Chronic Pain: How to Get Relief

What is chronic pain?

There are 2 types of pain: acute and chronic. Acute pain doesn't last long and usually goes away as your body heals. Chronic pain lasts at least 6 months after your body has healed. Sometimes, when people have chronic pain they don't know what is causing it. Along with discomfort, chronic pain can cause low self-esteem, depression and anger, and it can interfere with your daily activities.

How is chronic pain treated?

Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants and anticonvulsants. Different types of medicines help people with different types of pain. Usually you use long-acting medicines for constant pain. Short-acting medicines treat pain that comes and goes.

Several types of therapy can help ease your pain. Physical therapy (such as stretching and strengthening activities) and low-impact exercise (such as walking, swimming or biking) can help reduce the pain. Not doing physical activity or trying to do too much can hurt chronic pain patients. Occupational therapy teaches you how to pace yourself and how to do ordinary tasks differently so you won't hurt yourself. Behavioral therapy can reduce your pain through methods (such as meditation and yoga) that help you relax. It can also help get rid of stress.

Lifestyle changes are also an important part of treatment for chronic pain. Getting regular sleep at night and not taking daytime naps should help. Stopping smoking helps, too, because the nicotine in cigarettes can make some medicines less effective. Smokers also have more pain than nonsmokers.

Most pain treatments will not take away all of your pain. Instead, treatment should reduce how much pain you have and how often it occurs. Talk to your doctor to learn how to best control your pain.

What should I tell my doctor about my pain?

Telling your doctor about your pain will help him or her find the right treatment for you. Tell your doctor where the pain is, how bad it is and how often your pain occurs. Also talk about what makes the pain better or worse.

Your doctor may review other health problems (such as arthritis, breathing problems and heart conditions) you may have because these may keep you from doing some types of therapy. Your doctor may also ask if you have had any problems with sleep, mood or anxiety.

Other Organizations

American Council for Headache Education
http://www.achenet.org

American Pain Society
http://www.ampainsoc.org

American Pain Foundation
http://www.painfoundation.org

American Chronic Pain Association
http://www.theacpa.org

Chronic Pain Medicines

What drugs can treat chronic pain?

Many medicines can decrease pain, including the ones listed below. Each one may have side effects. Some side effects can be serious. It's important to listen to your family doctor carefully when he or she tells you how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your doctor or your pharmacist.

Acetaminophen

Acetaminophen (one brand name: Tylenol) helps many kinds of chronic pain. Remember, many over-the-counter and prescription pain medicines have acetaminophen in them. If you're not careful, you could take more acetaminophen than is good for you. Taking too much acetaminophen could cause liver damage. If you often have to take more than 2 acetaminophen pills a day, tell your doctor.

Nonsteroidal Anti-inflammatory drugs (NSAIDs)

Other drugs that help with pain are called nonsteroidal anti-inflammatory drugs, or NSAIDs. Examples include aspirin, ibuprofen (two brand names: Motrin, Advil) and naproxen (two brand names: Aleve [over the counter], Naprosyn [prescription]). These medicines can be taken just when you need them, or they can be taken every day. When these medicines are taken regularly they build up in the blood to levels that fight the pain of inflammation (swelling) and also give general pain relief. Many of these medicines are available in low-dose forms without a prescription.

If your doctor wants you to take an NSAID, always take it with food or milk because the most common side effects are related to the stomach. If you are taking other pain medicines, don't take NSAIDs without first talking to your doctor.

Narcotics

Narcotics can be addictive, so your family doctor will be careful about prescribing them. For many people with severe chronic pain, these drugs are an important part of their therapy. If your doctor prescribes narcotics for your pain, be sure to carefully follow his or her directions. Tell your doctor if you are uncomfortable with the changes that may go along with taking these medicines, such as inability to concentrate or think clearly. Do not drive when taking these medicines.

When you're taking narcotics, it's important to remember that there is a difference between "physical dependence" and "psychological addiction." Physical dependence on a medicine means that your body gets used to that medicine and needs it to work properly. When you don't have to take the pain medicine any longer, your doctor can help you slowly and safely decrease the amount of medicine until your body no longer "needs" it.

Psychological addiction is the desire to use a drug whether or not it's needed to relieve pain. Using a narcotic this way can be dangerous and may not help your pain. If you have a psychological addiction to a narcotic, your doctor may give you another drug to help with your psychological problems. Or your doctor might recommend that you talk to a counselor. Your doctor might also change the medicine that you are addicted to by lowering the dose, changing to another drug or stopping the medicine altogether.

