Chronic Pain: What are your options?

When you get hurt or catch an infection, your nerves send warning signals to the brain that trigger pain.  This alerts you to the problem so you can avoid additional injury.  But sometimes, the body keeps sending these pain messages even after you have healed.  This can lead to chronic pain, which can last for months or even years.  Many conditions - including arthritis, migraines, and cancer - also cause chronic pain.

Begin by seeking help

Pain, by itself, is hard enough to cope with. But chronic pain also can affect how you eat, work, sleep, and get around. This, in turn, can cause irritability, sleeplessness, and depression, all of which can cause pain to become worse.

The first step in avoiding this cycle is to talk to your doctor. She or he will be better able to recommend appropriate therapies if you can describe your pain in detail.

The following questions can help you consider the types of details your doctor will want:

• What does the pain feel like? Is it burning, throbbing, dull, sharp, or shooting?
• Is the pain constant? Or does it only occur from time to time?
• What activities or events tend to make the pain worse or better?
• Is your pain different at different times of the day or night?

Everybody feels pain differently. That's why it's important to describe your pain to your doctor.

Research even shows differences between women and men. For instance, women seem to respond to some pain medicines differently than men do.

Self-care strategies may help many

Which therapies work best for you will depend on the cause and severity of your pain. Your doctor may begin by recommending self-care strategies.

1. Healthy Lifestyle Choices

• Stop smoking, if you do. Nicotine may increase pain and make certain pain medicines less effective.
• Lose excess weight, if necessary. Some painful conditions, such as osteoarthritis and back pain, are worsened by extra weight.
• Get plenty of sleep. If you have trouble sleeping, talk to your doctor about strategies that can help insomnia.
• Learn some techniques for managing stress. Too much stress tends to aggravate pain.
• Eat a healthy diet. Vitamins and nutrients are important for maintaining good muscles, which may affect rheumatoid arthritis and other kinds of chronic pain.

2. Over-the-Counter Pain Relief

Just because aspirin and other over-the-counter (OTC) pain remedies are easily obtained doesn't mean they don't work. They are all very good at relieving minor to moderate pain. Acetaminophen is gentler on the stomach than other OTC medicines.

Your doctor can tell you more about the benefits and risks of different OTC pain medicines. He or she also can tell you about the safety of supplements and herbal remedies.

3. Exercise

Regular exercise may help retrain the nervous system so it stops sending needless pain signals. Exercise also helps relieve tension. Both physical and mental tension can contribute to headaches and other types of pain.

For some conditions, exercise even addresses potential causes of pain. For example, even a fairly small increase in quadricep strength was found to lower the risk of developing knee osteoarthritis by 20 to 30%.

Talk to your doctor before starting an exercise program. Depending on your health and the cause of your pain, your doctor may recommend physical therapy.

4. Heat & Cold

Warmth can relieve pain by relaxing muscles. In contrast, cold relieves pain by reducing inflammation. For some types of pain, your doctor may recommend a combination of the two treatments.

5. Relaxation Techniques

There are many different types of relaxation therapies. They include meditation, prayer, imagery, and yoga.

With all of these techniques, you usually:

• repeat or focus on a word, prayer, phrase, body sensation, or muscle movement
• ignore intruding thoughts or sounds.

Research shows that these techniques can effectively relieve pain for many conditions. Like exercise, relaxation therapies ease tension.

Some techniques also teach people how to view pain as something remote. This can produce a sense of detachment.

6. Counseling & Support Groups

Cognitive-behavioral therapy may help many types of pain, including backaches, cancer pain, and arthritis. This type of therapy teaches you how to change thoughts and actions that can make pain worse. Patients learn to focus on positive statements, such as "I am strong enough to handle this."

Support groups give pain sufferers a chance to share feelings and coping strategies. Women with breast cancer who attended a support group reported half the amount of pain after one year than non-attendees with breast cancer.

7. Massage

Massage can help restore normal movement to stiff joints. For this reason, it may help back pain and arthritis pain.

Studies also show that massage can help relieve pain in burn patients and migraine sufferers. But some experts remain skeptical of massage.

Massage decreases stress hormones, which can contribute to pain. It also seems to increase levels of endorphins, which are natural painkillers.

Other pain relief strategies

If self-care strategies fail to relieve your pain, you may want to explore other pain relief methods.

• Prescription medicines. If your pain is severe or constant, your doctor may recommend stronger medicines. Options range from prescription pain relievers to antidepressants that increase natural painkillers.
• Hypnosis. Studies show that 15 to 20% of people who can be hypnotized report complete relief of pain through hypnosis. One problem with hypnosis is that not everyone can be hypnotized.
• Biofeedback. Biofeedback teaches people to control various physical responses that contribute to pain. For example, tension headache sufferers may learn to control the tightness of their neck muscles.
• Electrical stimulation. Electrodes send electrical current through the skin near the painful area, which helps block pain messages to the brain. Sometimes acupuncture-like needles are used rather than electrodes.
• Acupuncture. The effectiveness of acupuncture for relieving pain is still being debated. Some studies show it can help relieve backaches and pain related to arthritis, diabetes, and dental surgery.
• Chiropractory. Some research shows that chiropractory, or spinal manipulation, can help certain patients with back pain. However, other studies fail to show any benefit.
• Surgery. Surgery may help some people with certain kinds of chronic pain who get no relief from other treatments. Some operations involve cutting parts of the nerves that carry pain messages to the brain.