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Basic Pain Management Techniques

One in four Americans - 75 million people - live in chronic, debilitating pain. In fact, pain affects more Americans than diabetes, heart disease and cancer combined. Here are some steps you can take to get relief.

What is pain?

The early Greeks and Romans advanced the idea that the brain played a role in producing the perception of pain. In the 19th century, physician-scientists discovered that opiates such as morphine could relieve pain and chemist Felix Hoffmann developed aspirin from a substance in willow bark. Aspirin remains the most commonly used pain reliever today.

In 1994, the International Association for the Study of Pain (IASP) defined pain as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage."

According to a survey by the National Center for Health Statistics (2006), 26% of adults experienced pain lasting more than 24 hours in the month prior, and 10% experienced the same pain for a year or more. Pain requires particular attention in infants and children since they are not always able to describe the type, degree, or location of pain they are experiencing.

The truth about women and pain

Pain is a regular, if unwelcome, reality for many women, perhaps even more than it is for men, and yet, according to the American Pain Foundation, they are often undertreated. Most women have pain with menstruation at some point in their lives, and childbirth can be painful. Some common disorders of the female reproductive tract are painful. Also, painful autoimmune diseases are much more common in women. To cope with their pain, women tend to use more approaches than men, such as learning about their condition, turning to others for support, and finding ways to relax more and manage stress.

Still, it can be hard for a woman to get help for her pain. Some doctors are less likely to give women painkillers because they think that women overstate the amount of pain they feel. Studies have shown that given the same amount of pain, men are less likely to report it than women. Men might feel they need to "tough it out." But this doesn't mean that the pain women are reporting isn't real.

Chronic pain

Women are more likely to have chronic pain conditions. Pain is chronic if it lasts
more than three months. Chronic pain can sometimes last years or even decades. Sometimes, pain is caused by injury or disease. In such cases lab tests show definite signs of injury or disease in an organ or other body part. In other chronic pain conditions, the pain can't be traced to any specific disease or injury. The exact cause of the pain is unknown. In these cases, the chronic pain itself is the disease.

Whatever its cause, chronic pain can interfere with all aspects of your life. It can:

make it difficult to work and interact with family and friends.
make you feel irritable and depressed.
make it hard to sleep.
make you lose interest in food and sex.
make you less inclined to get physical activity (as a result, you may gain weight, which can make some chronic pain problems worse).
lead to dependency on narcotic pain-killers or alcohol as a way of coping with chronic pain.
cause you to have the burden of many doctor bills that come from trying to treat it.

Chronic pain is different from acute pain, which is pain that lasts less than three months. Acute pain, such as pain from a cut, is closely linked to an injury, infection, or inflammation. Inflammation is the body's response to injury or irritation, signaled by pain, swelling, redness, and heat. When the cause of the acute pain goes away, so does the pain.

Diagnosis

During your first visit, your doctor will ask you questions about:

when your pain started
location of your pain
how your pain feels (for instance, does it feel like a sharp stabbing pain, a steady burning, or a dull ache?)
what makes your pain better or worse
how the pain affects your activities of daily living (for instance, bathing, dressing, and eating)
all of the medicines that you have ever used to treat your pain (both prescription and over-the-counter)
any side effects you may have from these medicines.

Your doctor may ask you to rate the intensity of your pain on a scale from 0 to 10. He or she may also ask you questions to find out if you are depressed. Being depressed is quite common among patients with chronic pain. For some patients, though, the depression comes first. The chronic pain may be caused by or be part of the depression. In fact, many people who are depressed complain about pain problems, such as frequent headaches, back pain, or stomach pain, rather than depression. The only way your doctor can accurately diagnose and treat your problem is for you to answer your doctor's questions honestly.

Treatment

Treatments for pain include medicines, physical therapies, psychological and behavioral therapies, complementary and alternative therapies, and surgery. To get a treatment plan involving a variety of approaches, you may want to try a pain clinic. These clinics have a team of professionals, including doctors, psychologists, physical therapists, complementary and alternative therapists (such as acupuncturists or massage therapists). Together, the team will put together a pain management plan for you, often involving a combination of different treatments. If you do not have a pain clinic where you live, ask your doctor for referrals to therapists near you. Because everyone is different, a treatment that works for one patient may not work for others. You may have to try a variety of treatments before you find one or more that work for you.

Medicines
Medicines that reduce pain are called analgesics. They block the pain signals carried by nerves but do not cure the problem that is causing the pain. When an analgesic wears off, the pain often returns.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of analgesics. They reduce pain and also reduce fever and inflammation. Common ones include: aspirin, ibuprofen and naproxen. When used once in a while, these drugs cause few side effects. But long-term use can irritate the stomach and intestines. NSAIDs other than aspirin also may increase the risk of heart attacks and stroke. Some of the NSAIDs may cause liver or kidney disease as well.
Acetaminophen works in much the same way as NSAIDs but doesn't reduce inflammation. Acetaminophen is less likely to bother the stomach, but taking too high a dose can damage your liver, especially if you drink a lot of alcohol.

