When your body's in pain, it can be all-encompassing, affecting your work, activities, sleep, mood, and even your relationships. And chronic pain is much more common than most people realize; in a groundbreaking 2011 report, the Institute of Medicine (IOM) estimated that 116 million Americans suffer from chronic pain. As you know, if you suffer from it, when chronic pain continues for a long time, it can get awfully discouraging. There are solutions out there, though, with new approaches being tested all the time. Here are the top 10 strategies for conquering chronic pain.
Find the Right Expert to Beat Chronic Pain
Why it's important: Chronic pain is among the most difficult problems to treat, because the solutions aren't always clear-cut, and in many cases there isn't one guaranteed fix. A lot of trial and error is necessary to figure out what eases the pain. Managing that process requires doctors to stay on top of the situation, remember what was said and done before, and be receptive when you come back and say, "No, that didn't help." Many people with ongoing problems, such as arthritis, report having to switch doctors two, three, or even more times before finding someone who really "gets it."
What to do: At every appointment, pay attention to whether the doctor is really listening to you, and whether he or she is proactive about ordering tests to find the cause of the problem -- and suggesting physical therapy, medication, or other forms of treatment tailored for you. If the treatment doesn't solve your problem, don't hesitate to go back, and pay even closer attention to how the doctor reacts to your "What next?" questions. It shouldn't be a problem to come in for repeat visits while you and your doctor try to get to the root of your pain and find a solution. If you start getting the feeling that the doctor is shrugging off your concerns, is implying that you've run out of options, or is sending the message that it's "all in your head," it's time to find another doctor.
Tip: You may also need to ask for a referral to a specialist or surgeon. Some medical practices now also provide referrals for acupuncture or osteopathy. If you can afford it, it may be worthwhile to go outside your regular medical network. Some chiropractors, osteopaths, and specialized sports clinics can provide potentially helpful treatments, such as prolotherapy, that may or may not be covered by insurance.
Check Medications to Beat Chronic Pain
Why it's important: There are significant differences in how pain medications work and which work best for a specific problem. Even if you have a favorite, go-to choice for pain, you may need to try other options, depending on the physical effects, time of day, and other factors.
What to do: Get familiar with the most common pain medications and when to use them. Even if you've gotten relief from a particular medication in the past, pay close attention to any side effects and to whether the drug loses effectiveness over time. Even better, make an appointment with your doctor specifically to discuss medications, and prepare by making a list of everything you're taking, when you tend to take it, and how often. (Or, simply take all your medications -- both prescription and over-the-counter -- with you.) Be honest; the doctor can't help you if he or she doesn't have a clear picture of what's happening. You'll also want to be very candid with your doctor about whether you're using alcohol or other recreational drugs.
Tip: Make sure you know both the generic and the brand names of all the drugs you're taking -- both prescription and over-the-counter -- to avoid confusion and double-dosing. Doctors say they see a surprising number of overdoses caused by taking both the generic and brand-name version of the same drug.
Watch Out for Residual Pain
Why it's important: As pain becomes chronic, it can lead to changes in the central nervous system -- including the spinal cord - that get worse, not better, as time goes on. Experts don't fully understand this type of pain yet, but research shows that inflammation and pathological changes can sensitize nerve signaling pathways so that pain becomes amplified and residual, meaning it continues after the original injury is treated and healed.
What to do: Some medications originally developed to treat depression and seizures can be effective in controlling chronic residual pain. Antidepressants and anticonvulsants at low dosages seem to calm sensitized nerves and interrupt the affected nerve signals. The 2011 IOM report defines chronic pain as pain that continues after the original injury as healed -- in other words, as residual pain, and paves the way for more doctors to understand and treat this type of pain.
Tip: Make sure your doctor has you rate your pain on a pain intensity scale, in which 1-3 is mild pain and 10 is unbearable. This will give her a clear idea of how debilitating you find this condition. Then discuss trying one of the more popular nerve pain medications, which are usually given at a titrating (gradually increasing) dose. It may take two or three different medications before you find the one that brings longterm relief.
How Physical Therapy Can Help Beat Chronic Pain
Why it's important: For knee, hip, back, and other types of joint pain, physical therapy can be one of the most effective treatments -- but only if you're taught the right exercises and do them diligently.
What to do: To be truly effective, your physical therapy regimen needs to be individually tailored to your specific injury and other needs. All too often, those with chronic pain are referred to "one-size-fits-all" physical therapy programs, which can be unhelpful at best, and discouraging at worst. "People do a generic physical therapy course, then conclude that physical therapy doesn't work, and that they're stuck with the pain," says Marc Lum, a senior physical therapist at Kaiser Permanente in the San Francisco Bay Area. "But a lot of time the problem is that the exercises just weren't the right ones, or the patient didn't stick with them long enough."
Tip: Ask for a referral to a physical therapist for one-on-one therapy, at least for one or two sessions. That way you'll have the individualized attention necessary to develop the exercises suited to your needs and to make sure you're doing them correctly.
Take a Load Off to Beat Chronic Pain
What it's important: Joint pain is directly affected by physical activities. And a great deal of pain is caused by repetitive overuse of certain muscles and joints, which can't heal if they're repeatedly subject to the same pressures that caused the injury in the first place. If you have upper back pain and continue to sit at your computer in the same position you always did, your arthritic joints can't recover, much less heal.
What to do: Pay attention to what hurts, and experiment with what eases the pain. This can be anything from making ergonomic changes to your workstation to wearing orthotic insoles in your shoes or sleeping on a contoured neck pillow. If sitting all day is contributing to your pain, get a standing desk or experiment with sitting on an exercise ball or chair insert. Make changes to your routine and substitute activities that put less strain and pressure on the affected joints and muscles.
