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Non-Medication Pain Relief for Chronic Pain

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The Options | Applying Heat or Cold | Relaxation | Exercise | Acupuncture | Meditation | Hypnotherapy | Attitude and Communication

For people who suffer from mild to moderate chronic pain, medicine may offer relief. But many people find they can gain long-term control over their pain through complementary methods. "For the vast majority of people who have chronic pain, there just aren't any pharmacological or physical interventions that can totally eliminate the pain," says University of Washington (Seattle) pain management expert Dennis C. Turk, PhD. "Pain is a chronic condition, just like hypertension or diabetes," Dr. Turk explains. "When you have a chronic condition, you need to do more things for yourself. It's going to last a long time. It's best to help yourself and learn to self-manage and control your pain."

The Options

In addition to traditional pain relievers, nondrug methods of pain relief may help you gain that control. Some techniques, like imagery, relax the muscles, help you sleep, and distract you from symptoms.

While some techniques require little expertise or help from others, some may require instruction from a professional. Dr. Ronald Glick is the director of the University of Pittsburgh Pain Evaluation and Treatment Center. Dr. Glick recommends that patients seek advice from a chronic pain specialist who can coordinate all aspects of management, including physical therapies and other techniques.

Below are examples of the many nondrug options that are available.

Applying Heat or Cold

"The most important thing about heat and cold is that it gives a sense of control," Dr. Turk says. "They are things you can do yourself to help relieve the pain, which can immediately reduce the emotional stress."

"Heat and cold can be quite helpful for people with musculoskeletal conditions," adds Dr. Turk. "Something as simple as a bag of frozen peas wrapped in a towel can be a useful self-management technique that relieves muscle tension in the back, neck, and shoulders."

Most of us are familiar with holding an ice pack on a twisted ankle or lying on a heating pad for a sore back. But hot and cold treatments can be used in other ways. For example, moist heat, which is often more effective than dry heat, can be applied with a warm towel or a soak in the tub. A small paper cup filled with water and kept in the freezer can become an excellent tool to apply to a painful area, while iced washcloths can be used to cover a larger area.

When using heat or cold therapy, do this for only 15 minutes at a time. Allow the area to return to normal body temperature before reapplying the therapy. Some people obtain added relief by alternating heat and ice. Others use heat before exercising and ice after.

Always place a towel between the cold or heat and the skin. Never lie directly on a heating pad, and if it feels too warm, take it off.

Relaxation

The "relaxation response," is a term coined by Herbert Benson, MD, of the Mind-Body Medical Institute in Boston. It is an array of beneficial physiological effects associated with focused relaxation. Some of which may mitigate the perception of pain. For best results, make relaxation a part of your daily routine.

There are a number of ways to invoke the relaxation response, and many audio and video downloads are available to help. One popular approach is to assume a comfortable position, take several deep breaths, and then focus on your breathing, or a word or sound, while passively avoiding intruding thoughts.

Progressive muscle relaxation is a technique that may be effective for both muscle spasm pain and stress reduction. "Relaxation skills are useful in reducing muscle tension and can help reduce frustration and some of the stress," says Jennifer Markham, PhD, at the University of Pittsburgh Pain Clinic. Progressive muscle relaxation involves focusing your attention on each muscle group until it feels heavy and relaxed. You usually begin in the feet and gradually progress upward.

Imagery, which often accompanies the management of pain through relaxation, allows you to visualize what it would be like to "let the pain go." If you know what is causing the pain—for instance a pinched nerve in the spine—the idea is to picture the encroaching vertebral space opening and freeing the trapped nerve. By calling on a variety of senses, you can take yourself to a favorite place, like the beach or the mountains. Music, nature sounds, and instructional audio make it easier for beginners to escape to a mental paradise.

"Relaxation techniques redirect your thinking from physical pain and onto something else," says Penney Cowan, founder and executive director of the American Chronic Pain Association. "Imagining the beach, the sun on your face, and the warmth of the sand helps divert your mind from how much your head is hurting."

