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Coping with Chronic Pain

Pain is an unpleasant experience that is affected by your physical condition, past experiences, and your attitudes and emotions. Pain can affect your activity level, appetite, sleep, energy, mood and relationships. Each individual learns the meaning of pain through their own experiences related to injuries in early life and this is the basis for their tolerance and their coping capabilities to pain.

Pain is one of the most common reasons why people seek medical care. The most common types of pain are: headaches, arthritis pain, low back pain and cancer pain,

There are many causes of pain - illness, surgery, procedures, and even some types of treatment can cause pain. Acute pain (cuts, bums) lasts a short time whereas chronic pain (arthritis, cancer) may last for years. More than 50 million suffer from chronic pain (one in three) caused by various diseases and disorders, and each year another 25 million experience acute pain as a result of injury or surgery. Sick time, reduced productivity and direct medical and other benefit costs due to chronic pain among employees is estimated at $90 billion annually.

Learning to manage pain is important to your health and well being. The best way to relieve pain is to treat the cause. Almost all types of pain can be controlled with pain medicines and proper treatments. And many of the 44 alternative" treatments can be effective without medication. These are from the University of Wisconsin and City of Hope Pain Resource Center.

Relaxation relieves pain or keeps it from getting worse by reducing tension in the muscles. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety and make other pain relief methods work better, such as a hot or cold pack.

Imagery is using your imagination to create mental pictures or situations. It can be thought of as a deliberate daydream that uses all of your senses
sight, touch, hearing, smell and taste. Some think of it as a form of self
hypnosis. It can also help reduce the closed
in feeling you may get when you must stay in bed or in the house for extended periods of time.

Distraction means turning your attention to something other than the pain, such as watching television, listening to the radio, reading, working with your hands or going to a movie. Distraction may work better than medicine for sudden and intense or brief pain (5 to 45 minutes), since it takes awhile for most pain medications to work.

Skin stimulation is the use of pressure, massage, vibration, heat, cold or menthol preparations (Ben-Gay, JointRitis) to excite the nerve endings in the skin. In theory, stimulation alters the flow of blood to the affected area, and when nerve pathways transmit these other sensations, this can cause the pain to be lessened or blocked.

Note: Some menthol preparations contain an ingredient similar to aspirin, so if you have been told not to take aspirin, do not use until you check with your doctor.

Other methods that may be useful are acupuncture, biofeedback, TENS units (Transcutaneous Electric Nerve Stimulation) and nerve block injections.

Not all doctors know how to treat pain and as a result most pain goes untreated, under treated, or improperly treated. Pain is not something you "just have to live with." And you shouldn't be afraid of taking pain medications even morphine. There are many different medicines that can be used to treat pain including many that we buy over the counter. As you will soon see, they are not all equally effective.

  Aspirin Tylenol Advil Actron Aleve
Headache O O O O O
Fever O B O O O
Osteoarthritis O B O O O
Inflammation O No B O O
Menstrual Cramps O No B O O
Blood Thinning B No No No No
B = Best O= OK No = Avoid

Salicylates: Aspirin is the best known of this group, often touted as a wonder drug, relieving headaches, menstrual cramps, osteoarthritis and inflammation. But it can also cause upset allergic reaction, asthmatic's breathing can be affected and it is associated with Reye's syndrome in children. It is not recommended for those With Ulcers. new mothers, or someone about to undergo surgery or tooth extraction. Bufferin adds some antiacid to counteract the stomach upsets and some manufacturers apply an enteric coating (Ecotrin) to make them resistant to stomach acid, but it also slows digestion and delays the onset of pain relief.

Acetaminophen: Tylenol falls into this category and is effective as aspirin for headaches, fever and mild pain. It is one of the gentlest analgesics on the market. It also doesn't thin your blood as does aspirin. It is considered safe for children. But ... it doesn't help with menstrual cramps or inflammation, a major cause of pain, or with arthritic symptoms. If taken on a regular basis, one should limit their alcohol intake to avoid liver damage.