Opioids, or narcotics, are the most powerful pain medicines. Opioids commonly prescribed include morphine, methadone, and oxycodone. ide effects include:

nausea
vomiting
feeling drowsy
difficulty having a bowel movement

If you take an opioid drug for more than a week or two (and, for some people, as little as a few days), you can become physically dependent on the drug. This means that you will have withdrawal symptoms when you stop taking it. Withdrawal symptoms include nervousness, diarrhea, and tremor, or shaking. Physical dependence on opioids is a normal response to taking the drugs and not something to be overly concerned about. Physical dependence is not the same as addiction. Addiction to opioids means that you crave opioid drugs and feel driven to take them for reasons other than easing your pain. When taken properly, the chances of becoming addicted to opioids are low.

Early research suggests that women's pain responds better than men's to a class of opioids called kappa opioids. This suggests that male and female brains handle pain signals in different ways. It also suggests that kappa opioids might be an option for women in pain who do not respond well to typical opioids. More research is needed in this area.

Researchers are also working on developing opioid medicines that hopefully will not be addictive and will have fewer side effects. Some of these are showing promise in research on animals. But none are yet available for use in humans.

Antidepressants and anticonvulsants. Some medicines used to treat depression can treat some painful conditions, including migraine and tension headaches. In a way, this is not surprising, because we know that the part of the brain where pain is processed is also involved in depression. Pain can make depression worse, and depression can make your pain worse. So if you are in pain and also are depressed, you need to treat depression and pain at the same time.

Other medicines that have been used for treating certain types of pain are anticonvulsants. These medicines were developed to treat epilepsy. But they are sometimes useful for treating painful conditions caused by damage to the nervous system.

The promise of research
Advances in basic and clinical genetics are making it possible to both characterize genetic factors related to pain sensitivity and develop novel therapeutic approaches. NIH-supported scientists, for example, identified a gene variant of an enzyme that reduces sensitivity to acute pain and decreases the risk of chronic pain.
COX-2 (cyclooxygenase-2) is a major contributor to pain associated with inflammation. A study of genes affected by COX-2 led to the discovery of its role in connection to multiple cellular pathways that contribute to pain relief and adverse side-effects. With these discoveries will come the ability to better personalize pain management strategies.

Other therapies for pain

Your therapists may suggest nondrug treatments instead of or along with taking medicines. Not only do women use more nondrug therapies than men, women are more likely to respond well to them.

Physical therapy
Many patients with chronic pain move as little as possible, thinking that physical activity will harm them. In fact, the opposite is true. When you get out of shape, your pain may become worse. If you have a chronic pain problem, a physical therapist can help you find a physical activity program that is gentle, moderate, and right for you. You should follow the program, even if you feel some pain during physical activity. In this case, the pain does not mean that you are harming your body.

Types of physical therapy that may help your pain include:

heat treatment—hot water baths, heating pads, high-frequency sound waves to produce gentle heat deep in your tissues
cold treatment—ice packs, ice baths, ice massage
gentle stretching
muscle—strengthening physical activities
massage—applying pressure to specific points on the body
vibration therapy—a probe is applied to a part of your body with moderate pressure and vibrated several thousand times per second

Nerve stimulation therapies
These therapies involve the use of low electrical currents and/or fine needles that are placed in specific parts of the body. Acupuncture is one example. These therapies seem to interfere with the sending of pain signals to the brain. They may also cause the body to release natural painkillers, called endorphins.

Psychological and behavioral therapies
Therapies that help you relax or change your thinking patterns can sometimes help you cope with pain. Examples of these therapies include:

Cognitive therapy—helps you to gain control over your pain by teaching you to recognize and change emotions that can make pain worse, such as anxiety, anger, and sadness
Progressive muscle relaxation—tensing and then relaxing muscles helps to ease muscle tension that may be adding to your pain
Deep breathing exercises—helps you to relax
Guided imagery—imagining a pleasant scene takes your mind off your pain
Biofeedback—electronic equipment tells you about your muscle tension, skin temperature, and other body functions, so you can learn to control these functions and reduce your pain

Stress reduction and "self" pain management
You also might be able to lessen your pain or muscle spasms and deal with other aspects of living with your disease if you try meditation or self-hypnosis. You can learn to do these through self-help books, tapes, or with the help of an instructor. You also can use imagery (using the power of your thoughts to "destroy" your pain) or distract your focus on your pain by doing a hobby or something else you enjoy.
To use imagery, set aside 15 minutes two or three times each day:

Put on your favorite calming music.
Lie back on your favorite chair or sofa. Or if you are at work, sit back and relax in your chair.
Close your eyes.
Imagine your pain or discomfort.
Imagine something that confronts this pain and watch it "destroy" the pain.

Adapted in part from the National Women's Health Information Center (www.womenshealth.gov) and information from the National Institute of Nursing Research at the National Institutes of Health