Narcotic drugs often cause constipation (difficulty having bowel movements). If you are taking a narcotic medicine, it's important to drink at least 6 to 8 glasses of water every day. Try to eat 2 to 4 servings of fresh fruits and 3 to 5 servings of vegetables every day. Be sure to tell your doctor if constipation becomes a problem for you. He or she may suggest taking laxatives to treat or prevent it.

Other medicines

Many drugs that are used to treat other illnesses can also treat pain. For example, carbamazepine (one brand name: Tegretol) is a seizure medication that can treat some kinds of pain. Amitriptyline (one brand name: Elavil) is an antidepressant that can also help with chronic pain in many people. Your doctor may want you to try one of these medicines to help control your pain. It can take several weeks before these medicines begin to work well.

Remember -- if you are taking any pain medicine, be sure to ask your doctor or pharmacist before you take any other medicine, either prescription or over-the-counter.

Are drugs the only way to treat chronic pain?

No. Many other treatments can also decrease pain. They can actually change the body's chemicals that produce pain. Almost anything we do to relax or get our minds off our problems may help control pain. It's important to add relaxing activities to your daily life, even if you are already taking medicine for pain. You might have to use stress reduction methods for several weeks before you notice a decrease in pain. Your doctor can give you tips about stress reduction and relaxation methods.

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Understanding Chronic Pain

If you or a loved one suffers from chronic pain, then you already understand how chronic pain and illness can take their toll.

Pain that persists and does not respond to medical therapy impairs your ability to perform basic tasks of daily living. It can also sap your strength and spirit, and jeopardize relationships with the people closest to you. Understanding how pain works is an important first step in finding a therapy that brings you relief, restoring your ability to participate in the activities and with the people you enjoy most.

Pain Is a Natural Response
Pain is the bodys natural response to physical harm or possible damage to tissue or organs. Pain occurs when specialized nerve endings, called pain receptors or nociceptors, are activated by injury or illness.

There are millions of nociceptors located throughout your body. Nociceptors can be triggered by acute or chronic diseases, as well as various types of injury, including trauma, excessive heat or cold, physical pressure, or chemical changes within body tissues that signal damage.

Nerve Fibers Send Pain Messages to the Brain
When a pain receptor is activated at the site of the injury or illness, it triggers the release of chemical messengers that transmit the pain message to the brain. This message is relayed across a pain nerve pathway. The pathway begins at the nerve ending, and is carried along the nerve fiber to where the nerve enters the spinal cord. When the message reaches the spinal cord, it is transmitted to the brain, which interprets the electrical impulse as the feeling we call pain. This unpleasant sensation instantly prompts you to do something to stop the source of pain.

Two Types of Pain
There are two types of pain: nociceptive pain and neuropathic pain. Each is differentiated by its cause, how long it lasts, what it feels like, and the types of medical treatment to which it responds.

Nociceptive pain is caused when specific nerve endings called nociceptors are irritated. Nociceptive pain is the type of pain you feel when you burn your hand, twist your ankle, or stub your toe. Nociceptive pain is characterized by a dull or sharp aching pain, and it can be mild or severe. The pain can usually be controlled if the cause of the irritation is removed, or otherwise medically treated. Nociceptive pain usually responds well to mild pain medications, anti-inflammatory agents, or other drug therapies. Nociceptive pain can be a temporary condition, such as when you have a sprained ankle or a stiff neck. In certain conditions, however, nociceptive pain can be a chronic condition. Cancer pain and arthritis pain are common types of chronic nociceptive pain.

Neuropathic pain is caused by dysfunction or damage to the nervous system, through injury, disease, or localized insult or trauma (for example, an infection or surgery). Neuropathic pain is sharp, intense and constant in nature. It is often described as an extremely painful burning, tingling, shocking, or shooting pain. Neuropathic pain is also very stubborn. It usually does not respond as effectively to standard pain therapies such as mild analgesics and other pain medications.

The Challenge of Chronic Pain
When pain lasts for a long time, it is called chronic pain. At what point pain becomes chronic pain varies somewhat among medical professionals. Many doctors consider pain to be chronic when it has lasted for six months or longer.

Today, chronic pain is one of the most pressing healthcare issues in the world. In the United States alone, more than 34 million people suffer with some type of chronic pain. Chronic pain takes its toll on personal lives, healthcare resources and the economy, too. More than half of chronic pain sufferers are partially or totally disabled. In fact, chronic pain disables more people than cancer or heart disease, and it costs the American public more than both cancer and heart disease combined more than $100 billion in medical expenses annually