Tools for pain management
From nerve blocks to physical therapy, discover what your options are.
"Tell me where it hurts. I'll make it all better."
Remember when a few magic words and a kiss were all it took to make pain go away? If only it was still that simple. Acute or chronic, mild or severe, everybody experiences pain.
The National Center for Health Statistics reports that 41 percent of adults have experienced chronic pain (pain that lasts more than a year). The majority are women, who have twice as many nerve fibers in their skin, but who, on average, receive less treatment. In fact, women's symptoms are often attributed to psychological or emotional causes rather than physical sources. Low-income individuals suffer more than those with high-incomes. And back pain is the most common complaint, followed by migraine, joint, abdominal and soft tissue pain. Pain is a growing health issue, and one that's not going away anytime soon.
The pain problem
Acute pain resulting from injury, surgery or illness usually responds to medication, heat or ice, rest and, that healer of all wounds, time. With long-lasting pain caused by disease, nerve damage, stress or repetitive injuries, finding relief is complicated. Even when the initial injury has healed, the pain sticks around.
As our population ages, pain management is becoming a key medical focus. The best news, however, comes from research and treatments done on soldiers returning from active duty with a wide array of pain issues. Studies show that veterans experience significantly worse pain compared with the general public because exposure to trauma and psychological stress increases pain and compounds therapy. This has led to multidisciplinary treatment plans where traditional medicine works in tandem with alternative therapies. The results are promising.
Traditionally, the simplest tools for managing chronic pain are over-the-counter medications like ibuprofen, acetaminophen or aspirin. Stronger, prescription, non-steroidal anti-inflammatories like Celebrex and Voltaren, or opiates such as Vicodin and Percocet, are the next step. If that doesn't cut it, doctors pull out the power tools.
Nerve blocks inject local anesthetics, steroids or opioids near nerves to prevent pain signals from reaching the brain. Doctors who treat veterans discovered that using nerve blocks as soon as possible after injury may disrupt pain circuits before long-term changes set in. Trigger point injections work on muscles that become knotted, inflamed or irritated. Intrathecal pumps deliver continuous small doses of local anesthetic into the spine. These treatments are almost always used in conjunction with physical therapy.
Kate Thompson, RNP, a family and psychiatric nurse practitioner with the Legacy Good Samaritan Pain Management Clinic in Portland, Ore, says: "Research shows multidisciplinary pain clinics have the best outcomes overall. Patients are empowered with information to understand why they're hurting, how to manage their pain, the benefits of activity, and getting sleep cycles under control. People with ongoing pain lose function, relationships and activities that give them pleasure and joy. Depression and anxiety start eating away at their quality of life."
Thompson explains that successful programs integrate physical therapy, pain education, stress management, mental health practitioners, social workers, vocational rehabilitation, occupational therapy, and medication management to hit all the targets.
Alternative, integrative modalities aren't just for hippies anymore. Studies show that 80 percent of Americans acknowledge that their mental health affects their physical health. Emotional and physical pain form a cycle where stress increases perception of pain and, in turn, pain increases stress. These days, acupuncture, chiropractic, massage therapy, biofeedback, yoga and meditation are big players in the war on pain.
- Chiropractic: Studies show that chiropractic care is as effective as traditional medicine for treating some headache, back and joint pain. The American Chiropractic Association explains, "Chiropractic adjustment restores joint mobility by manually applying a controlled force into joints that have restricted movement." Once patients recover from pain, chiropractors focus on lifestyle changes, including nutrition, stress management, fitness and occupational habits to prevent injury.
- Acupuncture: The National Institutes of Health reports that acupuncture is widely successful in treating pain. In Chinese medicine, it's thought that pain and disease result from blocked energy channels that run along meridians, or energy pathways, throughout the body. By placing needles at specific points along the channel, healthy energy is restored. Western medical research shows that acupuncture at specific pain points releases our body's natural pain killers (endorphins and opioids), along with immune system cells, neurotransmitters and neurohormones.
- Biofeedback: This treatment is most effective for patients willing to do the work. Patients are trained to use their mind to control typically involuntary body functions, like muscle tension, that may contribute to pain. Using electromyography sensors, the patient receives auditory or visual cues, such as "tense muscle." Once they learn to associate these functions with pain, they learn to control them through relaxation techniques.
Put your body into it
The American Pain Foundation says that meditation also eases tension and fatigue, and teaches us we can choose how to pay attention to pain and diminish the negative chain of psychological responses we have to it. Instead of responding unconsciously to pain, we become aware of our habitual and automatic responses.
Thompson explains that "exercise and physical therapy are crucial elements in pain management." Physical therapy is reported to be as effective as surgery in treating certain types of spine, muscle and joint pain. A wide variety of physical therapy styles match patients' unique issues; some with a sports focus, others offering yoga-based exercises, massage, ultrasonography, or occupational therapy.
Yoga is particularly effective at treating back pain by providing stress relief, improved joint range of motion, muscle tone, flexibility and circulation. Be careful to choose a supervised program that's safe for your injury. You don't want to get stuck in a downward dog you can't get out of.
"The better informed patients are about medication, the more willing they are to be physically active and use relaxation strategies, the more successful they will be." Thompson explains. "We empower patients to take
charge of their pain, instead of letting pain be in charge of them." While there's no one magic solution for pain, integrative care can go a long way toward making it better.
Jeanne Faulkner is a freelance writer and registered nurse in Portland, Ore. Her work appears regularly in Pregnancy and Fit Pregnancy, and she has contributed articles to the Oregonian, Better Homes & Gardens, Shape and other publications.