Tips for Dealing with Your Pain
Pain has been in the news lately, and not always in the ways that we would hope. On the one hand, Time Magazine featured the issue of treating chronic pain on its cover in February, and the Today show featured a five-part, educational series on chronic pain in March. On the other hand, the DEA’s withdrawal of the Frequently Asked Questions document has increased confusion about prescribing proven medications for the treatment of pain, further stigmatizing pain patients. And now, the withdrawal of two COX-2 non-steroidal anti-inflammatory (NSAID) medications and the more stringent, FDA-mandated warnings on all NSAIDS have created fear and confusion about what’s safe and effective for treating pain.
You may be feeling overwhelmed and confused. You may ask yourself, “What’s safe? What medications can I take? Who can I trust to provide accurate and complete information about my condition and my treatment options? What can I do now that I can no longer take this medication? What can I do if my doctor is no longer willing to prescribe to me? What things can I do to improve my quality of life?”
The important thing to remember is that you are not alone. Millions of Americans suffer from chronic pain, and there are many organizations working to address this serious, life-altering and profoundly difficult problem. Overcoming suffering and pain is difficult – sometimes it even seems impossible, but there are things you can do to help yourself. You must be your own “best” advocate.
Now, more than ever, is the time to educate yourself about your treatment options and empower yourself by doing what you can to care for yourself physically, emotionally, and spiritually.
Unfortunately, there is no magic pill or cure to relieve chronic pain or its underlying conditions. Medication alone often is not enough, especially for people who have chronic pain. As some of your medical options may be disappearing, it may be time to reevaluate what’s working for you and what you can do differently to help yourself. Relieving pain requires work both on the part of the physician and on the part of the patient. People with chronic pain must be active participants in their care.
How to Feel More in Control of Your Pain Condition
Find an understanding and knowledgeable pain specialist If you are looking for a pain specialist, you have some different options for your search. First, you can ask for a referral from your primary care physician. This is often the first step that should be taken. You can also ask others to recommend a doctor.
Many professional physician organization web sites have listings of their members available to the public. See the links at the bottom of this article for a list of some of these sites. These directories oftentimes can help you locate an appropriate pain medicine physician in your area. You can print the directory and share it with your primary care physician to identify the best physician for your particular needs.
Once you have identified a physician, you should ask specific questions to help you determine whether the physician will best meet your needs. Some of the questions below can help you make an informed decision.
•How many cases of my type of pain condition have you treated? •What are your special qualifications to treat my pain condition? •Have you participated in any special training about pain management techniques? •What is your philosophy of management of my pain condition in terms of medications and alternative therapies? •What types of medications do you usually prescribe? •What types of non-medication therapies do you use? •Where do you refer patients who need additional treatment? •Is your clinic listed with any professional societies? •Are you, or is someone in the clinic, available 24 hours a day if I need help? Finding an understanding and qualified pain specialist is one of the first steps in fighting to regain your life.
Take care of the things you can control Part of being an active participant in your care is caring for your body. No one but you can care for your body. Getting adequate rest, eating a healthy diet and engaging in physical activity are vitally important to maintaining function and health. It may seem like a catch-22 – you’re in pain, so you don’t want to move or you’re finally feeling a little better, but you’re afraid to move because your pain might come back. Avoiding exercise can be detrimental to your health – you lose muscle tone and strength, your heart and lungs work less efficiently, and your pain can increase.1 On the other hand, the benefits of incorporating activity into your lifestyle are immeasurable and include increased muscle strength and flexibility, improved sleep, and stress relief.2
Following are some suggestions for increasing your activity level:
•Choose exercises that can be incorporated into your daily routine and that you enjoy. •Set a schedule. •Ask your doctor about appropriate exercises and activities for your situation. •Set appropriate goals.3 No goal is too small – visiting friends or walking around the block may be appropriate goals, depending on your pain and physical condition. Ask your physician which exercises are safe for you. In addition to a healthy diet and exercise, relaxation techniques such as meditation, visualization, hypnosis, and biofeedback may help you feel better. Your health care provider can help you decide which techniques may be beneficial for you.
