Living a Healthy Life with Chronic Pain (43 page)

There
are
treatments out there that may help you manage your pain better. But before you explore your options, you need to know how to evaluate what you hear and read. Ask yourself these important questions before making a decision about any treatment, whether it is a mainstream medical treatment or a complementary or alternative approach.

Did your doctor or other health care provider suggest it? Was it reported in a scientific journal? Or did you read about it in a supermarket tabloid, print or TV ad, website, or flyer you picked up somewhere?

The source of the information is important. Results that are reported in a respected scientific journal are more credible than those you might see in an ad or supermarket tabloid article. Journals such as the
New England Journal of Medicine, Lancet
, and
Science
are very careful about what they approve for publication. Other scientists thoroughly review research studies before they appear in these publications. Many alternative treatments and nutritional supplements, in contrast, have not been studied scientifically. These alternative options are not as well represented in the scientific literature as medical treatments are. If you hear about something outside of a reputed mainstream media source, a scientific journal, or your doctor’s office, you need to be extra careful about analyzing what you read or hear.

In the past, studies were often done primarily on college students, nurses, or white men. This has changed, but it is still important to find out if the people whose pain improved are like you. Are they members of the same age group, sex, and race? Did they have the same health problems as you do? Do they have similar lifestyles? If the subjects of the study aren’t like you, you may not experience the same results that they did.

A woman returns from a two-week stay at a spa in the tropics and reports that her chronic pain improved dramatically thanks to the special diet and supplements she received. But did the warm weather, relaxation, and pampering have even more to do with her improvement than the supplements or the diet?

If you experience positive results after starting a particular treatment, it is important to look at other things that have changed in your life.
It is common to take up a generally healthier lifestyle when starting a new treatment. Could that be playing a part in the improvement? Did you start another medication or treatment at the same time? Has the weather improved? Are you under less stress than you were before you started the treatment? Can you think of anything else that could have affected your health?

Does a treatment that you are considering require that you stop taking another basic medication because of dangerous interactions? If the other medication is important, discuss this new treatment in detail with your health care provider before making a change.

Some treatments may suggest that you eliminate some important nutrients or stress only a few nutrients. Maintaining a balanced diet is important for your overall health. If you change your eating habits, be sure you’re not sacrificing important vitamins. Don’t put excessive stress on your body by concentrating on only a few nutrients to the exclusion of others.

All treatments have side effects and possible risks. Discuss these matters thoroughly with your health care provider. Only you can decide if the potential problems are worth the possible benefit, but you must have all the information in order to make that decision.

Many people think that if something is natural, it must be good for you. This may not be true. “Natural” isn’t necessarily better just because it comes from a plant or animal. The powerful heart medication digitalis comes from a plant, but the dosage must be exact or it can be dangerous. Some treatments may be safe in small doses but dangerous in larger doses.

The sale of supplements is not regulated the way the sale and distribution of medications is. Only a few countries (such as Canada and Germany) have a regulatory agency responsible for determining if what is listed on the label of a nutritional supplement is actually what’s in the bottle. (See
Chapters 13
,
page 206
, for information about regulations.) Do some research about the company selling the product before you try it. Ask your doctor or pharmacist before adding any supplement to your medication regime, even if it is “natural” or herbal.

Do you have the money to give this treatment the time it needs to produce an improvement? Is your health strong enough to maintain this new regimen? Do you have the necessary support in place? Will you be able to handle it emotionally? Will this put a strain on your relationships at home or work?

If you decide to try a new treatment after asking yourself all these questions, it is very important to inform your health care provider about it. After all, you and your provider are partners, and you will need to keep your partner informed on your progress during the time you are taking the treatment.

The Internet is a useful resource for up-to-date information about these treatments. But be cautious. Not every piece of information on the Internet is correct or even safe. Seek out the most reliable sources by noting the author or sponsor of the site and the URL (Internet address). As we discussed in
Chapters 3
, addresses ending in .edu, .org, and .gov are generally more objective and reliable; they originate from universities, nonprofit organizations, and governmental agencies, respectively. Some .com sites can also be good, but because they are maintained by commercial (for-profit) organizations, their information may be biased in favor of their own products.

