Chronic Pain

What is chronic pain?

Chronic pain is pain that may come and go for weeks or months at a time. Or you may have it all of the time. The pain makes it hard for you to keep doing your normal activities. The pain may be caused by an injury; illness; or other medical problem, such as arthritis.

The sensation of pain differs from person to person. For example, it may be burning, aching, or pulsating. You may have pain most days, or it may come and go.

How does it occur?

An injury, illness, or other medical problem that causes pain may, in some cases, change your nerves. Because of these changes, you may keep having pain even though the injury or condition has healed. You may feel pain more easily or more strongly than you did before your injury or illness. Physical contacts that didn't cause pain before, such as simple touching, may now be painful. The area of pain may have grown larger than the area first affected.

Pain can also have emotional causes. For example, if you are anxious or depressed you may feel pain more strongly.

Things that can make pain worse include:

• worsening disease
• more damage (for example, to joints or muscles)
• tense muscles
• being tired
• negative thoughts
• stress and worry
• depression

How is it diagnosed?

First your healthcare provider will check to see that the chronic pain is not caused by a new problem. Your provider will examine the painful area.

Your provider will ask about the history of the pain. It is very helpful if you keep track of:

• where it hurts
• when it hurts (for example, day or night, with activity or after sitting or standing for a long time), how long it hurts, and if it is off and on or constant
• what kind of pain it is: for example, if it is sharp, dull, burning, or stabbing, or if it is a feeling of pressure
• how bad it is, for example, on a scale of 1 to 10, with 10 being the worst
• what makes it better and what makes it worse.

An important part of the diagnosis and treatment of pain is determining how much the pain affects your lifestyle, responsibilities, and relationships at home, at work, or during leisure activities.

How is it treated?

The goals of pain management are:

• Make it easier to do the things you want to do.
• Have less pain.

You may not be able to get rid of all of your pain, but you will be able to get along better with it.

The treatment of chronic pain depends on the kind of pain you have, how long you’ve had it, and how disabling it is. Your treatment may involve a team of healthcare providers. It is helpful to talk with your provider about the goals for your treatment.

Nondrug treatments

A physical therapist may want to see how well you can use the painful part of your body. They may help you stretch, relax, and strengthen that area. They may also use techniques, such as ultrasound, to help reduce the pain. You may be treated at the therapist's office or the gym. You may be given exercises to do at home.

Your physical therapist may recommend a nerve stimulator, called a TENS unit. TENS relieves pain by sending small electrical impulses to your nerves through electrodes put on the skin. The electrical impulses block pain.

Your healthcare provider or physical therapist may recommend other treatments, such as:

• heat
• ice
• water therapy in swimming pools, hot tubs, or whirlpools
• massage
• acupuncture
• hypnosis
• biofeedback
• meditation and other relaxation methods.

An occupational therapist (OT) specializes in helping people do everyday chores and tasks. Often these tasks are things we take for granted, like dressing, eating, cooking, and going to the bathroom. The OT can help you learn different ways of doing these tasks, so that they are easier and less painful. This may help you be more independent and need less help from others. The OT may recommend bathroom or shower equipment, or a couple of simple tools for the kitchen.

A psychologist, counselor, nurse, or your doctor can check your emotional health. If you have anxiety or depression, these problems need to be treated. Anxiety or depression can be helped with counseling or medicine. Counseling can help you learn stress management and coping skills.

Medicine

Your healthcare provider may recommend or prescribe medicine to help with the pain. This may be nonprescription pain medicine or stronger painkillers that you need a prescription for. Some commonly used nonprescription medicines are acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen.

• NSAIDs should be used with care, exactly as recommended by your provider. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.
• Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome.
• Also be careful with your use of acetaminophen. It can cause liver problems if you use more than the recommended dose. Don’t take more than 4000 milligrams (mg) a day (8 extra strength tablets).

Your provider may recommend creams or soft ointments that contain numbing medicine.

Narcotics such as hydrocodone, oxycodone, and morphine are sometimes prescribed to manage chronic pain, but only after other medicines and nondrug treatments are tried. Narcotics, also called opioids, can be addicting. However, people using these drugs for pain usually do not become dependent on them if they use the drugs exactly as prescribed.

Your healthcare provider may prescribe medicines usually used to treat epilepsy or depression. Some of these medicines have been shown to lessen chronic pain if they are taken daily for a while.

Steroids and sedatives are also sometimes used to control chronic pain. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

Muscle relaxants are used when the pain is thought to be mostly in the muscles, ligaments and tendons. These medicines, especially when used with heat or ice and massage, can be very helpful.

Pain medicine is not expected to get rid of all pain, but it should control it so you can feel better and be able to do more. Be sure to take all medicines as directed. Taking your medicine at higher doses or more often than prescribed may be harmful. Read and follow all label directions and your healthcare provider’s instructions. If you are having side effects from the medicine or the medicine is not working well for you, tell your provider.

