Coping with Chronic Pain

We have all had pain, admittedly some more than others. (I put that in for the women readers muttering, ‘you men have no idea’). Sometimes it is mild, sometimes it is unbearable. Some are short lived and others chronic. Pain is difficult to explain as it is so subjective. It is also variable depending on the circumstances we are in. People have been known to ignore pain when focused on something else; Footballers have carried on playing with broken bones, Mountain climbers have cut their limbs off to escape when trapped.

What is chronic pain?

Pain is not just hard to define for sufferers, it is equally hard to diagnose and measure for the health professionals. For years we worked on the premise that if you cannot see any obvious cause, then pain must be imaginary. Through research, improving technology and experience, we are now much better at understanding pain than ever before. However, at the frontline, pain management, especially for those with chronic pain, is not consistently good.

Managing long standing pain (anything that lasts longer than 3 months) is based on trust. The Doctor needs to believe the pain. The patient needs to honest about the pain and its impact. The Great British tradition of ‘not moaning’ makes people suffer in silence. I have seen many patients who have never fully discussed their pain, especially when professionals couldn’t find any obvious cause. When you have your first contact with health care, there may be some investigations. When tests do not show a major cause of pain, you are often told, there’s not much ‘wrong’. This makes you go away feeling that you may be suspected of exaggerating. You may also get the same treatment from friends and family as pain is so private.

Even when the cause of the pain is well known, like an old injury, arthritis, cancer, previous surgery etc., we are not very good at getting the right treatment. We may underestimate the level of pain killers needed in these circumstances or worry about addiction and choose not to take it at all, when it is much needed.

Why is it different?

The trouble with pain is the longer you leave it unsorted, the worse it can get. Sometimes the original problem that caused it may even go away, leaving the pain imprinted in your nerves. The brain and the nerves carrying the pain signals may get stuck in an endless loop, causing low moods, disability and distress. It is hard for the sufferer to know what to do. You may choose to avoid certain movements, leading to further problems. You may take over the counter or prescribed pain medication in copious amounts to try to relieve the pain. Trouble is they only work for a short period, making you take more and more. When you try and stop them, the pain or the perception of it may go worse, making you believe that you may never be off them. This causes a psychological dependence.

There are a variety of ways of managing pain.

Types of Pain


The pain itself has different components, ‘nociceptive’ which is pain from activation of the pain sensors in the tissue and ‘neuropathic’ where the pain is caused by the nerves transmitting the signals. The former can also be ‘surface’ pain from the skin and superficial tissue and ‘deep’ pain coming from muscle, ligaments, bone and in some cases deeper organs.

Managing Chronic Pain


Managing chronic pain is a difficult juggling act. It needs partnership working between the sufferer and the practitioner. Chronic pain is a case where patients exhibit heightened pain sensitivity, increased awareness of bodily symptoms, anxiety, a sense of futility and even depression. Often people may have tried some or more methods listed below in an unstructured and sporadic fashion, leading to poor results and loss of faith. This leads to multiple consultations at various portals, causing a drain for the patient and the health economy.

Multi-disciplinary approach


Chronic pain needs a multi-disciplinary team approach, involving Doctors, Nurses, Physiotherapists, Clinical Psychologists and Occupational therapists. The professionals may use a variety of interventions including drugs to help manage the pain. Before embarking on the treatment plan, it is better to give a good history and undergo a series of assessments including pain scales, mood and function.

Drug Options

The drugs we use to control pain range from simple painkillers such as paracetamol (acetaminophen) to high end drugs such as opioids including morphine & Codeine. The dosage is usually increased gradually till reasonable relief is obtained. The problem is that you may end of taking high doses of pain killers with little real relief but will be unable to stop them as the withdrawal symptoms make matters worse - this is why combination therapy is important.

