Living a Healthy Life with Chronic Pain (44 page)

If you suffer from chronic back pain, you are not alone. Back pain is one of the most common medical conditions in Western countries. There are 30 bones or vertebrae that make up the spinal column. These bones are divided into four regions: the neck area, the middle or thoracic area, the lumbar or lower back area, and the sacrum or coccyx, which is a group of bones fused together at the base of the spine. Muscles that attach to the spinal bones support the bones of the back.
The strong muscles in our abdomen also support the spine. Spinal bones or vertebrae are separated from each other by jelly-like cushions (called intervertebral discs) that act as shock absorbers as the body moves. A critical structure is the spinal cord, which contains the many nerves that travel to our brain. The bones of the back surround and protect the spinal cord. A healthy back is straight, strong, flexible, and pain-free.

Back pain can develop anywhere along the spine. The two most common areas for pain to occur are the neck and the lower back. Pain can be localized in one area or can spread to a wider area. Neck pain can spread to the shoulders and upper back; lower back pain can spread to the buttocks and down one or both legs.

Nearly everyone experiences back pain sometime in his or her life. It can be caused by many things, including poor posture, weak back muscles or weak abdominal muscles, lifting heavy objects incorrectly, twisting, excess body weight, and repetitive activities that require lifting or bending. Sometimes neck or other back pain is the result of a poorly designed workstation—for example a computer that is too high or low, or a chair that does not provide back support. Back pain can also result from motor vehicle or other accidents. An example is whiplash, a common neck injury that results from rear-end automobile accidents.

Most back pain gets better within one month. But for a small number of people, back pain becomes chronic. About 10 percent of chronic back pain is caused by arthritis or other diseases. See your health care provider to rule out disease-related causes for your back pain. Most people with chronic back pain have “nonspecific” back pain that is related to the muscles and ligaments that surround and support the spine, and not the spine itself. As with most chronic pain, changes occur in the central nervous system and the brain that perpetuate the pain. But you can take action to calm your nervous system to reduce your pain and improve your life.

The experience of chronic back pain is different for everyone. The location and intensity may be different. The impact it has on everyday functioning and family life also varies. If back pain starts when you are in your 30s or 40s, it may affect job and financial security. Job change and job loss are difficult to cope with. Review
Chapters 4
(
pages 70
–
73
) for more about coping with job loss.

Even though your back may cause serious pain, there are many ways you can learn to manage the pain and live a full, satisfying life. The most effective approach is to combine self-management techniques, such as the ones in this book, and care from your health care providers. Research has shown that staying physically active and developing a regular exercise program improves pain and function in people with chronic back pain. Sometimes, exercising can hurt a bit; remember that as long as you are exercising in a safe manner, “hurt” does not equal “harm.” The muscles and ligaments of your back have already healed, so being involved in regular physical activity will not harm them further unless you overdo it. So go slow. Always consult with your health care provider about the type of exercise to avoid before beginning an exercise program.
Chapters 7
,
8
, and
9
can help you get started with exercising. There are specific suggestions about exercise and chronic neck and back pain in these chapters.

Emotional distress and depression can make chronic back pain harder to deal with. That’s why it is very important to learn and use the coping skills and relaxation techniques in
Chapters 4
and
5
. Communicating with your family and maintaining intimacy with your partner can be challenging with back pain. Read
Chapters 10
and
12
as you address these challenges. Another key self-management technique for chronic back pain is pacing. Look at
Chapters 6
to begin implementing these strategies and get more accomplished with less pain.

Healthy eating and weight management are other key self-management goals. Carrying excess weight can really impact your back pain by causing increased stress on muscles in your back and abdomen and on your joints. See
Chapters 13
and
14
for information on these topics. Research findings are consistent about smoking being a risk factor for many types of chronic musculoskeletal pain problems such as back pain. This is true especially if you are under the age of 50. If you smoke, talk to your health care provider about ways to stop.

Heat and cold applications, acupuncture, and massage, especially when combined with physical activity and self-management education, have been shown to help people with chronic lower back pain. More studies are being done on chiropractic spinal manipulation treatment. Some studies have shown a positive impact from spinal manipulation, while others have not. In addition to these types of treatments, your health care provider may prescribe medications such as acetaminophen, mild anti-inflammatory medicines, low-dose antidepressants, muscle relaxants, and other more powerful medications if pain is severe. Please see
Chapters 16
for more specific information about pain medications.