Often, what works best is a combination of treatments tailored to your particular pain problem. You and your healthcare provider may need to work together for several weeks or months to find what works best for you. Always let your provider know if a particular combination of treatments and medicine is working well for you.

Another important part of treatment is making sure that your family and friends understand that the pain you feel is real and that all of these ways to treat the pain can be helpful.

If you are following your treatment plan and the pain has not gotten any better, there may be other options. In this case, ask your healthcare provider if shots (injections) of medicine into the nerve to numb the pain, or surgery to cut the nerve(s) causing the pain, might be helpful. Your provider may refer you to a pain specialist to see if there are other pain control methods that will help you.

You should have regular visits with your healthcare provider to see how well your treatment is working. If you are not getting better, ask for a referral to a pain specialist.

How long will the effects last?

Your treatment may not get rid of the pain completely. But it should allow you to participate in and enjoy life more than you could before treatment. If you carefully follow all aspects of your treatment program, the pain may gradually go away after many weeks or months.

How can I help take care of myself?

You can improve your quality of life even though you have pain. The key is to take an active role in managing the pain. This means doing things every day for your pain condition. It also means working as a partner with your healthcare provider, physical therapist, and others providing care for you. This can help you be in control of your pain, instead of the pain controlling you.

Here are some things you can do to manage your pain.

• Use your pain medicine correctly.
  • If you are taking pain medicine just when you need it, take it when the pain starts getting worse unless it has not been long enough since your last dose. If you wait until the pain gets really bad, it is harder to control it.
  • If you are taking pain medicine around the clock, make sure you take your medicine even if you don't feel you need it. This helps keep pain under control.
• Get some physical exercise or active time on most days. This will build your strength. Even on "bad days" do something, such as a short walk.
• Pace your activities. Try to do about the same amount of physical activity each day. Even during the day, spread activities out more evenly with rest periods in-between. Break tasks down into small steps that are easier to manage.
• Be social. Even when you don't feel like it, get out and be with people. Spend time with friends and family who are supportive. Share your thoughts and feelings with others. Make time for fun activities.
• Learn ways to cope with stress and anxiety, such as exercise and relaxation, and get treatment for depression. Do things to relax and reduce tension, such as deep breathing, meditation, and yoga. Managing your stress can help you be more in control of your pain.
• Use positive self-talk. Negative thoughts can increase your stress.
• Focus your attention on something else to relieve even bad pain for a short time—for example, by doing things such as counting backwards, listing things such as flowers or types of cars, or doing an activity or hobby that interests you, such as watching a funny movie or a sports game or listening to music. Give your attention to things that you enjoy and make you feel satisfied instead of focusing on pain.
• Get enough sleep and eat healthy foods. Follow a regular sleep schedule. Talk to your healthcare provider about any problems you have with sleep. Sleep problems can make it harder to control pain.
• Limit your use of chemicals that can increase stress such as nicotine (smoking), caffeine (coffee, colas, chocolate), and alcohol. Avoid using recreational drugs.
• Don’t smoke. Nicotine tightens blood vessels, which reduces blood flow. When there is not enough blood to an area, it doesn't heal as well and there can be pain. Smoking can trigger headaches and increase back pain. Smoking can also make you more tired and your muscles weaker, which can worsen pain.
• Practice good posture. If you have had pain in your back or other part of your body for a long time, you most likely have made changes to your posture and the way you move. Pain causes you to move with caution and to tense muscles that are normally relaxed. You may have learned ways to control pain by bracing your body, limping, or standing differently. These postures may have helped at first, but over time, they cause more stress on your joints, spine, and muscles. Standing and sitting straight, and lifting and moving properly, can lessen the stress on the spine and muscles and help prevent injury or flare-ups of pain. It helps your treatment for pain work better because you are not continuing to irritate your muscles and spine. It’s also important to avoid activities that increase stress on the spine and muscles such as lifting heavy objects, twisting or bending while lifting, or sitting without support for a long time.
• Keep a pain diary. It can help you learn what helps your pain and what makes it worse. Rate your pain on a 0 to 10 scale. Record where the pain is, when it occurred, and how long it lasted. Note what you did to relieve the pain and how much it helped. Also note your activities or feelings. You may notice a pattern of things that increase or decrease your pain. Consider sharing what you have learned from your diary with your healthcare provider.
• Talk with your healthcare provider if you do not have good pain control. Describe the location and intensity of your pain, anything about your pain that has changed, and to what extent medicines and other treatments relieve the pain. Changes to your treatment plan may be needed.
• Learn about ways to manage pain. You can get more information about this from:

  The American Chronic Pain Association
  Phone: 1-800-533-3231
  Web site: http://www.theacpa.org/default.aspx

How can I prevent chronic pain?

The only way to try to prevent chronic pain is to treat pain caused by illness or injury right away. This might prevent the changes to the nervous system that are thought to cause chronic pain.