Anti-inflammatory drugs such as ibuprofen and diclofenac help when tissue inflammation is involved, especially in cases of arthritis and back problems. In case of neuropathic pain drugs such as amitriptyline, pregabalin, Gabapentin and some other anti-epileptics help. Anti-depressants can also be of great value in managing chronic pain. Emerging trends is also to use skin patches to deliver the pain relief so that patients don’t have to ‘clock-watch’ waiting for their next dose.

Therapeutic Options


Massage therapy, Acupuncture, suitable Exercise, Weight management, Cognitive Behaviour Therapy, Hypnosis and TENS machines have all been found beneficial. Swimming, Tai-chi, Yoga can also help by improving posture. These should always be performed under expert guidance and support. Injections of local anaesthetic with a corticosteroid into the affected areas tend to work well in arthritis and inflamed tendons such as tennis elbow, frozen shoulder etc. These are safe and effective when administered by a trained practitioner and can be repeated after an interval. It helps to try a co-ordinated approach to the multiple interventions rather than go from one to another with long gaps in-between.

Holistic Approach

Whether newly diagnosed or established, we need to pay attention to chronic pain with a sense of immediacy due to its devastating effect on the person, their family and the nation’s economy due to disability. An empathetic understanding, shared management plan, involvement of relevant professionals, regular review and continuity of care by familiar faces, access to exercise and other therapies, quick elimination of serious problems will all help to cut short the relentless progression. This will help patients and their families to restore their faith in the Therapist and Therpaeutics.

 

Copyright   © Mohan Kumar 2010

More by this Author


Comments 34 comments

Pamela99 profile image

Pamela99 5 years ago from United States

I have had chronic pain for a number of years due to specific disease and tried many types of drugs, etc. I have learned not to get stressed as little as possible, to stop and rest when tired, to eat healthy as I can tell when I don't and to keep a positive attitude. I keep my mind occupied with other things as much as I can. I seek to have some control over my life which in itself seems therapeutic to me.

Very good topic as many people suffer from chronic pain for a number of reasons. There is good information in your hub.


Just Ask Susan profile image

Just Ask Susan 5 years ago from Ontario, Canada

Very informative hub and well written!


Docmo profile image

Docmo 5 years ago from UK Author

@ Pamela99 - I am sorry to hear about your chronic pain situation. I agree on a holistic approach to treating this problem that can be a bane for so many. If there is anyway I can help let me know.

@ Just Ask Susan, glad you found this informative and useful. Thanks.


KoffeeKlatch Gals profile image

KoffeeKlatch Gals 5 years ago from Sunny Florida

I have also had to deal with chronic pain for years. I have found deep breathing, trying to stay away from stress as much as possible, and a positive mental attitude help s me more than a pain killer. Great hub. Great information. Rated up and useful.


kathryn1000 profile image

kathryn1000 5 years ago from London

Good to write to occupy the mind!


izettl profile image

izettl 5 years ago from The Great Northwest

great info here!


JayeWisdom profile image

JayeWisdom 5 years ago from Deep South, USA

I've lived with chronic pain for several years and know it is going to be with me for life. Like KKGals, I also strive for a positive mental attitude and stress management.

One thing that has helped me a lot is becoming a vegan. (I was a vegetarian for several years, but eased back into eating seafood and meat for a while. Reading the book EATING ANIMALS by Jonathan Foer last year caused a late-in-life epiphany, and I became an "instant" vegan.) This way of eating makes me feel better on many levels, and I try to move more, including stretching exercises.

While my pain has not gone away, these things make it manageable without resorting to a lot of pain medication. I am also planning to learn easy yoga for people who are physically challenged.

It is very helpful that the physicians who treat my various maladies are perceptive, understanding and kind. A person with chronic pain needs that attitude from the healthcare professionals with whom she (or he) consults.

Thanks for this information. JAYE


Pamela N Red profile image

Pamela N Red 5 years ago from Oklahoma

Great article about something we all deal with at one point or another.


Docmo profile image

Docmo 5 years ago from UK Author

@ Mark thank you- I am glad it helped understand this difficult and chronic problem..