Biofeedback offers a measurable response to relaxation and imagery techniques. Through the use of sensors connected to a computer, you receive visual or auditory cues that indicate an increase or decrease in muscle tension, heart rate, and skin temperature. Using this feedback, you train yourself to control body functions that you normally don't even think about. Biofeedback may be useful in chronic pain or other conditions associated with muscle spasm or tension, like some headaches.

Exercise

Although you may not feel like getting off the couch because you hurt so much, exercising within the confines of your physical limitations can decrease pain. Why? The reasons are complex, but one prominent theory is that exercise releases endorphins, which are natural pain relieving chemicals in your brain.

"Exercise is absolutely critical," says Dr. Turk. "The type of exercise will depend on the condition, but as a general rule of thumb, the more active you remain and the more you use your muscles, the better off you're going to be."

A physical therapist can tailor an initial exercise plan based on your capacity to exercise, and then gradually make recommendations for increasing how much you do and for how long. Pain experts recommend pacing activities. Overdoing it on good days can come back to haunt you later. It's fine to cut back on your exercise during a flare-ups of your pain, but it's important to resume your exercise routine as soon as you feel better.

Acupuncture

Acupuncture is a form of Chinese medicine. It involves inserting very thin needles into the skin at different and very specific points of the body. While the evidence to support the use of acupuncture for the treatment of chronic pain, like back pain, has been mixed, acupuncture may be worth a try if other self-care options have not been helpful for you.

Meditation

The benefits of meditation go beyond relaxation response. Daily meditation may be an excellent tool in fighting chronic pain. Since there are a variety of different meditation techniques, try to find a meditation style that is right for you. Meditation can be done easily in a privacy of your home.

Hypnotherapy

When you think of hypnosis, you may picture a performer on the stage with a handful of audience members. But, hypnotherapy is done by a trained and licensed therapist who uses several techniques, like progressive relaxation methods, to create a hypnotic state. This alternative therapy has been used for a number of conditions, including pain relief.

Attitude and Communication

The way you think about your aches and discomforts, your level of anxiety and depression, your expectations, and your ability to cope determines how much pain you feel. Cognitive-behavioral therapy can help change unhealthy attitudes and habits that can develop when pain is chronic.

"Psychology helps people begin to understand they do have some control, even if they don't have a magic wand to make the pain go away," says Dr. Markham. "When they realize they have some control [over their pain], it gives them hope."

RESOURCES:

American Chronic Pain Association

http://www.theacpa.org/

American Pain Foundation

http://www.painfoundation.org/

CANADIAN RESOURCES:

Canadian Psychiatric Association

http://www.cpa-apc.org/

References

Acupuncture. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated February 23, 2012. Accessed April 18, 2012.

Chronic low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated April 4, 2012. Accessed April 18, 2012.

Gatlin CG, Schulmeister L.When medication is not enough: nonpharmacologic management of pain. Clin J Oncol Nurs. 2007 Oct;11(5):699-704. Review.

Hypnotherapy. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated August 2, 2011. Accessed April 18, 2012.

Lee H, Schmidt K, Ernst E. Acupuncture for the relief of cancer-related pain—a systematic review. Eur J Pain. 2005; 9:437.

Physical rehabilitation in managing pain. International Association for the Study of Pain website. Available at: http://www.iasp-pain.org/AM/AMTemplate.cfm?Section=HOME&CONTENTID=7615&TEMPLATE=/CM/ContentDisplay.cfm&SECTION=HOME. Published November 1997. Accessed April 18, 2012.

Rydholm M, Strang P. Acupuncture for patients in hospital-based home care suffering from xerostomia. J Palliat Care. 1999; 15:20.

Wright LD. Meditation: a new role for an old friend. Am J Hosp Palliat Care. 2006 Aug-Sep;23(4):323-7. Review.

Last reviewed May 2012 by Peter J. Lucas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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