Living a Healthy Life with Chronic Pain (42 page)

In addition to medicines, your primary doctor, pain specialist, or other health care provider may suggest other types of interventions to treat your chronic pain. These treatments include a variety of physical, psychological and medical therapies, and self-management tools that we discuss in detail in the following material.

Acupuncture is the practice of inserting thin, solid needles into one or more of 361 specific points in the skin that lie along “meridians”—lines of energy flow in the body. The area where the needles are inserted are stimulated when a practitioner twirls the needles for brief periods. The needles are so thin that virtually no pain is felt when administered by a qualified practitioner.

Acupuncture originated in China and has been used for thousands of years. Scientists are not exactly sure how it works, but they think that the needle stimulation may release endorphins and other pain-relieving substances to close the gate in the spinal cord. (See
page 6
). Recall from
Chapters 1
that endorphins are neurochemicals that serve as the body’s natural painkillers. Acupuncture may also activate the immune system and improve blood flow. Another contributing factor to the effectiveness of acupuncture may be the person’s belief that it will help them. This placebo response is exactly the same as believing that medicines will work. Again, this is another example of how powerful our mind can be. (See
Chapters 15
,
pages 252
–
253
.)

Much research on acupuncture has been conducted in the United States, Canada, and Europe over the past 40 years. There is now solid evidence that the procedure can help some people with chronic back and neck pain, shoulder pain, osteoarthritis, and chronic headache. It is not known if acupuncture is helpful for fibromyalgia. Acupuncture is now routinely used in the United States military for pain management. As with any treatment, if you decide
to have acupuncture, be sure to seek a qualified practitioner. In the United States, contact the National Certification Commission for Acupuncture and Oriental Medicine (
www.nccaom.org
) or the American Academy of Medical Acupuncture (
www.medicalacupuncture.org
). In Canada, contact the Acupuncture Foundation of Canada Institute (
www.afcinstitute.com
).

Exercise is an essential component of chronic pain treatment for everyone. Various types of movement, physical activity, and exercise are discussed in
Chapters 7
,
8
, and
9
. Effective exercises include the gentle Moving Easy Program, balance exercises, aerobic activity such as walking, biking, and water aerobics, as well as resistance or weight training, yoga, and tai chi. There are many people who can help you develop a physical activity program that is right for you. Review these chapters to incorporate exercise into your overall pain treatment plan.

Pain treatment options include injecting medications into painful areas of the body, injecting medications around certain nerves, surgically inserting an electrical device or medication pump into the spinal canal, or surgically cutting nerves.

Trigger point injections are injections of anesthetic into so-called trigger points, which are hard knots of muscle, ligaments, or tendons. These painful trigger points can be caused by direct pressure on a muscle, chronic muscle tension, abnormal posture, or prolonged muscle fatigue. Injecting trigger points with anesthetic can result in temporary relief of pain. This pain relief can in turn allow the person to stretch and exercise to improve their function. Trigger points can also be managed with massage, exercise, and relaxation techniques.

A nerve block is an injection of an anesthetic or steroid medicine into an area of the body such as a sore joint, or into the space around the spinal cord. This technique has been used for more than 50 years for lower back pain, neck pain, and arthritis. Results are varied; some people experience pain relief while others do not. If there is relief, it can last from hours to days to weeks, but the effect is temporary.

For more severe pain problems, surgeons insert an electrical device called a spinal cord stimulator around the spinal canal. This reduces pain signals going to the brain. Another option is a surgically implanted small pump that delivers pain medications (such as local anesthetic and opioids) directly into the spinal fluid. Both of these techniques are very expensive and do not help everyone who undergoes the procedures. Cutting nerves surgically is usually a treatment of last resort in patients with terminal cancer who have severe pain.

Manual or hands-on therapy can consist of mobilization, manipulation, and massage. Mobilization involves gently moving a joint through its existing range of motion. Manipulation is a more forceful movement of a joint, sometimes beyond its range of motion. Both mobilization and manipulation can improve the range of motion of a joint, allow increased movement and activity, and reduce pain.

Massage is a form of hands-on therapy that works on the muscle and other soft tissue. It has been studied a lot and it has few risks. There are many kinds of massage therapy, including Swedish massage, sports massage, lymphatic drainage, and massage that focuses on trigger points. Massage can help relax muscles and tissues and improve blood flow to an area. It is helpful for people with chronic lower back pain, chronic neck pain, and osteoarthritis of the knee, and it may also help reduce depression. It may temporarily reduce pain, fatigue, and other symptoms for people with fibromyalgia. Studies are currently being done to assess its impact on headache.

Spinal manipulation has been studied and found to be helpful for chronic lower back pain, and it may be helpful for chronic tension-type headaches, neck-related headache, and the prevention of migraines. While it is safe for most people if performed by a qualified practitioner, there are some risks. See the National Institutes of Health fact sheet
Chiropractic: An Introduction
(
www.nccam.nih.gov/health/chiropractic/introduction.htm
).

