Living With Chronic Pain
If you suffer from chronic pain, you're not alone. Learn what you can do to help manage your pain
If you suffer from chronic pain, you're not alone. Millions suffer with back problems, migraines, whiplash and arthiritis just to name a few. There are, however, some pain management programs that can help.
Janice is in pain. A nerve problem in her neck and shoulder makes it impossible to get comfortable sitting, standing or lying down. Sometimes it throbs, other times it's characterized by a sharp, stabbing sensation, other times, it feels like jolts of electricity pulsating down her arm to her fingers. It hurts more when she's seated at the computer or driving. She gets a little relief by laying on the floor with her arms above her head, but one thing is certain: the pain never completely goes away. At times, she thinks if she could just tear the whole appendage from her body, she could finally get some needed rest. According to a 1996 Louis Harris poll, chronic pain accounts for one fourth of all sick days taken by full-time workers, costing our economy 50 million lost workdays and three billion in lost wages. Chronic pain disables more people than cancer or heart disease.
Chronic pain may be costly for the economy, but perhaps more profound is the toll it takes on the human spirit. Fatigue, depression and stress are secondary symptoms of the condition. Chronic pain sufferers may become irritable and short-tempered with loved ones and co-workers, making it a disease that damages relationships as much as one person’s physical health. As the pain wears them down, sufferers may grow weary of life, become socially isolated – even suicidal.
Types of Chronic Pain
Chronic pain is defined as pain that lasts over six months and is not relieved by medical and/or surgical care. It may result from old injuries improperly healed. It can also stem from a variety of conditions including:
- Neuropathy (nerve impingement or inflammation that can lead to deep neuromuscular pain and/or numbness)
- Carpal Tunnel Syndrome
- Migraine headaches
- Pelvic problems
- Whiplash
- Fibromyalgia
- Arthritis
- Osteoporosis
- Degenerative Disc Disease
- Herniated disc
And many other causes
Non-Invasive Non-Drug Pain Management
The most widely accepted comprehensive pain management programs include:
- Exercise — Includes water therapy, flexion exercises and aerobic activity. May involve active, passive, and resistive elements.
- Manual techniques — Manipulation of affected areas by chiropractic adjustments, osteopathy, physical or occupational therapy, massage therapy and other techniques.
- Behavioral modification — Use of behavioral methods to help patients control their response to chronic pain and other painful stimuli. Cognitive therapy involves teaching the patient to alleviate back pain with relaxation techniques, coping techniques, and other methods. Biofeedback involves the gradual alteration of neuromuscular signals for improvement of symptoms.
- Cutaneous stimulation — Superficial heating or cooling of skin using hot and cold packs. This method should be used in conjunction with exercise.
- Electrotherapy — The most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system.
Medication
Pain relievers and related drugs are used in all stages of medical treatment of pain, from the initial onset of acute pain to rehabilitation and alleviation of pain that may result from failed surgery. The most common non-invasive pharmacologic treatments for chronic back pain are:
- Analgesics— Such as acetaminophen. Long-term or higher doses involves risk of liver and kidney damage.
- Non-steroidal anti-inflammatory agents (NSAIDs) — Such as aspirin, ibuprofen, naproxen, all of which can cause stomach upset and should be taken with food, and the newer COX-2 inhibitors such as Celebrex®.
- Muscle relaxants— Often used with pain relievers to treat muscle spasms due to pain and protective mechanisms within the muscles.
- Narcotic medications— Often most appropriate for acute or post-operative pain. Since the use of narcotics carries a risk of addiction if not properly supervised, they are rarely used for chronic conditions.
- Anti-depressants and anticonvulsants— Often used in conjunction with other modalities to treat neuropathic (nerve) pain.
Invasive Techniques
When non-invasive methods fail to get desired results, invasive procedures may be necessary. These may include:
- Epidural steroid injections
- Trigger-point injections
- Lumbar sympathetic blocks
In extreme pain management cases, doctors may implant a pain-control pump. For example an Intrathecal drug delivery is designed to reduce pain by delivering pain medication to the intrathecal space surrounding the spinal cord. The system consists of a pump and catheter, both of which are surgically placed under the skin. A catheter connects to the pump and is tunneled under the skin to the site where medication is delivered at a set rate.
Another option is what's called a pain pacemaker. An implanted lead (a flexible insulated wire), powered by an implanted battery or by a receiver, is placed near the spinal cord. This lead and an implanted neurostimulator send electrical impulses that block the pain messages to the brain.
Medical opinions on the efficacy of the pain pacemaker and the medication delivery pump are mixed. Patients should obtain multiple opinions from physicians and pain specialists before opting for these treatments. For referral to a pain specialist, patients should consult their primary care physician.
Emotional and Spiritual Support
Those who must cope every day with chronic pain may be struggling with loneliness and a crisis of faith as the pain wears them down physically, emotionally and spiritually. It may help to join a chronic pain support group. The following are a list of links to organizations that specialize in helping chronic pain sufferers and their families:
Dave Dravecky’s Outreach of Hope