The term fibromyalgia is made up of three root words: “fibro” means fibrous or connective tissue, “myo” means muscle, and “algia” means pain. Fibromyalgia literally means pain in muscle and connective tissue. Connective tissues are the tendons and ligaments that connect muscles to bones and bones to bones in your body. The pain and tenderness of fibromyalgia last longer than three months, are widespread, move from one area of the body to another, and change over time. Up until 2010, a health care provider would diagnose fibromyalgia only if a person had 11 to 18 trigger points as well as widespread pain. (Trigger points are sensitive areas over muscle and are painful when touched.) Since 2010, new guidelines for the diagnosis of fibromyalgia have been developed based on the latest research evidence. While people with fibromyalgia may have a number of trigger points, trigger points are not required for a diagnosis of fibromyalgia.

Fibromyalgia also displays other common symptoms, including fatigue, sleep disturbance, problems with thinking and memory (called “fibro fog”), depression, and anxiety. You might also experience headache, irritable bowel or bladder, painful menstrual cycles, or other painful problems. Sometimes fibromyalgia occurs with other chronic painful diseases such as osteoarthritis or rheumatoid arthritis.

Fibromyalgia is two times more common in women than in men. It can develop at any age, including childhood. The cause of fibromyalgia is not known but is likely due to multiple factors. New research suggests that certain genes may make you more likely to develop fibromyalgia. Also, it may be associated with early negative childhood experiences, including abuse. What scientists know for sure is that if you have fibromyalgia, there are abnormalities in the processing of pain in your central nervous system and your other body systems such as the stress/response system and systems that regulate sleep and mood.

Like other chronic pain conditions, fibromyalgia can be managed. And, like all chronic pain conditions, the goals of fibromyalgia treatment are to manage symptoms, be as healthy as possible, and maintain or improve physical and social functioning. The latest guidelines state that regular physical activity is the cornerstone of fibromyalgia treatment. No one specific type of exercise is recommended; you can engage in a combination of aerobic, strengthening, flexibility, and balance exercises. Your exercise options can be very gentle like slow walking, the Moving Easy Program (see
Chapters 8
), gentle yoga, or tai chi, and also include more vigorous exercise once you build up your stamina. Exercise can be done in water or on dry land, either at home or in a group. The best exercise is the one that you will do. Review
Chapters 7
,
8
, and
9
for more ideas about exercise.

Fibro fog is the term used to describe the problems with thinking and memory that can accompany fibromyalgia. You can best manage fibro fog by pacing your activities (
Chapter 6
) and taking some of the specific actions described in
Chapters 4
on
pages 69
–
70
. You can learn how to manage other fibromyalgia-related symptoms you experience by reviewing the appropriate sections of
Chapters 4
and
5
. Of course, eating well and maintaining a healthy weight are part of optimizing your overall health. Explore
Chapters 13
and
14
for guidelines for healthy eating and weight management.

Your health care provider will likely prescribe medications to help manage some of your symptoms. Most of the medications used for the treatment of fibromyalgia are discussed in
Chapters 16
. Be sure to also review
Chapters 15
for more general information about medications and how to manage them.

Headache is one of the most common pain conditions. The World Health Organization recently reported that 47 percent of adults worldwide experienced headache in the past year. For many people, headaches occur infrequently, are not severe, and last only a short time. But, there is another group of headache sufferers who deal with headache pain on a regular basis—daily,
weekly, or monthly. Persistent or chronic headache can wear you down, make you depressed and anxious, and negatively impact your quality and enjoyment of life.

What is a headache? Headache is pain that occurs in any region of your head. It can be on one or both sides of your head, on the top or the back of your head, or both. It can also be pinpointed in a specific spot. If pain is located in your face, mouth, or jaw, it may be termed orofacial pain. Headache pain can be sharp and jabbing, throbbing and pounding, or dull and achy. It can be mild or it can be so severe that it is disabling. It can come on gradually or suddenly and can be gone in an hour or last for many days at a time. Depending on the type of headache, a person may also have other symptoms such as nausea or extreme sensitivity to light and noise. In short, headache is often quite different for different people.

