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Video: Tips for managing chronic pain

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    >>> g kid cereals.

    >>> this morning on "today's health ," how to deal with chronic pain . more than 43 million americans report living with some sort of chronic pain with no relief in sight. courtney smith is the executive editor of prevention magazine and she's here to talk about the five common mistakes and five solutions to help ease your pain. courtney , good morning.

    >> good morning.

    >> i know that chronic pain is defined as pain that lasts about -- at least three months or more. but a lot of people aren't really treating their chronic pain . right? or it goes sort of -- they think that they can treat it on their own and do the over-the-counter thing.

    >> yes. but the new thinking is that chronic pain is a disease, not a symptom. you really need a comprehensive program that may include medication , lifestyle changes, natural therapies , and you want to consider your goal. because eliminating your pain may not be possible, but you should get enough relief so you can do the things you love. that is realistic.

    >> there is no magic bullet necessarily or no cure-all.

    >> there isn't. you'll have to try different things to see what works. it may take time but you will get better.

    >> talk about the mistakes a lot of people are making when it comes to dealing with the chronic pain , the first being, as i mentioned, they feel that they can just tough it out. many think just give it a little bit of time, this, too, shall pass. when do you really need to go to the doctor?

    >> it is okay to wait for four weeks. but after that, you should see your doctor if you're still in pain. most injuries will resolve themselves after about a month. the longer you wait, the more havoc you're wreaking on your body and mind because your muscles weaken, your joints stiffen and the most surprising thing is that your brain literally shrinkses under the stress of chronic pain . you'll be less likely to be able to cope. so don't wait longer than four weeks.

    >> mistakes number two then, once you are going to the doctor, a lot of people decide to go see lots of doctors, doctor hopping. why is that not a good idea? when you really are in the market of finding that person who is going to be just right for you.

    >> if you see different specialists, you may get different tests, get conflicting diagnoses and it may be hard to sort out yourself, so you want one doctor to follow you through the process and help you put it in perspective. for most of us, that's our primary care doctor. even if that person is not trained in pain specifically, they should take your pain seriously, give you a comprehensive program where you're trying different things, and the most important thing is see him frequently enough so they're really evaluating that's working, stick with that, that's not working, let's try something else. you will probably have to tweak the routine to find what works for you.

    >> exercise is a great way to keep the body healthy but a lot of people when they're suffering from chronic pain , it is probably the last thing they're thinking of doing. you say that's a big mistake .

    >> it is a mistake . you don't want to become sedentary because exercise heals pain on every level. it strengthens the muscles, oils the joints, it fights imfla mags inflammation that comes with gout and rheumatoid arthritis and it raises endorphins. the instinct is to sit still but you want to pursue low-impact exercise that keeps you moving, keeps you functional. that can be a ten-minute walk, swimming, aquatica aerobics.

    >> people think surgery will be the cure-all. not the case.

    >> it sounds like a quick fis but the evidence on the effectiveness of surgery is mixed. also watch for risk of infection, nerve damage . that can actually worsen pain. the advice is exhaust non-invasive remedies. medicine, natural remedies , alternative therapies .

    >> that's the other thing you say to explore.

    >> yes. people try them on their own but bring them to your doctor, fold them into your routine. there are well studied remedies li acupuncture, omega-3 fatty acids .

    >> courtney smith , thank you so much .

By
updated 4/20/2010 10:27:36 AM ET 2010-04-20T14:27:36

An estimated 43 million Americans report living with chronic pain, defined as lasting for at least 3 months. Yet experts agree that it’s woefully undertreated in our country. Despite breakthroughs in the understanding of pain, few doctors are aware of these advances or are trained in pain management.

One major shift in thinking is that chronic pain is now believed to be a disease, not a symptom, and that treating pain is about not simply targeting the source but treating the whole person. Like heart disease or other chronic conditions, there’s no magic bullet, so you need to draw on a number of approaches, from exercise and medication to relaxation techniques and talk therapy.

Eliminating your pain entirely may not be realistic; what is attainable is to lower it enough to improve your life and do the things you love. If you’re making any of the mistakes that follow, we’ve got the right formula for lasting relief.           

Mistake: You’re trying to tough it out
One in four pain sufferers waits at least 6 months before seeing a doctor, typically because of downplaying pain or thinking it’ll pass on its own, according to the American Pain Society. And many sufferers self-treat with OTC painkillers.

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Get relief: Seek treatment sooner rather than later. Studies show that the majority of injuries resolve themselves in about 4 weeks, so if yours hasn’t — or if your pain is affecting your ability to function — see your doctor. Waiting can wreak havoc on your body and your mind.  When pain keeps you from being active, muscles weaken and shrink and joints stiffen, setting you up for further injuries.

Research shows that chronic pain can also lead to depression and even shrink your brain. A study of 26 patients who had back pain for at least 1 year found that they had a 5 to 11% loss of brain cells in two areas of the brain — the thalamus and prefrontal cortex — compared with a control group.  One explanation is that the neurons are hyperactive for so long that it causes them to break down and die. Researchers hypothesize that if the pain persists, it may become less responsive to treatment because of the brain changes.

Mistake: You’ve seen more than one specialist
In our fragmented health care system, with a specialist for every ailment, it’s easy to jump from one doctor to the next. But doctor hopping, experts say, can waste time and money, lead to excessive MRIs and other diagnostic tests, and delay treatment.