The National Center for Complementary and Alternative Medicine (NCCAM) is an excellent source of up-to-date reliable information about chronic pain and complementary treatments. This National Institutes of Health agency rigorously studies the usefulness and safety of complementary and alternative interventions. The web-page “Chronic Pain and Complementary Health Approaches: What You Need to Know” (nccam.
nih.gov/health/pain/chronic.htm
) is updated frequently because research in this area is growing quickly. Check this website every few months to keep up with the latest information on what might help chronic pain. Another source for useful information about questionable treatments is Quackwatch, a nonprofit corporation whose purpose is to combat health-related frauds, myths, fads, and fallacies (
www.quackwatch.org
).

Just as you should be vigilant when researching alternative treatments, you should be careful about more common treatments as well. Sometimes it is wise to refuse conventional medical treatments. For example, after reviewing the medical evidence, various medical specialty organizations have recommended that nearly 50 common treatments and procedures should
not
be done (see
www.choosingwisely.org
).

Making decisions about new treatments can be difficult, but a good self-manager asks the questions presented in this chapter and follows the decision-making steps in
Chapters 2
to achieve the best personal results. For more information on finding reliable informational resources, see
Chapters 3
.

I
N THIS CHAPTER WE DISCUSS
some of the more common and prevalent conditions that result in chronic pain. The more you can learn about how to recognize your particular symptoms and triggers, the better you can positively self-manage your condition and live a full and satisfying life. All of the conditions that cause chronic pain can also cause fatigue, loss of strength and endurance, and emotional distress. As we discussed in the first chapter of this book, the healthy way to live with chronic pain is to work at managing the physical, mental, and emotional concerns rooted in your particular condition. We hope the material in this chapter will help you rise to the challenge of learning how to function at your best even in the face of chronic pain and ultimately help you to achieve the things you want to do and to get pleasure from life.

Arthritis is a disease that causes joint and musculoskeletal pain. It consists of more than 100 different conditions that affect all ages, races, and genders. The most common form of chronic arthritis is osteoarthritis. Generally affecting older people, osteoarthritis causes sore or stiff joints, especially in the hips, knees, and lower back. It can also affect the neck and shoulders, fingers, ankles, and big toe. The cause of osteoarthritis is not precisely known, but it involves the breakdown of cartilage, the material that cushions the joint. Cartilage is like a shock absorber and when it erodes, it causes bones to rub against each other. This causes stiffness, pain, and loss of movement.

Other kinds of arthritis are due to inflammation. The most common forms are those caused by rheumatic diseases such as rheumatoid arthritis, metabolic diseases such as gout, and psoriasis. With these diseases, the lining of the joint becomes inflamed and swollen and also secretes extra fluid. As a result, the joint becomes swollen, warm, red, tender, and painful to move. If present for a time, inflammatory arthritis can also result in destruction of cartilage and bone, which can ultimately lead to deformity. The cause of the inflammation associated with many of these conditions is not precisely known, but rheumatoid arthritis and psoriatic arthritis are thought to be autoimmune diseases that cause the body’s own immune system to mistakenly turn against itself.

Most arthritic diseases do not affect only the joints. Joints are crossed by tendons from nearby muscles that move the joints and by ligaments that stabilize the joints. When the joint lining is inflamed or the joint is swollen or deformed, those tendons, ligaments, and muscles can be affected. They may become inflamed, swollen, stretched, displaced, thinned out, or even broken. Also, in many places where tendons or muscles move over each other or over bones, there are lubricated surfaces to make the movement easy. These surfaces are called bursas. With arthritis, they too may become inflamed or swollen, causing a condition known as bursitis. Thus arthritis of any kind does not simply affect the joint. It can affect all of the structures in the area around the joint.

Although arthritis can have damaging effects, you can do a lot to offset or eliminate these effects. Active self-management, the proper use of medications, and developing or maintaining supportive social relationships are key to leading a productive and satisfying life.

