Prevention

How to Safely Combat Pain

There’s nothing worse than feeling pain. The longer you experience it, the more it seems to affect you. Whether your pain is acute or chronic, pain is pain. And what’s primary on your mind is what to do about it. But before you make a decision about getting a prescription for an opioid painkiller, consider the other remedies for alleviating pain that may be a better option.

Acute vs. Chronic Pain

First, however, it’s important to differentiate between acute and chronic pain. According to WebMD, acute pain begins suddenly and is sharp in quality. It may serve as a warning sign of disease or some kind of threat to the body. Acute pain may be mild and last only a short time, or it can be severe, lasting many weeks or months. Usually, acute pain lasts less than six months – disappearing when the underlying condition is treated or heals. Examples of incidents causing acute pain include childbirth, dental work, broken bones, cuts and burns, and surgery. If the underlying condition remains untreated, however, acute pain can become chronic pain.

Chronic pain, on the other hand, is pain that persists even after an injury has healed. WebMD advises that pain signals remain active in the body’s nervous system for varying lengths of time: weeks, months, or even years. Chronic pain has numerous physical effects, including limited mobility, changes in appetite, lack of energy and muscle tenseness. It also has several emotional effects, including anger, anxiety, depression, and fear of re-injury. All of these effects may serve to prevent the chronic pain sufferer from returning to work or normal activities.

People complaining of chronic pain may have one or more of the following pain causes: arthritis, cancer, headache, low back problem, nerve damage, or psychogenic pain (pain not caused by past injury, disease or visible sign of damage).

Methods to Treat Pain

Numerous methods exist to treat pain. These include non-prescription or over-the-counter (OTC) and prescription drugs, nerve blocking, alternative treatments, electrical stimulation, exercise and physical therapy, spinal decompression therapy, surgery, psychological counseling, and behavior modification. Some of these are more effective when combined with other forms of treatment. In addition, pain sufferers often need to try several different methods in order to obtain the needed relief. We’ll examine each of the pain treatment methods separately.

Non-Prescription Medication

The quickest pain relief for many individuals is to reach for a bottle of aspirin, Motrin, Aleve, or Tylenol. Pain relievers and fever reducers are safe when used as directed, but do pose risks for people with certain conditions or who are taking specific medicines. Acetaminophen products include Tylenol and Panadol. Non-steroidal-anti-inflammatory drugs (NSAIDs) include such OTC products as aspirin, ibuprofen (Advil and Motrin), naproxen sodium (Aleve) and ketoprofen (Orudis KT). These products can cause stomach bleeding with an increased risk for consumers over the age of 60, those who take prescription blood thinners, steroids, or who have a history of stomach bleeding. They may also cause reversible kidney problems in those who have a preexisting kidney disease or are taking a water pill (diuretic).

Prescription Drugs

Depending on the severity and duration of the pain, some patients turn to stronger prescription painkillers (opioids) to ease their suffering. Medications commonly prescribed for pain include codeine, morphine, and anesthesia.

According to the National Institute on Drug Abuse (NIDA), opioids include hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil). The chief caution about long-term use of opioids is that they can lead to physical dependence and addiction. Opioids, according to NIDA, can produce constipation, drowsiness, and, depending on the amount taken, may even depress breathing.

When taken as prescribed by a physician, and not abused, alone or in combination with other prescription and/or OTC drugs, illegal drugs or alcohol, most painkilling medications are safe. They are meant to be taken as a short-term pain remedy, however, and are not appropriate for long-term use. In addition, certain opioids, as well as other prescription drugs such as stimulants, sedatives and tranquilizers, have side effects.

Elderly people are particularly vulnerable to prescription drug abuse, since they are more often prescribed several medications for a number of different health conditions.

Nerve Blocking

Chronic pain such as that caused by herniated discs may be alleviated by nerve blocking. This involves using local anesthetics to block a group of nerves. Since the pain of herniated discs is aggravated by inflammation, temporary nerve blocking with anesthetics allows the inflammation to decrease, thus reducing pain. For severe chronic pain, the pain management physician may order a series of nerve-blocking injections, spaced a week or more apart.

SpineUniverse lists the various types of spinal injections/nerve block therapies that help reduce and stop back pain. Injections deliver pain reducing medicine directly to the source of the pain. The types of injections include:

• Epidural
• Diagnostic
• Nerve Block
• Spinal Joint Blocks and Injections
• Cervical: Specific Injection Therapies
• Lumbar: Specific Injection Therapies
• Thoracic: Specific Injection Therapies
• Soft Tissue Injections – also called trigger point injections

It is important to note that spinal injections to alleviate pain are considered an adjunct treatment. It is used to facilitate participation in active exercise programs. Practitioners say it may help the patient with chronic pain to avoid surgical intervention.

Alternative Treatments

Acupuncture, yoga, relaxation and biofeedback are examples of alternative methods to safely combat pain.

