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How to Manage Chronic Pain

May 11, 2021 - Sheshe Giddens

From a minor cut to sciatica, pain is an unwelcomed, yet underappreciated visitor, who comes bearing an important warning that something's wrong with your body. Without this important messenger, we may forego critical medical treatment or continue with activities that may worsen the situation.

Sometimes pain overstays its welcome and outlives its original purpose. Long after the initial injury or condition that may have triggered the pain heals, pain continues to linger as pain signals continue going off throughout the nervous system — tormenting the sufferer, who frantically searches for a moment's relief and, sometimes, must come to grips with the ever-fading hope for some semblance of normalcy.

They have joined a group that no one wants to belong to — a community of people whose pain has persisted longer than three months, which becomes classified as chronic pain.

Americans have become all too familiar with this dilemma. According to the Centers for Disease Control and Prevention, 20.4% of adults have experienced chronic pain, with 7.4% of adults experiencing what is known as high-impact chronic pain, which has frequently limited their lives and work activities.

What are chronic pain conditions?

Many of the leading causes of disability, including musculoskeletal disorders, back pain and osteoarthritis, also involve long-term, debilitating chronic pain — also known as chronic secondary pain because the pain is a symptom of another condition. Chronic primary pain conditions include syndromes, such as fibromyalgia and chronic regional pain syndrome, nonspecific neck and low back pain, and chronic migraine — conditions that cannot be attributed to another pain-causing complaint.

Other examples of conditions that can cause chronic pain include:

  • Arthritis of the spine
  • Failed back surgery
  • Headaches
  • Neuropathic pain
  • Neuropathy (nerve pain – diabetic and peripheral)
  • Radiculopathy (from when a nerve is pinched, damaged or inflamed)
  • Sciatica
  • Shoulder, knee and hip pain

Can chronic pain be all in your head?

Sort of, but not in the way some people think; chronic pain isn't imaginary. It's a real phenomenon that is hard to quantify. One person's pain scale rating for an arthritic knee may be at a 3, while it feels like an 8 to someone else. It's all about what constant pain does to the nervous system.

"What we've found is that when patients have chronic pain, in general, there starts to be this kind of rewiring that happens within the brain and the spinal canal," said Dr. Sagar Chokshi, a pain medicine specialist with Houston Methodist Department of Neurosurgery.

"As these pain signals get propagated, there becomes a feedback loop that doesn't necessarily come from an original injury. And, as it gets ingrained in the brain, it becomes really hard to break that feedback loop."

How do you manage chronic pain?

Pain will make even the most reluctant of us eager to go to the doctor or the ER to find relief. Pain and pain-causing conditions are among the most common reasons people go to the doctor. But, when pain persists for too long, sufferers may benefit from consulting a pain management specialist.

"If you are experiencing chronic pain, it's never too early to talk to a specialist. Treatment can go off course if you wait too long, causing the pain to last longer. Also, patients who don't want to have surgery will often consult with a pain specialist to find out if there are nonsurgical options for treating their pain," explains Dr.Chokshi.

"If pain develops, get evaluated by your primary care doctor or in the emergency room. The basic treatments for injury usually involve rest, ice and heat, and some low-dose medications, perhaps even a steroid. If whatever you're doing is not significantly helping and you've gone a couple of times to the primary care doctor or even had an emergency room visit, I think it's appropriate to consider an evaluation with the pain management specialist."

What are treatment options for chronic pain?

Since there are so many conditions that can cause chronic pain, treatment primarily focuses on addressing the underlying cause.

"When the body has rewired itself to constantly think about pain and creates a feedback loop that doesn't necessarily directly involve an injured area, the pain signals continue to go from the brain to the spinal cord and back to the brain. Unfortunately, it's very difficult to treat this type of chronic pain, because these signals continue to persist within the central nervous system," admits Dr. Chokshi.

Along with nonopioid medications, doctors may prescribe physical therapy or surgery as well as recommend therapies, such as acupuncture and massage, the use of a deep-brain stimulation device, or even an anti-inflammatory diet.

"Often, we strongly recommend physical therapy, injections, biofeedback and relaxation strategies with cognitive behavioral therapy because learning different strategies can be very helpful," says Dr. Chokshi.

Opioids aren't the solution for chronic pain

It may feel like doctors are holding out on the "good stuff" that will knock out the pain, but there are good reasons why the medical community now frowns on prescribing opioids — narcotics made from the opium poppy plant, which includes potentially highly addictive prescription medications, such as hydrocodone, fentanyl and oxycodone, used for treating pain.

With time, patients taking these medications build up a tolerance and possibly dependence on opioids — meaning patients require higher and higher doses of the medication, so they become less effective in treating chronic pain.

Opioids are medications that block pain signals in the brain. For an acute injury, such as a fracture or a surgery, there's a reasonable time to be taking these types of medicines. After this time, if you're continuing to take a medicine, it's a temporary fix for a bigger issue," says Dr. Chokshi.

"Patients develop a tolerance to these medications, meaning that the same dose isn't as effective as the first time you took it. Then you keep taking more and more medication. That's when we start to see a lot more of the side effects. Also, taking oral opioids interferes with the body's natural endogenous opioid production, causing hyperalgesia, meaning that things that shouldn't hurt become painful because the body has completely shut that system down in your brain."

Opioids come with a high risk of dependence and addiction as well — with approximately 2.1 million prescription opioids users in the U.S. developing opioid use disorder.

Tips for coping with chronic pain

Get some support. Some chronic pain sufferers face stigma because family and friends think they are exaggerating or simply seeking attention. And, because of the opioid crisis, some patients fear that the medical community will lump them in with those who are drug-seekers. This is especially true for those who are suffering from pain caused by an unknown origin. Consider talking to a therapist to develop strategies to cope with the pain.

Be open to trying various treatments. It may seem counterintuitive to ask someone in a lot of pain to go to physical therapy or exercise, but if you don't move it, you may lose it. Maintaining or improving mobility, which includes exercising and stretching, may improve your pain or keep it from getting worse. It is important to consult your doctor or a physical therapist about which exercises are appropriate for you because you don't want to make your pain worse. Ask if activities like walking, swimming and water exercise, yoga, or tai chi are okay for you to try.

Before trying alternative therapies or natural remedies, discuss them with your doctor first. If the advertisement claims to "cure" your condition or eliminate pain, you should treat it with a healthy dose of skepticism and get the okay from your doctor before trying it. Even natural remedies can cause harm and interact with your other medications.

Practice self-care. Living with chronic pain robs you of enjoying life fully. It takes a physical, mental and emotional toll on those living with it. Develop a plan to take care of yourself. When your pain is more intense, it may be helpful to think about the things that have been helpful in the past, such as taking certain as-needed prescription or over-the-counter medications, applying ice or heat to a painful area, stretching or using self-massage. If laughter is a good distraction for you, have your favorite comedies on standby. Most importantly, be kind to yourself because being in pain means you may not be able to do what you used to do. If the house doesn't get cleaned as often or if you miss a few activities with family and friends, so be it. Just take care of yourself.

You may also need to adjust your expectations. Depending on the cause of your chronic pain, you may have to come to terms with a new normal. That doesn't mean that there isn't any hope. Work with your doctor on exploring treatment options and keep yourself educated on new treatments being developed. It's important for you be your own health care advocate.

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