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Get relief: Find one doctor who can be your point person to coordinate other treatments. Your primary care physician is likely the best person for this. Just make sure you get a sense that he or she takes your pain seriously, offers you a treatment strategy, and sees you frequently enough to monitor your progress — or refer you to a specialist if your plan is not working.

If you’ve been suffering for months with no improvement, then it may be time to seek out a comprehensive pain management center. If you don’t have pain management experts near you, look for a specialist who deals with the source of your pain, like an orthopedist for back pain or a rheumatologist for arthritis or fibromyalgia.

Mistake: You’re afraid to exercise
It may be the last thing you feel like doing when you’re hurting, but study after study shows that exercise reduces all kinds of pain. It strengthens your muscles and oils your joints, making you less likely to get reinjured. It also releases natural pain-relieving endorphins, which can boost your mood, and it fights the inflammation associated with a number of painful conditions like gout and rheumatoid arthritis.

Get relief: Start slow and easy, especially if you’ve been sedentary for a few months. Do 5 or 10 minutes of walking or another low-impact activity a couple of times a day if that’s all you can do. Swimming or aquatic aerobics, especially in warm water, makes it easier to move, takes pressure off joints, and reduces stiffness and pain. The goal is to get you to a comfortable level of functioning. For people who have fibromyalgia, low- or moderate intensity activities reduce pain better than high-intensity ones.

Mistake:Your instinct is surgery before therapy
Surgery may feel like the most efficient option, but for chronic pain, the research is mixed. Studies show that operating to relieve lower-back pain without any evidence of nerve pressure, for example, may offer minimal, if any benefit, compared with a rehabilitation program — not to mention that it comes with risks. The truth is any surgery has a chance of making your pain worse from infection, scarring, and nerve damage.

Get relief: Opt for pain medications, physical therapy, or exercise first. To treat back pain, for example, experts recommend trying a combination of the three for at least 6 months before discussing surgical options. Many people will improve enough to either avoid or no longer be eligible for surgery. You can also talk with your doctor about trying a shorter, more intensive rehabilitation program.

Mistake: You’re wary of narcotics
The news is filled with stories about unintentional deaths from pain meds or celebs who became hooked on them, so many pain sufferers prefer to play it safe with OTC pain relievers. Even some physicians avoid narcotics for fear of being punished for overprescribing them. But the reality is, most people in pain aren’t going to get addicted to or die from pain meds. And the benefits of taking them are immense — when you’re in less pain, you can be more active and speed your recovery.

Get relief: Most doctors start patients on low doses of opioids and require check-in evaluations every 3 or 4 weeks to make sure the medication is working well. If you experience that “drugged” feeling in the beginning, don’t worry — it’ll go away in a few days as your body adjusts to the medication. Take the drug only as prescribed — don’t increase the dose or combine it with other types of drugs, such as muscle relaxants or anti-anxiety drugs, unless you’ve talked with your doctor.

All that said, there are some people who may be predisposed to addiction. If you’ve had a problem with alcohol or drugs in the past, you’ll have to be monitored even more closely by your doctor. Signs of addiction include feeling compulsive about taking the drug, being unable to control how much you take, and showing no signs of improvement.

Mistake: You haven’t considered natural treatments
If you can’t take pain meds because of side effects or are just looking to enhance their effects, consider alternative treatments. Clinical studies show that acupuncture, for example, relieves osteoarthritis pain, sciatica, and lower-back problems. Rheumatoid arthritis sufferers can benefit from the anti-inflammatory effects of omega-3-fatty acids supplements; according to a large review of recent research, patients who took devil’s claw, white willow bark, and cayenne for lower-back pain had more relief than those who took a placebo.

Get relief: Herbal therapies are not without side effects and they may interfere with other medications, so talk with your doctor before taking them. Numerous studies also show that mental techniques can help ease pain. Start with some simple relaxation techniques: Practice deep breathing and tightening and relaxing different muscles for 15 to 20 minutes every day. A therapist can help you learn other types of relaxation, such as visualization, self hypnosis, and biofeedback — ask your doctor for a referral.

Mistake:You don’t discuss depression
About 54 percent of people with chronic back pain suffer from depression, but only one-third of them take antidepressants, according to a recent study. New brain-imaging research, however, clearly shows that our mental state is intricately tied to how we process — and deal with — pain. Brain scans show that in patients with chronic pain, the parts that light up are involved with emotion, not just sensation. It implies that our emotions have a profound influence on how we perceive pain, how much distress it causes, and ultimately how it affects our quality of life.

Get relief: If you feel hopeless, sleep more or less than usual, and gain or lose weight rapidly, you could be suffering from depression. Discuss your symptoms and options with your doctor, who may prescribe an antidepressant, recommend cognitive behavioral therapy, or even suggest a combination of the two. CBT teaches you how to better cope with and adapt to your pain (and even train your mind to reduce it), which helps lessen the emotional stress that can make the pain feel worse.

There is more science showing the benefit of cognitive behavioral approaches than there is for most of the drugs for pain. In one recent study, patients with depression and pain were randomly assigned to receive antidepressants and, after 3 months, were given six sessions of CBT. A year later, those in the intervention group were significantly less depressed and had less pain than those who were only informed that they had depressive symptoms and should seek advice about treatment.

Copyright© 2012 Rodale Inc.All rights reserved. No reproduction, transmission or display is permitted without the written permissions of Rodale Inc.

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