@Pamela N Red - Thanks for dropping by and your comment.


oceansnsunsets profile image

oceansnsunsets 5 years ago from The Midwest, USA

Great hub on helping people to understand and deal with chronic pain. I am sure these tips will help many people. Thank you for sharing this.


Docmo profile image

Docmo 5 years ago from UK Author

@oceansunsets- Thank you very much!


Docmo profile image

Docmo 5 years ago from UK Author

@oceansunsets- Thank you very much!


teaches12345 profile image

teaches12345 4 years ago

This is great information on the subject. I know people who have to live with chronic pain and take medication in order to function in life activities. It is good to know there are other options in dealing with this problem. Voted up and shared.


TToombs08 profile image

TToombs08 4 years ago from Somewhere between Heaven and Hell without a road map.

A very helpful hub for those dealing with pain, my dear Doc. :) Voted up and sharing.


Docmo profile image

Docmo 4 years ago from UK Author

Thank you Dianna ... I really need to expand this hub as it was one of my early attempts at hub writing.


Docmo profile image

Docmo 4 years ago from UK Author

TT.. you're a star. this hub was zzzing and I was hoping to resurrect it with more info. thank you!


tsmog profile image

tsmog 4 years ago from Escondido, CA

Great article Docmo. Thank you TTombs08 for sharing. This hub gets the FCFSD award and is now placed at that pin board. What a contribution this is and will be.

Mitch


rajan jolly profile image

rajan jolly 4 years ago from From Mumbai, presently in Jalandhar,INDIA.

Yes, we all have suffered pain at one point or the other in our lives. This is a very useful and comprehensive information on pain and its management, Mohan.

Voting this up, useful and interesting, and shared.


tillsontitan profile image

tillsontitan 4 years ago from New York

It is good to know there are some doctors who understand there is chronic pain with no explanation. I have seen many suffer with it and doctor after doctor tells them there is nothing wrong. Your understanding of the subject (as well as your patients, I'm sure) can help many that feel or have been told it is all in their mind. Another wonderful, helpful hub Mohan.

Voted up, useful, and interesting.


mary615 profile image

mary615 4 years ago from Florida

I enjoyed reading your Hub on chronic pain. I have a daughter who has RA and is in pain a lot. I am fortunate. I've only experience acute pain for short periods of time like in kidney stones.

i voted this Hub up, ETC.and will share.


AudreyHowitt profile image

AudreyHowitt 4 years ago from California

Very good article on chronic pain--so many people suffer from it and pain is difficult in the long term


rebeccamealey profile image

rebeccamealey 4 years ago from Northeastern Georgia, USA

Good advice on using the pain meds for chronic pain. A well written and useful Hub!


ananceleste profile image

ananceleste 4 years ago from California

Hi Docmo!

Having advanced MS,I know what Chronic pain is. Sometimes is so unbearable that I would sob unto my pillow until I fall asleep. I meditate a lot, and do breathing exercises. To try to make it less traumatic. Needless to say , I only have few moments of relief.

You can imagine the things that goes through the mind of a person that is constantly in pain. Not good.


tlmcgaa70 profile image

tlmcgaa70 4 years ago from south dakota, usa

i suffer from fibromyalgia among other things. i try to take as little narcotic pain killer as possible, and atm i take one oxycodone at night along with a muscle relaxer and ibuprofen. there are many days and nights when i do not take any medications whatsoever. i wont take meds unless the pain is unbearable. i have found breathing, relaxing, positive attitude and staying focused on other things to be a great help in managing my pain. i have a wonderful doctor now, but in the beginning i was met by doctors who believed it was a figment of my imagination. the dr i have now was at least willing to refer me to a rhuemetologist. he said he didn't know enough about it to accept or discard it. he has been my dr ever since. i know someone who suffers major chronic pain...she has faced several drs who refuse to give narcotic pain killers such as oxy...drs these days are paranoid about people getting addicted. sometimes if it is a matter like hers and she is already well into her sixtes with major health issues i dont see what it matters even if they did get addicted, they have to take them either way for the rest of their lives...and sometimes the only thing that will take sever pain is narcotics pain killers. i feel bad for this friend of mine. great hub, voted up and shared.