Your health care provider might suggest techniques for pain management that you can do at home. One of the most common is transcutaneous electrical nerve stimulation, or TENS. With TENS, a small, battery-powered machine about the size of a pocket radio transmits electrical impulses that counteract pain. You connect two electrodes from the machine to your skin, near where you are feeling pain. When the machine is turned on, you will feel a tingling sensation or vibration that may mask pain signals. While this treatment does not help everyone, it does have some advantages. It is easy to learn, safe, inexpensive, and within your control. It can be set for different wavelength frequencies and intensities so that you can experiment with the setting that works best.

Manual therapy can be conducted by a variety of licensed health care providers, including physical therapists, chiropractors, osteopaths, and registered massage therapists. As with any treatment, be sure to seek a qualified practitioner by going to your state or provincial certification boards.

Treatment for the body is only one part of managing chronic pain. You also need to be sure your mind and your emotions are doing okay. As discussed in
Chapters 5
, at times you may need help dealing with your thoughts, emotions, and feelings. This is where psychologists can be very helpful. Psychologists are highly–trained therapists who specialize in human behavior and emotional health. Talk to your health care provider about how you are feeling. He or she can ask you questions to determine if you may have an underlying depression or other disorder that can be medically treated. If you need help dealing with your emotions and stress, he or she can help you locate a qualified health psychologist in your area, or you can contact your state or provincial licensing body to find a psychologist with expertise in chronic pain.

One of the most frequently used therapies for chronic pain is cognitive-behavioral therapy, or CBT. This approach is based on the idea that what we think and feel influences how we behave, and how we behave influences our thoughts and feelings. CBT helps people think realistically about their pain by encouraging
them to examine their thoughts, feelings, and behavior, including their stress responses and make positive changes. Researchers have found that CBT reduces depression and anxiety, disability, and negative or catastrophic thinking and improves everyday functioning in people who suffer from many kinds of chronic pain. This includes people who have pain conditions including lower back pain, headaches, arthritis, mouth or face pain, and fibromyalgia.

With other therapies in addition to CBT, psychologists help people learn specific ways to manage their stress responses and quiet their nervous system. Sometimes, relaxation techniques can be improved by coaching from a therapist. Coaching can be for individuals or groups. A biofeedback machine is another tool used to manage stress. In biofeedback, sensors record bodily processes such as heart rate, skin temperature, and muscle tension. Through relaxation approaches such as deep breathing and focused attention, a person can produce changes in the body and mind that improve pain and other symptoms. The biofeedback machine helps people to see how this works by recording changes that occur in the body when relaxation techniques are used.

Pain clinics offer a variety of treatments and education. Some clinics are staffed only by pain physicians who offer expert advice on medications and other medical procedures, such as trigger point injections and nerve blocks. The best programs have a multidisciplinary team that may include psychologists, physical and occupational therapists, social workers, nutritionists, pharmacists, specialist nurses, exercise specialists, and others. Multidisciplinary pain programs use a combination of the treatments and techniques described in this book. Although these programs are usually for people with severe chronic pain, there are also pain assessment services and short programs for people who are less disabled by their chronic pain.

Ask your doctor or health care provider if a pain clinic is an option for you. He or she should be able to refer you to one that addresses your specific pain problem. Pain clinics are in most U.S. states and Canadian provinces. If your doctor is not able to help, try contacting your local hospital, medical school, or pain-related organizations.

Chronic pain affects everyone differently. There are a variety of medicines, treatments, and resources to help you. Finding the right combination takes patience and persistence. Work closely with all your health care providers so that you can find ways to manage your pain and do the things you want to do every day.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources. See also the suggested readings and other resources for
Chapters 15
.

Darnall, Beth.
Less Pain, Fewer Pills: Avoid the
Dangers of Prescription Opioids and Gain
Control over Chronic Pain
. Boulder, Colo.: Bull Publishing, 2014.

Foreman, Judy.
A Nation in Pain: Healing Our Biggest Health Problem
.New York: Oxford University Press, 2014.

Y
OU HEAR ABOUT NEW TREATMENT,
new drugs, nutritional supplements, and alternative treatments all the time. Hardly a week goes by without a new medical discovery of some kind showing up in the news. Drug and nutritional supplement companies run television commercials and place large ads in newspapers and magazines. E-mail inboxes are filled with promises of cures from spammers. You are bombarded with promotions for over-the-counter alternative treatments in the market and pharmacy. Your health care providers may recommend new procedures, medications, or other treatments that you don’t know much about.

What can you believe? How can you decide what treatments to try?

An important part of managing your own care is being able to evaluate claims or recommendations so you can make informed decisions about your own health. It is easy to think that a special diet or new treatment may be the answer to chronic pain. We all want the “magic bullet” that will take the pain away. Unfortunately, this seldom happens with chronic pain.

In this chapter, our aim is to help you learn to ask the right questions so you can better evaluate claims and suggestions. If you are able to gather the right information, you are one step closer to making the right decisions for you and being a successful self-manager.