Tip: Joint pain in the knees, hips, and shoulders can benefit greatly from being stabilized either with an elastic brace or bandage or by wrapping the offending joint with inflexible sports tape. A physical or sports therapist can teach you how to wrap a painful area so the joint is stabilized and doesn't cause pain with movement.
Dial Down Your Diet to Beat Chronic Pain
Why it's important: Many chronic ills, such as arthritis, are inflammatory diseases, and what you eat -- and don't eat -- plays an important role in the inflammatory process.
What to do: Eat a diet high in antioxidants to build up resistance to oxidative stress, which causes inflammation at the cellular level. Foods high in antioxidants include most fruits and vegetables and some spices -- the richer the colors, the higher the density of protective phytochemicals. (Other clues include a strong smell, such as in garlic or onions, or strong flavors, such as in chili peppers and broccoli.) The second "“ and for many people, harder "“ step is to cut out or reduce sugar and white flour. Eating sugar and white flour (which your body quickly converts to sugar) triggers the release of insulin, contributing to the inflammatory process. Gluten, a protein in wheat, is also receiving attention for its affect on inflammation, so many nutritionists advise that you avoid flour and other wheat products.
Tip: If you're not a veggie lover, make combination juices and smoothies with vegetables pureed and mixed with fruit juice to mask the flavor.
Listen to Your Body to Beat Chronic Pain
Why it's important: One of the biggest mistakes you can make is to continue with "business as usual," not realizing that every ache, pain, and twinge is trying to tell you something.
What to do: Don't ignore pain. Pain, like a cranky child, has a tendency to get louder in order to get your attention. Instead, stop what you're doing, focus your attention, and try to pinpoint the pain's exact location and quality. This will give you helpful information you can use to report to your doctor, and also helps develop awareness of what feels worse and what feels better. And you may find that the "nagging" of your pain lessens.
Tip: Some chronic pain sufferers have found that meditating on the pain itself can actually help ease it. "I stop fighting the pain and sit down, close my eyes, and 'listen' to it. Where exactly is it? How do I feel it? How would I describe it -- throbbing, sharp, stabbing, aching? I attempt to hear it like a trusted friend talking to me, not shushing it like a bothersome child interrupting me and trying to get my attention." Stick with this, and you'll find eventually your mind gets bored and starts to wander, a sign that your body is no longer fighting and reacting to the pain. A study of people with chronic back pain who were enrolled in a multidisciplinary pain-management program found that practicing this type of mindfulness was linked to lower levels of disability, anxiety, and depression.
Don't Stop Moving to Beat Chronic Pain
Why it's important: It might seem intuitive to avoid exercise when you're in pain. But exercise, done right, eases stiff joints, increases blood flow to affected areas, strengthens the muscles that support the joints, and can even curb pain flare-ups. Exercise also helps you sleep more deeply, lifts your mood, and helps you lose weight, which in the long run will reduce pressure and pain.
What to do: If hiking and climbing hurts your knees but you can't give up your favorite pastime, get hiking poles and learn to use them. If you love to run but it's taking a toll on your joints, try buying new running shoes designed to reduce impact, or switch to a combination of walking and short sprints, which is much easier on the joints than the pounding action of long-distance running. If you wake up in the morning stiff and achy, your back is letting you know that it wants to move, and that lying in one place all night (flat on your back tends to be particularly troublesome) isn't working. Get extra pillows and position them around yourself until you feel the strain ease. And if you wake in the middle of the night, change sides or otherwise shift around so the pressure isn't affecting all the same places all night.
Tip: If exercise or activity routinely leaves you sore, ice and heat are both effective therapies for muscle and connective tissue pain. Ice is best immediately after exercise or injury, as it prevents inflammation. Elevating the area while icing may boost the effect. As time passes, heat therapy is more effective. Applying heat increases blood flow to the area, healing the tiny tears in muscles and connective tissue that make you feel stiff and sore days after exercise. Soaking in a bath or hot tub, taking a sauna or steam, or using heating pads are all effective ways to use heat.
Learn New Ways to Think About Chronic Pain
Why it's important: How you think about and respond to pain plays an important role in how you experience it, and how debilitating it is. For example, when you tense up in response to pain, you tend to create more pain over time. Cognitive behavioral therapy (CBT), which is also used in the treatment of depression and anxiety, can help people develop more constructive ways of coping with daily pain.
What to do: Ask your doctor for a referral for cognitive behavioral therapy. This type of therapy may be also available within a multidisciplinary pain center.
Tip: If your insurance doesn't cover this type of treatment, an alternative is to get a workbook on using CBT to help with chronic pain. Several such workbooks, written by experienced therapists, are available through online booksellers or public libraries.
Take Symptoms of Depression Seriously to Beat Chronic Pain
Why it's important: It's common for people to suffer from both chronic pain and depression. In fact, an estimated 56 percent of those with chronic pain are affected by depression. People who suffer from both problems tend to suffer from more disability and higher healthcare costs; studies have also suggested that pain medications work less well in people with depression. Although pain can contribute to depression symptoms, treatment of depression can improve function and quality of life in those with chronic pain.
What to do: If you find yourself often sad or unable to enjoy things, or you have any other symptoms of depression, be sure to pursue further evaluation from a doctor. Depression can be treated with psychotherapy or medication; using a combination tends to give the best chance at remission.
Tip: If you're already being treated for depression, make sure you get regular follow-up appointments to check on your symptoms, and adjust your treatment if indicated. This is especially important if your symptoms haven't fully gone into remission.