Physicians classify headaches into two types: primary or secondary headache. Primary headaches are caused directly by activity in your blood vessels, muscles, and nerves in your head and neck, as well as any chemical activity taking place in your brain. Common examples of primary headache are tension headaches, migraine, and cluster headaches. Secondary headache is a symptom of another health condition that stimulates the pain-sensitive nerves in your head. Many conditions can cause secondary headache. Dehydration, fever, and infection such as colds or flus can result in secondary headaches. More serious problems can also bring on headache, including high blood pressure, stroke, blood clots, head injury, arthritis in your neck, or other pain conditions in your face or jaw. A common but not well understood cause of secondary headache is the overuse of pain medicines, sometimes called rebound headache. Ask your health care provider to take a careful medical history from you and perform tests to rule out any disease-related causes for your headaches.

If you are a person who gets headaches often, you may not be able to get rid of them entirely. But self-management strategies, such as the ones in this book, can help reduce the number and severity of your headaches.

One of the first things you can do is identify triggers that might bring on your headaches or make them worse. Become a “headache detective” and keep a diary for at least two weeks or, even better, for a month. When you get a headache, stop and take a few minutes to write down the events or actions that led up to the onset of the pain. Consider what might have triggered it or made it worse. Many things can affect headache. You may have sensitivities to certain foods, alcohol or other beverages, or strong odors.
Chapters 13
(
page 219
) lists some common food triggers. You may be under excess stress or be upset or emotional about something going on in your life. Have you skipped meals or changed your activity pattern? Are there any changes to your posture—resulting from a change in the chair or desk you use, for example—that might cause neck or shoulder strain? Are you fatigued or sleeping poorly? Are you going through hormonal changes? Does the weather seem to be a factor? In addition to identifying triggers, it is important to note what you do when you get a headache. Keep a record of the self-management strategies you try, including medications, and whether they help. The lifestyle diary in
Chapters 14
on
page 242
can help you get started on your detective work or serve as the basis for making your own chart.

After you have kept your diary for a few weeks, begin to look for patterns. Remember, sometimes a combination of things can trigger pain. If you identify some possible triggers, divide them into triggers you can avoid (certain foods or drink), triggers you can’t avoid but can learn to manage (stress, emotional reactions, fatigue, poor posture), triggers you can minimize (missed meals, late nights), and triggers that are not in your control (hormonal or weather changes). Being aware of the triggers that can be controlled, even partially, is the first step to managing your headaches.

Once you have a sense of your headache patterns and triggers, you can start planning how you will avoid, manage, or minimize these triggers.
Chapters 4
and
5
discuss methods to self-manage stress, strong emotions, fatigue, poor sleep, and other factors that might impact your headache. The information in
Chapters 6
on pacing can help you plan to balance your activity and rest and stay below your headache “threshold.” Your headache threshold is the point at which you start to feel a headache coming on. You may find that if you take action as soon as you have signs that you will have a headache (like taking a short walk, doing a relaxation or breathing exercise, taking medication, etc.), you can prevent or reduce the intensity of the headache.

Living an overall healthy lifestyle is also important for headache self-management. Regular moderate exercise can give you an overall sense of well-being, reduce stress and anxiety, lift your mood, and reduce the frequency of headache attacks.
Chapters 7
,
8
, and
9
discuss ways to increase your physical activity and exercise. If you suffer from migraine headaches, you may need to be careful when you exercise. Work out at a moderate pace, not too fast or too hard. Stay hydrated and don’t exercise if you have not eaten. Eliminating food triggers and eating a healthy diet with regular meals is also important. Read
Chapters 13
and
14
for more information on nutrition. Also, be sure to communicate with your family, friends, and coworkers about how they can support you when you do get a headache.
Chapters 10
can help you learn how to communicate in a positive way.

Medications can be effective in managing headache, but they need to be taken with care. Review
Chapters 15
and
16
about the management of medications. Over-the-counter medicines such as aspirin, acetaminophen (Tylenol
^®
, Panadol
^®
), and anti-inflammatory medicines such as Advil
^®
and Motrin
^®
can be used. But they should not be taken for more than 14 days in a month. This is because the overuse of pain medications can be the cause of daily or frequent headaches in some people. This is not addiction, but a side effect of taking too much of any given drug. If you are taking multiple medications or high doses for headache and have frequent or daily headache, talk to your health care provider about the possibility of medication overuse and how you can reduce the amount you take. If you suffer from severe migraine or cluster headaches, your health care provider may prescribe other types of headache medicine.