[Editor's Note: This article provides a brief overview of chronic pain and some tips to alleviate it through non-medicinal methods. It is a component of the Healthwise Knowledgebase, which is a product of Healthwise Incorporated. Healthwise reviews the contents of the Knowledgebase on a quarterly basis. This article was last reviewed in January 1999]

Overview

Chronic pain is a common problem in many chronic diseases. Chronic pain often affects your thoughts and feelings about the pain and affects how much pain you feel. Feeling anxious, angry, frustrated, or out of control about your pain may make it worse. Your mind and body are important allies in your efforts to manage pain. Your brain can release natural substances called endorphins, which can block pain. Their release depends on how you are thinking and feeling about your pain.

You can train yourself to think and feel differently about chronic pain. These ideas are not a substitute for treatments or advice from your doctor, but they may be a helpful addition to your regular medical care.

• Take control of the pain. This may mean accepting that the pain is not going away while you decide to take active steps toward managing it and keeping it from affecting your life too much.
• Track how your moods, thoughts, and feelings affect your pain. Make a record of your pain level, activities, moods, thoughts, and feelings several times a day for several days. You may find that your pain is worse during or after certain activities or when you are feeling a certain emotion.
• Recognize negative self-talk. Your thoughts can affect your perception of pain. Try to recognize any negative or self-defeating thoughts you have about your pain, such as This pain will never get better, or I'll never be able to play with the grandkids with this pain.
• Practice positive self-talk. When you catch yourself in a negative thought, actively replace it with a positive statement, such as I can manage this pain, or I will relax before the kids get here.
• Try a relaxation technique. Chronic pain causes stress and tension, which in turn may increase pain. See the topic Stress, Distress, and Relaxation Skills in Related Information for relaxation techniques. Gentle exercise, such as walking, also helps relieve tension.
• Change the way you do daily activitiesso that you can do them with less pain. Try assistive devices.

If you can put your mind to work against the pain, you may find that you can manage it better and that it interferes less with your life. See the topic Home Health Library in Related Information and read the section Dealing With Chronic Pain and other "pain" resources.

Dealing With Chronic Pain

There is no magic solution to chronic pain, whether it is caused by arthritis, osteoporosis, back problems, cancer, or any other condition. Nothing offers complete and total relief. However, the following tips may help.

• Experiment with heat, cold, and massage. Find out what works best for you. Touch is important, too. Ask for and give lots of hugs.
• Continue to exercise. Find enjoyable exercise that does not aggravate your pain. Use stretching exercises every day.
• Try to relax. Severe pain makes your body tense and tight, and the tension may make the pain worse. See the topic Stress, Distress, and Relaxation Skills in Related Information. It takes practice to learn any relaxation skill. Give a method a 2 week trial. If it doesn't work for you, try another.
• Do something distracting. Focusing all your attention on your pain makes it seem all-consuming. Refocus your attention away from the pain and onto something else. Sing a song, recite a poem, or concentrate on a visualization.
• Expose yourself to humor. A good, hearty belly laugh can provide your body with natural pain relief. Laughter is the best medicine.
• Practice positive self-talk. Refuse to entertain negative, self-defeating thoughts or feelings of hopelessness.
• Consider alternative therapies such as biofeedback or accupuncture in addition to your regular medical care. Make sure to avoid fraud.
• Join a support group. Being around others who share your problem, can help you and your family learn skills for coping with pain. To find a group near you, contact the American Chronic Pain Association, P.O. Box 850, Rocklin, CA 95677, (916) 632-0922.
• Consider going to a pain clinic. Be wary of those that promise complete relief from pain or that use only one method of treatment. Approved programs are registered with The Commission on Accreditation of Rehabilitative Facilities (CARF), 4891 East Grant Road, Tucson, AZ 85712, (602) 325-1044.
• Appeal to the Spirit. If you believe in a higher power, ask for support and relief from the pain..

[Editor's Note: Dr. Rita Cowan, Ph.D. is a Psychologist and Registered Nurse who specializes in Health Psychology at The Falls Pain Management Center, Cuyahoga Falls General Hospital in Cuyahoga Falls, Ohio USA. This article is being reprinted with permission. For more information about chronic pain, visit the Chronic Pain Solutions Website.]

Professionals who treat people with chronic pain have diverse strategies to assist patients in reducing their pain and increasing their quality of life. Biofeedback, relaxation techniques, and coping skills training have helped many patients. Overall, studies show that patients who engage in these treatments tend to do better than those who do not.