Non-asteroidal anti-inflammatory drugs (NSAIDs): This class of analgesics has anti-inflammatory benefits like aspirin, but they are much better tolerated. There are three main types. Ibuprofen (Advil, Motrin, Midol, etc.) is the most popular. Ketoprofen (Actron, Orudis KT) is the newest. Naproxen (Aleve) can cause a skin rash in children. All are effective for joint pain, stiffness, swelling and gout. They are the best choices for menstrual cramps, and also treat minor pain, fever and inflammation. They aren't recommended for broken bone pain, children, or anyone with allergies to aspirin. If these are taken for an extended period of time, they can cause silent intestinal bleeding which can be fatal. Ulcers and reduced liver and kidney functions are also possible.

Narcotics or Opioids: These include morphine and codeine and require a prescription. They work primarily by blocking pain sensation in the spinal cord and brain. Possible side effects include constipation, drowsiness, nausea and slowed breathing. Chances of becoming addicted are less than one in 10,000. There is a clear distinction between being temporarily "physically dependent" on a drug after you've taken it for several weeks (such as in an acute pain situation) and becoming psychologically addicted long after the drug is no longer needed.

With any medication, your body can get used to it so that you need to take more medicine to equal the same effect. This only means you have developed a tolerance to the medicine, not that you are addicted. You can either increase the level, add a complementary medication, or switch to another type.

To keep your pain under control, you will need less medicine and have fewer side effects if you take it on a regular basis even if you aren't hurting.

In discussing pain with your doctor, here are some points to remember. It's good to write them down before you go

When you leave the doctor's office you should have established set goals for problems you want to tackle, e.g., sleep, work, etc. Developing a pain management plan could include medications, physical therapy, and/or some alternative methods. Keep a pain diary so you can track what works. If you need some emotional support for coping with the pain, find a support group or see a medical professional. After several visits, if you are not getting relief, find another doctor or pain care program.

The Pain Care Bill of Rights has been provided by The American Pain Foundation. Although not required by law, as a person with pain you should, expect to have:

  • The right to have your report of pain taken seriously and to be treated with dignity and respect by all health care professionals.
  • The right to have you pain thoroughly assessed and promptly treated.
  • The fight to be informed by your doctor about what may be causing your pain, possible treatments, and the benefits, risks and costs of each.;\
  • The right to participate actively in decisions about how to manage your pain.
  • The right to have your pain reassessed regularly and your treatment adjusted if your pain has not been eased.
  • The right to be referred to a pain specialist if your pain persists.
  • The right to get clear and prompt answers to your questions, take time to make decisions, and refuse a particular type of treatment if you choose.

Isolation and fear can overwhelm a person who has coped with chronic pain over a long period of time and it may take a great deal of time and effort to return to a more rewarding life. The American Chronic Pain Association feels there are 10 steps to help you move from being a Patient back to being a Person. 1) Accept the pain. 2) Get involved in your care plan. 1) learn to set *priorities. 4) Set realistic goals. 5) Know your basic rights. 6) Recognize your emotions. 7) Learn to relax. 8) Exercise, eat well and drink plenty of water. 9) See the total picture, focusing on your abilities not disabilities. 10) Reach out and share what you know with the other "one out of three" who also suffer.


References: The American Chronic Pain Association at http://www.theacpa.org/ or 1-916-632-0922; the Cancer Care at http://www.cancercare.org/ or 1-800-813-HOPE; the American Pain Foundation at http://www.painfoundation.org/ or I-888-615-PAIN; the American Academy of Pain Medicine at http://www.painmed.org/; the American Pain Society at http://www.ampainsoc.org/.


Senior Update Editorial Board: B. Mulholland, Editor; D. Brown, J. Ellefsen, C. McLain, D. Nelson, J. Selby, J. Steiner, L. Epstein, F. Rose, N. Hartschen; M. Kaufmann, Staff and Desktop Publishing; B. Williams, Volunteer.




Article used by permission.


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