• Acupuncture – WebMD indicates that acupuncture is thought to decrease pain by increasing the release of endorphins that block pain. The practice of acupuncture involves the use of disposable, stainless steel needles that are inserted into the body’s 14 major meridians (also known as energy-carrying channels), in order to correct imbalances in the body and overcome or resist illnesses and conditions. Acupuncture is most effective in treating chronic pain such as low back, neck or muscle pain, headaches, and menstrual cramps. It is also used to treat pain caused by arthritis, shingles, spastic colon and colitis, among other conditions. After the needles are inserted, they are twirled to produce electricity, or electricity flows through them. The needles remain in place for a few minutes. If the tingling from the electricity is too strong, the patient can ask the acupuncturist to reduce the intensity. In typical sessions and over the course of treatment, different combinations of needles and techniques are used to help stimulate new sources of healing. Acupuncture appears to be safe, with relatively few side effects. Go to a well-trained and experienced acupuncturist.

• Yoga, Tai Chi and Pilates – As reported in an L.A. Times story, a three-year study of 90 chronic low back pain funded by the National Institutes of Health found that twice-weekly yoga sessions for a period of 24 weeks appeared to relieve pain and improve mood. Six months after the study ended, those in the yoga group reported significantly more improvement in pain and functionality as compared to a control group. The yoga classes were taught by an instructor certified in Iyengar yoga, a type of yoga that emphasizes posture. Tai Chi is a gentle program of exercise shown by scientific studies to relieve pain, strengthen muscles, and improve blood circulation, stamina, balance and relaxation. While there are many different Tai Chi programs, special emphasis is placed on strengthening the deep stabilizing muscles of the back. Strengthening these muscles improves pain and improves physical function. Pilates, on the other hand, according to AltMD, is an ideal and easy way to alleviate neck pain by stretching and elongating muscles, aligning posture and improving strength, balance and flexibility. Like yoga, Pilates pays close attention to form and sustained stretches. Pilates uses eight guiding principles: relaxation, concentration, alignment, centering, breathing, coordination, flowing movements and stamina. Pilates should only be practiced under the guidance of a well-trained and certified Pilates instructor.

• Hypnosis – Scientists believe that hypnosis helps relieve pain by blocking nerve pain receptors in the brain. In the brain, these receptors control sensations of anxiety, discomfort and pain. Studies have shown that cancer-related pain and pain from back injuries, surgeries, and migraine headaches, appear to respond well to hypnosis. You learn the skill from a trained therapist and then are able to self-hypnotize. In general, you learn to focus your attention to achieve a desired purpose – such as alleviating pain. In essence, you focus your attention on an image, and your mind seizes on that image, blocking the perception you have of pain. As a result, you feel less pain. With practice, your subconscious mind replays that image again and again, effectively blocking pain.

• Relaxation – Pain can also be relieved by relaxation techniques. Some of these techniques include rhythmic breathing, deep breathing, visualized breathing, relaxing to music, mental imagery relaxation (also called guided imagery), and massage.

• Meditation – Research has shown that meditation helps lower blood pressure and improves heart rate, brain waves, and breathing. Tightness and tension melt away from muscles as the body receives gentle, quiet messages to relax. Traditionally, a single word or phrase is repeated, the “mantra,” all the while focusing on breath and ignoring thoughts. Practitioners of meditation report feeling soothing warmth, calmness, and a sense of heaviness (groundedness) while they meditate. You can learn meditation from a teacher or you can pick up the skills on your own. Meditation classes are a good start.

• Biofeedback – The American Pain Foundation says that biofeedback is a “time-tested methodology for using the power of the mind to treat pain.” Biofeedback is a spectrum of techniques that may involve using different machines and electrical technology to help patients receive information about their bodies react to the way they think. Through biofeedback training, patients gain control over their pain, and may also be able to control high blood pressure and depression. WebMD says biofeedback has been used to help control migraine pain, epilepsy seizures, and other common problems. Other mind-body therapies include mindfulness meditation, cognitive behavioral techniques, and hypnosis, although this is not an all-inclusive list.

Electrical Stimulation

Minimally invasive, cervical facet radiofrequency neurotomy, also called radiofrequency (RF) rhizotomy, reduces or eliminates pain of damaged facet joints by disrupting medial branch nerves that carry pain signals. The procedure, carried out under local anesthetic, takes about 1-2 hours and requires two sessions. The patient usually experiences relief from the pain within one month. Studies have found that successful RF neurotomies can last longer than steroid block injections.

Other electrical stimulation therapies include transcutaneous electrical nerve stimulation (TENS), radiofrequency ablation and spinal cord stimulation. Neurostimulation treatment involves using painless electrical impulses to interrupt pain signals. There are two types of neurostimulation systems – one is powered by a battery that is surgically implanted beneath the skin, and the other system uses a battery that is worn outside the body.

Exercise and Physical Therapy

For most back pain conditions, active back exercises and stretching – and not rest – are typically better at reducing pain and encouraging healing, according to Spine-Health. Stretching benefits everyone, whether getting ready to go on a hike or brisk walk, or to engage in modest exercises, or physical therapy regimen. In fact, stretching exercises should always precede any of these activities.

