14
Coping With Chronic Pain
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Learning Objectives
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Osteoporosis often causes painful fractures that can take months to heal. In many cases, the pain tends to diminish as the fracture heals; however, vertebral fractures are an exception. When a vertebrae breaks, some people have no pain, while others have intense pain and muscle spasms that last long after the fracture has healed. Most new fractures heal in approximately three months. Pain that continues more than three months is generally considered to be chronic pain.
Pain is the body's way of responding to damaged tissue. When a bone breaks, nerves send pain messages through the spinal cord to the brain where they are interpreted. How a person responds to pain is determined by many factors, including her or his emotional outlook. For example, depression seems to increase a person's perception of pain and decreases her or his ability to cope with it. Often, treating the depression treats the pain as well.
Chronic pain is pain that lasts beyond the expected time for healing and interferes with normal life. The damaged tissues have healed, but the pain continues. The pain message may be triggered by muscle tension, stiffness, weakness, or spasms. Whatever the cause of chronic pain, feelings of frustration, anger, and fear make the pain more intense. Chronic pain can often diminish the quality of a person's life psychologically, socially, and physically.
The following information will provide those suffering from chronic pain with an overview of different options for pain management. If you have chronic pain and need help managing it, you may wish to discuss these options with your doctor.
Physical Methods of Pain Management
Heat and Ice Heat, in the form of warm showers or hot packs, can relieve chronic pain or stiff muscles. Cold packs or ice packs provide pain relief by numbing the pain-sensing nerves in the affected area. Cold also helps reduce swelling and inflammation. Depending on which feels better, apply heat or cold for 15 to 20 minutes at a time to the area where you feel the pain. To protect your skin, place a towel between your skin and the source of cold or heat.
• Warm towels or hot packs in the microwave for a quick source of heat
• Frozen juice cans or bags of frozen vegetables make instant cold packs
• Freezing a plastic, resealable bag filled with water makes a good ice bag
Transcutaneous Electrical Nerve Stimulation (TENS) A TENS machine is a small machine that sends electrical impulses to certain parts of the body to block pain signals. Two electrodes are placed on the body where the person is experiencing the pain. The electrical current that is produced is very mild, but it can prevent pain messages from being transmitted to the brain. Pain relief can last for several hours. Some people may use a small, portable TENS unit that hooks on a belt for more continuous relief. TENS machines should be used under the supervision of a physician or physical therapist. They can be purchased or rented from hospital supply or surgical supply houses; however, a prescription is necessary for insurance reimbursement.
Supports and Braces Spinal supports or braces reduce pain and inflammation by restricting movement. Following a vertebral fracture, a back brace or support will relieve pain and allow the person to resume normal activities while the fracture heals. However, continuous use of a back support can weaken back muscles. For this reason, exercises to strengthen the muscles in the back should be started as soon as possible.
Exercise or Physical Therapy Prolonged inactivity increases weakness and causes loss of muscle mass and strength. Physical therapy and a regular exercise program can help a person regain strength, energy, and a positive outlook on life. Because exercise raises the body's level of endorphins (natural pain killers produced by the brain), pain will diminish. Exercise also relieves tension, increases flexibility, strengthens muscles, and reduces fatigue. A physical therapist can help the person reorganize their home or work environment so that injuries can be avoided. Physical therapists also teach proper positioning, posture, and exercises to strengthen the back and abdominal muscles without injuring a weakened spine. Pool therapy is one of the best exercise techniques to gently improve back muscle strength and reduce pain.
Acupuncture and Acupressure Acupuncture is the use of special needles that are inserted into the body at certain points. These needles stimulate nerve endings and cause the brain to release endorphins. It may take several acupuncture sessions before the pain is relieved. These techniques have been used in China to treat many types of pain and as an anesthetic.
Acupressure is direct pressure over trigger areas of the pain. This technique can be self-administered after training with an instructor.
Massage Therapy Massage therapy can be a light, slow, circular motion with the fingertips or a deep, kneading motion that moves from the center of the body outward towards the fingers or toes. Massage relieves pain, relaxes stiff muscles, and smooth out muscle knots by increasing the blood supply to the affected area and warming it. The person doing the massage uses oil or powder so that her/his hands slide smoothly over the skin. Massage can also include gentle pressure over affected areas or hard pressure over trigger points in muscle knots. However, deep muscle massage should not be done near the spine of a person who has spinal osteoporosis. Light, circular massage with fingers or the palm of the hand is best in this case.