Ruchira profile image

Ruchira 4 years ago from United States

Great hub, Doc.

I agree that pain cannot be felt or imagined thus, in my household we use the no. system. When someone is in pain, I tend to ask, "rate your pain from 1-10, where 1 is minimum and 10 is maximum". that helps me get a pix of how much the person is suffering and act accordingly.

I have arthritis and I usually depend on massages, alternative approach and if nothing works then pop in a painkiller.

I liked your informative hub!


DanaTeresa profile image

DanaTeresa 4 years ago from Ohio

Excellent article. I think one of the most important things you said is to encourage people to treat their pain. If it is there and it is bothersome, then do something about it. I lived for years with debilitating menstral cramps. Handfuls of ibuprofen just took the edge off (and destroyed my stomach). Some days I was curled up in a ball aching from knees to shoulders. I thought I would be ridiculed for seeing a doctor about it. When I finally explained my symptoms to a doctor she suggested an IUD. It was one of the best decisions I ever made. And I should have done it years sooner!

I am absolutely sharing this. It is important that people know they do not have to live in discomfort, and that there are many options to treat it. Thank u for writing this.


breastpumpreviews profile image

breastpumpreviews 4 years ago from TX

I live with chronic low back pain myself. I have a hub about my chronic pain and how it affects me. I got to the point I could no longer do my current job, very physical. I went thru hoops with my employer to get them to assist me in finding alternative work. (that will be a future hub)


MartieCoetser profile image

MartieCoetser 4 years ago from South Africa

Thanks to Terrye for pimping this hub. So this came like an answer from above....

Coping with chronic pain that baffles one's GP, could be quite traumatic. This paragraph says it all: ".... when tests do not show a major cause of pain, you are often told, there’s not much ‘wrong’. This makes you go away feeling that you may be suspected of exaggerating..."

If only we could make others feel our pain, including emotional pain, maybe we would all be more emphatic and compassionate.

Thank you for a brilliant article and advice to cope with chronic pain, Docmo. Off to pin this in my personal library.


DDE profile image

DDE 4 years ago from Dubrovnik, Croatia

A helpful Hub to many with chronic pain thanks for sharing such important information voted up!!!


tulika4321 profile image

tulika4321 4 years ago from Kolkata,India

Thanks to Docmo for sharing such important information abou chronic pain!


KDuBarry03 4 years ago

Very useful and informative, as always Docmo. This reminds me of a doctor I went to who didn't diagnose because of pain; it is very sad to see some professionals that way; however, there are doctors and nurses who will say, "The pain's all in your head, you're free to go home." Thank you for shedding light on this :)


unknown spy profile image

unknown spy 4 years ago from Neverland - where children never grow up.

thank you for this well presented hub understanding chronic pain. very helpful!


AtlantaPainClinic profile image

AtlantaPainClinic 3 years ago from 1801 Peachtree St Suite 250 Atlanta GA 30309

Nice Hub! I especially like that you included a section about the cycle of energy in an image. More stress should be put on the importance of sleep for pain management. From healing to the perception of pain, sleep is essential. Also, I thought it was great to point out a multidisciplinary approach to treatment is key to treatment and sometimes diagnosis. I touch on how your brain reacts to pain. Check it out Docmo. http://www.atlantamedicalclinic.com/brain-on-pain


Annsalo profile image

Annsalo 12 months ago from Somewhere

Great article. I have Fibro and they can't seem to get it managed. Lyrica, diclofenac, Tramadol, Keflex, and no relief. I don't understand how they haven't figured a way to fully treat chronic pain yet. Thanks for the great article to cover the topic.

    Sign in or sign up and post using a HubPages Network account.

    0 of 8192 characters used
    Post Comment

    No HTML is allowed in comments, but URLs will be hyperlinked. Comments are not for promoting your articles or other sites.


    Click to Rate This Article
    working