ordered and you may be evaluated by a physical therapist. Do not be surprised or offended if the doctor refers you for a psychiatric evaluation or for psychological testing. These are usual components of a comprehensive pain evaluation and can yield valuable information.
The management of chronic pain requires a multi-faceted approach and active involvement by the person who is suffering from the pain. In addition to treating the physical cause of the problem, there are emotional and social issues that need to be addressed as well. While complete relief of the pain is the preferred goal, this may not always be realistic. The more realistic scenario is for the pain to be reduced to a tolerable level and for good coping mechanisms to be employed by the person who suffers from the chronic pain. The goal of treatment is not to eliminate pain but to improve your quality of life.
Coping well with chronic pain is no easy task. Pain can become a drain on energy and make it difficult to move forward. In addition to a good primary care provider, a pain specialist, a psychologist and other specialists may be required. As with many other chronic conditions, a holistic approach can be very beneficial. Using the six dimensions of wellness as a guide can help to identify specific interventions.
Physical Dimension
For those with chronic pain the main thing to consider is getting the pain to a manageable level. As mentioned above, absence of pain may not be a realistic expectation.
• If medications have been prescribed, take them as directed and stay in touch with the health care provider
who prescribed them. Some trial and error may be necessary to get the right drug at the best dose.
• Exercise is an essential part of pain management. While this may seem counterintuitive, it has been
established through research. You may need the help and guidance of a physical therapist to be sure you
are doing the best exercises for your particular situation.
• Build in regular rest periods after periods of activity.
• Eat a balanced diet and drink plenty of fluids
• Consider having massages on a regular basis-they can help with relaxation and muscle spasms.
• Experiment with heat and cold treatments either alone or alternating with each other.
Emotional Dimension
Chronic pain often leads to emotional difficulties. You may feel sad, frustrated, angry and even depressed. If you are having difficulty coping to the point that it is interfering with your daily activities, get help through your primary care provider and/or a psychiatrist or psychologist.
• Using the power of your mind is very important in the management of chronic conditions. Focus on things
other than the pain by using music, relaxation, reading etc.
• Manage your expectations. Be realistic about the reality of your condition and the limitations that it
imposes. Once you have done that, you can find enjoyable activities that you can do within those
limitations.
• Avoid becoming dependent on others for things that you are able to do for yourself.
• Try journaling your feelings to help you get past them.
• Laughter can help to manage pain through the release of endorphins. Find ways to laugh every day.
Intellectual Dimension
• Become educated about your condition and try new things along the way.
• Learn a new skill or hobby. This can provide some distraction from the pain in addition to keeping your mind
sharp.
Purposeful Dimension
• Do something to help another person within the limitations of your condition.
• Become active in advocacy groups.
• Donate money to a cause related to your particular problem
• Consider participating in research that is appropriate for you and your condition.
Social Dimension
• Participate in social events on days when you are able. Being with others can be a distraction from your
pain
• Avoid talking about your pain too much. Enjoy conversation about other topics of interest to your social
companions.
• If you have difficulties in your family relationships related to your pain, consider family counseling as a part
of your overall treatment plan
Spiritual Dimension
• Use prayer and/or meditation as a means to relaxation and pain relief
• Try to have a daily moment of gratitude, reflecting on what is right with your life.
Chronic pain offers a challenge to anyone who experiences it. With appropriate support and persistent trial and error, a good quality of life can be achieved. Every person is different and will require an individualized approach. Find the right specialist who can help and take control of your life for maximum benefit.
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