Psychological Methods of Pain Management
Relaxation Training Relaxation involves concentration and slow, deep breathing to release tension from muscles and relieve pain. Learning to relax takes a great deal of practice, but relaxation training can focus attention away from pain and release tension from all muscles. Relaxation tapes are available to help achieve the desired effects.
Biofeedback Biofeedback is taught by a professional who uses special machines to help a person learn to control bodily functions such as heart rate and muscle tension. As the person learns to release muscle tension, the machine immediately indicates success. Biofeedback can be used to reinforce relaxation training. Once the technique is mastered, it can be practiced without the use of the machine.
Visual Imagery or Distraction Imagery involves concentrating on mental pictures of pleasant scenes or events or mentally repeating positive sayings to reduce pain. Tapes are also available to help visual imagery.
Distraction techniques focus the person's attention away from negative, painful images to positive mental thoughts. This may include watching television or a favorite movie, reading a book or listening to a book on tape, listening to music, or talking to a friend.
Hypnosis Hypnosis can be used in two ways to reduce a person's perception of pain. Some people are hypnotized by a therapist and given a posthypnotic suggestion that reduces the pain they feel; others are taught self-hypnosis and can hypnotize themselves when pain interrupts their ability to function. Self-hypnosis is a form of relaxation training.
Individual or Family Therapy A psychologist, psychiatrist, or psychiatric social worker can help people cope with the feelings of depression, frustration, and anger that often accompany chronic pain.
Medications for Pain Management
Over-the-counter Pain Relievers Aspirin, ibuprofen, naprosyn sodium, and acetaminophen can effectively relieve pain. While these medications are relatively safe, they can still cause side effects such as stomach upset. For this reason, these medications should be taken according to the manufacturer's directions. Before increasing the frequency of use or the dosage, the person should first check with her or his doctor or pharmacist.
Non-steroidal Anti-inflammatory Medications (NSAIDs) NSAIDs may be prescribed to treat mild to severe pain. These preparations block pain and treat inflammation. There are dozens of NSAIDs on the market, and a person may have to try several different brands to find the one that works best for her or his pain.
Muscle Relaxants Some patients also get relief from muscle spasms with well-tolerated muscle relaxants. These medications must be prescribed by the physician.
Topical Pain Relievers A variety of pain-relieving topical creams may also relieve pain when they are rubbed directly into the painful area. While some of these creams are available by prescription only, others may be purchased over-the-counter.
Narcotic Pain Medications Narcotics are powerful pain-relieving medications derived from opium or synthetic opium. Narcotics alter a person's perception of pain and also induce euphoria, mood changes, mental cloudiness, and deep sleep. These drugs may also cause nausea, lethargy, and constipation. People with osteoporosis must be very careful when taking these medications. Narcotics can affect a person's balance and increase the chance of falling. After repeated and prolonged use people may become dependent on or addicted to these medications.
There are two new medications that appear to relieve pain without the serious side effects of narcotics. Tramadol is a pill that appears to act like a narcotic in terms of pain relief but has fewer side effects. A skin patch that releases small amounts of a narcotic into the body through the skin is also available. Both of these medications can only be obtained by prescription.
Antidepressant Medications People who suffer from chronic pain frequently suffer from chronic depression as well. Several studies using antidepressant medications have noted that these medications may not only improve depression but may also relieve or reduce the amount of pain a person feels. Additional research is needed to determine whether antidepressants can treat the chronic pain of osteoporosis and which antidepressants give the best results.
Nerve Block In some cases, a physician may perform a nerve block, which involves the injection of pain-relieving medications into the tissues around an affected nerve. The block numbs the nerves and surrounding tissues so they can no longer sense pain. Pain relief may last for hours or months, depending on the medications used and the person's response to them.
All of these methods of pain management, alone and in combination, are used in hospitals and clinics across the country. People who are suffering from unrelieved chronic pain may wish to consult their physician for a referral to a physical therapist or a clinic specializing in pain management.
Source: National Osteoporosis Foundation
Reprint with permission.