Important goals of arthritis self-management are to maintain the maximum possible use of affected joints and to maintain good posture. Unless the affected joints are used, they will slowly lose mobility, and the surrounding muscles and tendons will weaken. Good posture is important to reduce strain placed on other parts of the body. For example, if arthritis affects the joints of one leg, that leg may be favored during walking. This can cause extra burdens on other body areas that result in even more pain.

The key to attaining joint mobility and good posture is exercise, an essential part of any
chronic pain management plan. Exercise will not make arthritis worse. In fact, failing to exercise can increase arthritis symptoms because of loss of joint mobility, muscle strength, and overall physical conditioning. To maintain joint mobility and healthy cartilage, you will need to move the affected joints through their full range of motion several times a day. Consult with a health care provider such as a physical therapist to learn the best way to move your joints safely. She or he can also examine your posture and provide ideas on improving your posture when doing different activities.

Gentle flexibility exercises such as the Moving Easy Program (MEP) and balance exercises are good ways to start increasing your activity. The MEP can also help with stiffness that can occur after periods of rest such as sleeping and prolonged sitting. Appropriate exercise programs for people with arthritis are described in
Chapters 7
,
8
, and
9
. Review this material to get started on a more active lifestyle.

As with all chronic pain conditions, other symptoms are frequently part of living with arthritis (see
page 13
). If you suffer from fatigue, review the sections on fatigue and sleep problems in
Chapters 4
. Pacing is an especially important fatigue and pain self-management skill. Review the ten pacing tips in
Chapters 6
so that you can better balance your activity with rest periods. Of course, having a regular fitness program is a key strategy in managing fatigue and many other related symptoms.

Arthritis can cause stress, anxiety, emotional difficulties, and sometimes depression. If you suffer from any of these symptoms,
Chapters 4
and
5
are especially important for you to read. You will learn many ways to manage these symptoms and how to recognize when you need to seek help and support. Remember that you do not have to do this alone. Effective ways to communicate with your family, friends, and members of your health care team are discussed in
Chapters 10
and
11
. The pain and discomfort of arthritis can also impact intimate relationships. See
Chapters 12
for more information on how to approach this sensitive subject with your partner.

Because the pain of arthritis is often located in one area of the body, self-management approaches such as the use of heat or cold can be helpful for joint pain and stiffness. Read
pages 44
–
48
in
Chapters 4
on tools for managing localized pain. Another important area of arthritis self-management is nutrition and maintaining a healthy weight. Read
Chapters 13
and
14
to help you plan healthier meals and achieve a healthy weight. If you are overweight, losing even a few pounds can reduce the strain on joints such as hips, knees, and feet.

Sometimes when joint function remains limited, assistive devices can be of benefit. Many types of devices are available, including braces, canes, special shoes, grippers, and reachers. If you need help making decisions about devices that could be most useful to you, consult an occupational therapist. They have specialized knowledge in this area and can help make daily living easier for you.

Because arthritis consists of many different conditions, your medical treatment will be specific to the type of arthritic condition you have. Your doctor will prescribe medications to prevent or control inflammation, swelling, and pain and to improve your physical function. The most commonly prescribed medications for the pain of osteoarthritis and some rheumatic diseases are acetaminophen and mild or strong anti-inflammatory drugs (NSAIDS). (See
Chapters 16
for information on these and other medications you may be prescribed, including antidepressants.) Other strong medications such as “disease-modifying” drugs, corticosteroids, and new biological agents may also be prescribed for the treatment of some inflammatory arthritis conditions. These stronger medications are powerful and need to be well managed. Take the time to develop a good relationship with your pharmacist and health care team so that you have all the information you need to manage your medications safely. Read
Chapters 15
to review your role in managing all the medications you take.

Sometimes, despite self-management and drug treatments, joints are damaged to the point where they no longer work effectively. Fortunately, modern surgical techniques allow for replacement of many types of joints, and replacement joints often function almost as well as natural joints. This is especially true for hips and knees. Modern surgery is efficient, and recovery is usually rapid.