Despite these treatments, many people do not improve. If the person who has chronic pain is reluctant to change certain behaviors, the outcome is greatly reduced. Often, people who suffer with persistent pain do not realize their responsibility in managing their pain. Chronic pain is, by definition, a continuing condition that often does not go away. Thus, the best many patients can hope for is a reduction in the intensity of pain. This awareness alone can cause frustration and reduce motivation to change behaviors.

Researchers have identified six stages we move through when changing from maladaptive to adaptive behaviors.

1) Precontemplation -- In this stage we do not believe we need to change and often show resistance to suggestions for change.

2) Contemplation -- We see the need for making a change and make some plan to do it in the future. However, we have not committed to start.

3) Preparation -- In this stage, we intend to change and begin the initial steps to make the change.

4) Action -- In the action stage, we are actively involved in behavior changes.

5) Maintenance -- In the maintenance stage, we have been successful in maintaining the adaptive behavior over a period of time.

6) Relapse -- Relapse is expected when people attempt to change behaviors. It is not a failure or a weakness.

Working through the stages of change with a psychologist or physician who is trained in this model can prove most helpful.

There are four behaviors for chronic pain sufferers to consider changing,

1. Increasing activity
2. Promoting restful sleep habits
3. Eating well
4. Reducing medication use to the level needed to manage your pain.

Living with chronic pain is challenging. You must recognize the need to re-evaluate your lifestyle and make changes that you may never have considered before. Determine where you are in the stage of change model regarding those changes and seek out professionals who are trained to assist you in reclaiming your life.

Accepting personal responsibility for change will decrease your pain perception and increase your quality of life.

[Editor's Note: The National Headache foundation states: "A panel of leading headache specialists recently convened to identify specific steps migraine patients can take to better communicate with their health-care providers and obtain a successful treatment program. Effective physician/patient communication is increasingly important given today's time constraints for office visits and the variety of new treatment options available." For more information visit the National Headache Foundation Webpage.]

The Ten Steps

1) Seek help. Be a self-advocate.

You owe it to yourself. Let go of the biases and guilt--there is no need for you to endure headache pain. Understand that migraine is a disease, and deserves the same attention and care as any health condition.

2) Educate yourself about migraine so you will know what to communicate to a physician.

Attend support groups and join resource organizations such as the National Headache Foundation (NHF) -- (800) 843-2256. Pay attention to newspaper, magazine, television and radio coverage of migraine and ask your physician about what you've seen or heard.

3) Visit a doctor specifically about your headaches.

Search for a physician who is interested in treating headaches and make an appointment about your migraine. Find out if your primary care physician (family physician, internists or OB/GYN) treats migraine. Consider seeing a headache specialist or neurologist. Call the NHF for a state-by-state list of member physicians.

4) Prepare for a dialogue with your physician. Keep a headache diary.

Be organized, specific, direct and ready to talk details. Be prepared to provide information on your headache history and general medical history. Track your attacks and how you treat them. Note the date, length of each migraine, severity, symptoms, triggers and impact on your life (i.e., how many days lost from work, how many family/social activities missed). Track medication taken, when, for how long and effectiveness in relieving pain and symptoms. Get to know your migraine patterns and triggers so you feel more "in control."

5) Have reasonable expectations about treatment.

Understand there is no cure for migraine, however the disease can be managed with an effective treatment program. Be patient and give treatment time to work. Realize that treatment success will ebb and flow. Be willing to listen to your physician and to yourself and be flexible; be open-minded and prepared to modify your treatment, as necessary.

6) Be honest about all current medications and other medical conditions.

Tell your doctor about all your current therapies, including prescription, over-the-counter and natural remedies (because certain medications interfere with each other). Share any psychological history or "emotional disturbances" and medications taken for those now or in the past.

7) Focus on solutions. Be positive.

Don't blame yourself; headaches are not your fault. Focus on finding the best treatment options by working with your physician to find solutions.

8) Ask for detailed instructions for taking medication--and follow them.

Ask for specific instructions on taking prescribed medication; i.e., how often, with meals or on an empty stomach, what to do if a dose is missed, side effects, what to do if pain and symptoms persist.

9) Partner with your physician for treatment success.

Enter into a partnership with your physician and bridge the communication gap. See your physician on a regular basis and develop a relationship -- treatment is a process that works better with in-person visits.

10) Follow-up regularly with your physician.

Your treatment program will only be as good as the time you invest. Schedule a follow-up appointment as you conclude each physician visit. Physicians say three months is usually a reasonable time period to evaluate the effectiveness of a treatment program.