Caring for Your Emotional Health
The effect emotions and psychosocial well-being have on pain cannot be ignored as emotions have a direct effect on your health.4 Pain so often is accompanied by loss – loss of function, loss of employment, loss of money, loss of friends and relationships to name just a few – it’s no wonder that people in chronic pain have an increased incidence of depression, anxiety, and sleep disturbances.5 Research has shown that people in chronic pain suffering from depression have poorer outcomes than those who are not depressed.6 It is natural for people in pain to grieve for what they’ve lost, and it is important to remember that your family members and friends grieve too. Your emotions may range from fear, anger, denial, disappointment, guilt, and loneliness to hope and optimism. Every person feels different emotions at different times, which can make relationships and pain control difficult.
Taking care of the emotional aspects of chronic pain is necessary to treat your overall pain condition. Your physician may want to prescribe medication for depression, anxiety, and sleep disturbances and, in addition, may suggest cognitive behavioral therapy (eg, relaxation techniques, coping strategies, psychological therapy).7 Your doctor does not think you’re crazy—he or she is treating you as a “whole” – not just the part in pain. Following are some suggestions to help you deal with the emotional aspects of pain:
•Keep a journal of your emotions. A journal can help you release some of the emotions you feel. •Share your thoughts and feelings with loved ones and allow them to share their feelings with you. People cannot read your mind – just as pain is an invisible disease, emotions can be difficult to discern. •Avoid isolation and loneliness by joining a support group. There are local support groups that you can attend with people who know what you are experiencing and there are online communities that offer support and understanding. The National Pain Foundation’s Community section is a good way to share your story and connect with others online. The American Chronic Pain Association has support groups throughout the country. Contact the ACPA at www.theacpa.org or (800) 533-3231 to find a group near you. •Be active – exercise can help relieve the stress and emotional pain you feel. Evaluate Your Treatment Options
Medications such as NSAIDs and selective NSAIDs (COX-2 inhibitors) are important tools in the management of chronic pain, but they are not the only tools available to help you. NSAIDs work by decreasing inflammation and pain. Traditional NSAIDs, such as ibuprofen and naproxen, tend to irritate the stomach and can lead to ulcers and bleeding. The COX-2 NSAIDs have become popular because they are less likely to cause ulcers and bleeding.
News that another NSAID has been withdrawn from the market and the fact that all NSAIDs will now have additional warnings on their labels can be frightening and disheartening for patients dealing with chronic pain. The first step in determining if NSAIDs and COX-2 NSAIDs are still an option for you is to speak with your doctor. All medications have benefits and all medications have side effects and risks. Different people react differently to medications, and choosing to take a medication becomes a very personal decision that must take into account the risks and benefits, your level of functioning without a particular medication, and your overall health. You and your doctor are the only people who can determine whether a specific medication is the right choice for you.
If you are taking any NSAIDs for pain, be sure your doctor knows your medical history, including any history of heart problems, high blood pressure, ulcers, and medication allergies. Be sure your doctor knows about all the medications you currently take, including medications prescribed by other doctors, over-the-counter medications and supplements. This information will help you and your doctor weigh the overall risk-benefit of a medication.
It is up to you to educate yourself about your health and your treatment options. There are many options for your pain, including:
•prescription and over-the-counter NSAIDs •other prescription medications such as opioids, anxiolytics/hypnotics, anticonvulsants, antidepressants, muscle relaxants and more, depending on your pain condition •complementary and alternative therapies, such as biofeedback, meditation, relaxation techniques, yoga, acupuncture, and more •physical therapy •interventional treatments (e.g., for arthritis, injections at the pain site containing a pain reliever and corticosteroid, or for back and neck pain, spinal cord stimulators and intrathecal drug pumps). Talk with your doctor. Developing an open and trusting relationship with your pain specialist is important to helping you determine which treatment options are best for you.
To help you locate a health care provider, visit the NPF’s Pain Care Provider Directory.
References 1.”Chronic pain: Exercise can bring relief,” Mayo Clinic (April 23, 2001). M Nicholas et al, Manage your Pain: Practical and Positive Ways of Adapting to Chronic Pain (Sydney: ABC Books, 2002) 84-89, 98-127. 2.”Chronic pain,” WebMD (March 2001). 3.”Chronic pain: Exercise can bring relief,” Mayo Clinic (April 23, 2001); Nicholas et al, Manage your Pain: Practical and Positive Ways of Adapting to Chronic Pain, 84-89, 98-127. 4.M McCaffery, C Pasero, Pain Clinical Manual, second ed (St. Louis: Mosby, 1999) 499-505. 5.Ibid. 6.Ibid. 7.Ibid.