Back pain exercises and rehabilitation programs will differ according to the patient’s condition and level of pain. For this reason, it is important that individuals see a spine specialist who can tailor a personalized program of back exercises and give instruction on how to correctly perform the exercises. The specialist will give the patient a prescription for physical therapy. Insurance may cover some of the cost of the physical therapy or rehabilitation. A balanced workout includes stretching, strengthening and low-impact aerobic conditioning. Typical physical therapy sessions begin with relaxing heat followed by a therapeutic massage of the affected area. Stretching of the loosened muscles then takes place, followed by a series of exercises, graduating in repetitions and complexity as the patient is able to do them without pain. The session concludes with icing of the affected area.

Those with chronic back pain may find that they require months of stretching in order to gain the mobility in their spine and soft tissues. After months of stretching, however, most chronic back pain sufferers find their pain levels have decreased and they are able to experience increased range of motion.

Benefits of low-aerobic exercise for persons with low back pain include an increased production of endorphins, the body’s natural painkillers, that can reduce pain after 30 to 40 minutes of exercise; an elevation of mood as a result of the endorphins (persons with back pain often suffer from depression); fewer episodes of back pain, and less pain when it does occur. Endorphins can also reduce the need for pain medication – a substantial benefit in order to safely combat pain.

Low-aerobic conditioning exercises include:

• Walking – 2 to 3 miles, three times a week
• Stationary bicycling or “spinning” classes
• Elliptical trainer or step machine
• Water therapy

Maintenance programs of vigorous physical exercise are also helpful once patients have reached an optimum stage of mobility and pain reduction. Any form of strenuous exercise will suffice, from brisk walking in the canyon trails, to participation in sports, working out at the gym, swimming, and others. To be effective, however, the maintenance exercise program should involve 30 minutes to one hour, four days a week.

Spinal Decompression Therapy

Instead of opting for surgery to correct back problems (and the resulting pain), many chronic back pain sufferers are opting to find relief with spinal decompression therapy. In this type of non-surgical therapy, vertebrae in the patient’s back are put into traction. In the procedure, the vertebrae are slowly pulled away from each other so that healing nutrients can flow into the damaged area, allowing healing to begin.

Treatments usually start off with several sessions the first week, followed by follow-up treatments that are spaced further apart. Decompression therapy has been successfully used to treat herniated discs.

Surgery

Spine-Health identifies certain structural spine conditions (degenerative disc disease, spinal stenosis and spondylolisthesis) as examples of chronic pain that can result in ongoing pain until the diagnosable anatomical problem is successfully treated. After several weeks or a few months of more conservative treatments (see above), spinal surgery may be considered as a treatment option.

Some surgeries to alleviate chronic pain include joint replacement, tumor excision, and discectomy. In severe cases of chronic pain where all other methods have proven ineffective, cordotomy may be performed. This involves severing nerve fibers on one or both sides of the spinal cord, eliminating sensations of temperature and pain.

Due to lengthy recuperation time and potential need for physical therapy and rehabilitation, as well as the risks associated with any such procedure, surgery should only be considered as a last resort option in most cases.

Psychological Counseling

Pain is a “whole person experience,” according to the Stanford School of Medicine Pain Management Center. Chronic pain can lead to profound psychological effects such as feelings of depression, sadness, anger, hopelessness and despair. Psychological counseling can help many pain sufferers to develop specific skills that both relieve pain and increase quality of life.

Individual and group psychological therapy is available, and both use a variety of techniques. Psychophysiological techniques include biofeedback and relaxation. Other techniques include behavioral (self-monitoring and paced, progressive increases in activity levels), cognitive (self-hypnosis and visual imagery, and emotional management), and home treatment aids.

Behavior Modification

This type of treatment involves training the patient incrementally to alter or change their specific behaviors and is often used in conjunction with other pain management or treatment modalities. Biofeedback and relaxation training, for example, are two types of behavior modification treatment for pain.

How to Choose the Right Method to Combat Pain Safely

Before deciding on any specific course of pain treatment, see your doctor for a complete physical examination. If the problem requires it, your doctor will refer you to a specialist, often a spine specialist, for further tests and evaluation. From there, a comprehensive and minimally invasive or nonsurgical treatment program can be personally designed to fit your circumstances and wishes. Some patients who have chronic pain may be candidates for surgery but may not wish such an invasive procedure with all its attendant risks. Others may have a condition that surgery cannot fix. In any case, only proceed under a doctor’s guidance. In addition, many of the procedures to eliminate pain require a prescription or referral from a physician (such as physical therapy, nerve blocking, electrical stimulation, etc.).

Remember that it takes time for any procedure or treatment to work. Be patient, follow your doctor’s or therapist’s advice, and look forward to the day when your pain will be reduced or eliminated – as safely as possible.

Article Written by Suzanne Kane