Conquering Chronic Pain
When the ache just won’t go away, it’s tempting to give up hope of ever feeling healthy. But today there are a host of therapies that can keep pain at bay.
Nine years ago, I made a foolish mistake: I helped a delivery guy carry new patio doors and windows into my house. Since then, I have struggled while doing the most basic things—opening heavy doors, picking up my kids or pushing a cart full of groceries. Any of these activities can bring on a deep ache or burning sensation in my left leg, heel or foot. To keep the pain at bay, I’ve given up activities I’ve loved—running, tennis, skiing and rollerblading.
There’s a name for my problem: chronic pain, which is defined as pain that persists for more than three months. And I’m not alone. About 42 percent of adults who report pain have experienced it for longer than a year, according to the American Pain Foundation. It’s an expensive problem, estimated to cost $100 billion in healthcare expenses, lost income and lost productivity. And it takes a toll on relationships and marriages; 30 to 60 percent of people with chronic pain experience depression and anxiety. The good news is that chronic pain is treatable. “You may feel like you have no control over your pain, but many therapies can empower you,” says Kenneth Park, D.O., director of pain medicine for Bergen Anesthesia Associates and a staff physician at Holy Name Medical Center in Teaneck.
HOW PAIN SETS IN
When you get hurt—stub your toe, for instance—nearby nerves send a message to the spinal cord, telling your brain to feel pain. The throbbing sensation forces you to rest so that your body can heal. But a more serious injury (such as one that involves nerve damage) or illness can actually change your nervous system, causing pain pathways to become overly sensitive, so that something that wouldn’t normally hurt—like getting a hug or playing a mean game of tennis—now causes a lot of pain.
The most common types of chronic pain include low back pain, migraine, neck pain and facial discomfort. The condition can develop as a result of a car accident, arthritis, fibromyalgia (in which joints, muscles, tendons and other soft tissues are hypersensitive), diabetes or other problems. About 10 percent of people who have surgery may develop chronic pain, and roughly 20 percent of cancer patients will feel discomfort two years after surgery or chemotherapy. Despite its prevalence, chronic pain is undertreated because many primary care doctors aren’t trained in pain management, and some are reluctant to prescribe pain medications because they’re worried about addiction and abuse.
“Once you hit the three-month mark, pain becomes very difficult to treat, so patients have to be more proactive,” says Robert Silverman, M.D., medical director of the Valley Institute for Pain in Paramus. (At the three-month mark, untreated pain may cause nerve cells in the brain to become hypersensitive so that you hurt even though your injury has healed.) If your primary care doctor has prescribed treatment and you haven’t experienced any improvement after four weeks, consider a pain management clinic. Many such clinics are affiliated with a major medical center. Research shows that if you receive treatment quickly, you may be able to prevent chronic pain from taking hold.
Experts agree that the best way to knock out chronic pain is to attack it from many angles. It’s unlikely to resolve with only one therapy because “there are often multiple causes of pain— muscle spasms as well as a herniated spinal disk, for instance,” says Dr. Park. Keep in mind that treatment is usually trial-and-error. “Try as many therapies as you can,” says Dr. Silverman. “You have to tease out what works and what doesn’t.”
Physical therapy (PT)
Many pain medicine experts recommend exercise programs that involve stretching to increase your range of motion, strength training and cardiovascular conditioning. They help reduce discomfort and restore flexibility, strength and function. You may experience a flare-up of symptoms during PT, though, so be sure to find a therapist who is knowledgeable about treating chronic pain.
Biofeedback can help you control bodily functions that you’re normally not aware of, such as muscle tension, heart rate and breathing. Using feedback from a computer or other device, you can learn how to relax muscles, which can help reduce pain.
A recent study showed that acupuncture was more effective than anti-inflammatory drugs, exercise and physical therapy in reducing low back pain among osteoarthritis patients. Acupuncture appears to reduce inflammation and stimulate the body’s natural opiate production.
Massage appears to reduce levels of the stress hormone cortisol, which is associated with pain. It may also decrease levels of a hormone that constricts blood vessels and raises blood pressure, both of which can boost pain.
Yoga may be able to reduce pain by stimulating the body’s natural opioids. Its calming effect may also be beneficial.
The Chinese herb thunder god vine was recently shown to reduce joint pain more effectively than a common medication among rheumatoid arthritis patients. White willow bark (Salix) may help relieve low back pain, and devil’s claw root may be beneficial for low back pain and osteoarthritis. Of course, the U.S. Food and Drug Administration doesn’t regulate these products, so their effectiveness, purity and safety are questionable.
Talking with a psychologist, social worker or counselor can help you reduce the impact pain is having on your life.
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