Pain Prevention

Here are some helpful tips to managing pain without medication.

Eat a healthy, well-balanced diet – to reduce inflammation and keep muscles & bones strong.

Maintain a healthy weight – excess weight puts stress on joints and muscles, thereby increasing pain.

Exercise regularly – choose low-impact activities such as walking, swimming, and biking. These activities don’t strain or jolt the back and allow the muscles to function better.

Build muscle strength and flexibility – building core strength helps ensure that the muscles supporting movement are healthy and strong, to improve your posture and protect the body from injury.

Focus on good posture and body mechanics – to reduce everyday aches and pains, do not sit for extended periods of time. Avoid heavy lifting and when you need to lift, let your legs do the work.

Quit smoking – smokers are more prone to pain than non-smokers. Nicotine restricts blood flow to the muscles and causes inflammation.

Manage stress – feelings of pain are increased when stress levels are high. Meditation, gentle stretching, tai chi and other methods of stress reduction can be very helpful.

 

Pain Management

What is pain?

Pain is something you feel physically and emotionally – it is not pleasant and is due to a perception of real or potential damage to your body.

How does your body process pain?

While pain may start at different places in your body, all pain is perceived and processed by your brain. Pain is your body’s warning system alerting you to harm. The pain signal travels through your nerves (usually – but not always – starting from those nerves close to the source of harm), up your spinal cord to your brain. Your brain then interprets the pain signal based on its intensity and location, as well as a variety of other information such as your surroundings, previous injury experience, your beliefs, your emotional state, and many other factors. You feel the pain after your brain has processed all of this information.

Pain is personal

When your brain processes a pain signal, it considers many factors that are personal to you. As a result, you feel pain differently from everyone else – even from people who may have the same disease or injury as you. Just like your experience with arthritis can be very different from someone else’s, the same goes for the pain you experience. This also means that pain treatments (including medications and other interventions) that work for one person may not work for another, or may work differently.

Types of pain

Acute pain is short-term pain that serves to protect you and prevents more damage by changing your behavior. Some examples are pain because of an injury, surgery, or a toothache. Usually this pain goes away when the damaged part of your body heals or no longer needs protection, or the unpleasant stimulus has been removed.

Chronic pain (also called persistent pain) lasts longer than acute pain, typically for more than three months. People who live with chronic diseases often live with chronic pain. This type of pain does not necessarily mean that damage is occurring – even though it might feel that way. While chronic pain is not fully understood, we know that it is sometimes caused by a problem with one or more nerves and the way they send pain messages to the brain.

 

Chronic Pain Coping Techniques – Pain Management

Clinicians who specialize in treating chronic pain now recognize that it is not merely a sensation, like vision or touch, but rather chronic pain is strongly influenced by the ways in which the brain processes the pain signals.

Chronic pain can provoke emotional reactions, such as fear or even terror, depending on what we believe about the pain signals. In other cases (such as in sports or another engaging, rewarding activity), chronic pain may be perceived by the individual as merely a nuisance, a feeling to be overcome in order to be able to continue in the activity.

The important role the mind plays in chronic pain is clearly recognized in the medical literature, as well as in the International Association for the Study of Pain’s definition of pain, which states that pain is always subjective and is defined by the person who experiences it.

The corollary is that the brain can also learn how to manage the sensation of pain. Using the mind to control chronic pain, or coping strategies, for managing persistent pain, may be used alone or in tandem with other pain management therapies

Managing Chronic Pain

Of course, the first step in coping with chronic back pain or other types of persistent pain is to receive a thorough medical evaluation to determine the cause of the pain.

 

Chronic Pain Control Techniques

To prepare for any chronic pain coping technique, it is important to learn how to use focus and deep breathing to relax the body. Learning to relax takes practice, especially when you are in pain, but it is definitely worth it to be able to release muscle tension throughout the body and start to remove attention from the pain.

Coping techniques for chronic pain begin with controlled deep breathing, as follows:

Try putting yourself in a relaxed, reclining position in a dark room. Either shut your eyes or focus on a point.

Then begin to slow down your breathing. Breathe deeply, using your chest. If you find your mind wandering or you are distracted, then think of a word, such as the word “Relax,” and think it in time with your breathing…the syllable “re” as you breathe in and “lax” as you breathe out.

Continue with about 2 to 3 minutes of controlled breathing.

Once you feel yourself slowing down, you can begin to use imagery techniques.

Altered focus

This is a favorite technique for demonstrating how powerfully the mind can alter sensations in the body. Focus your attention on any specific non-painful part of the body (hand, foot, etc.) and alter sensation in that part of the body. For example, imagine your hand warming up. This will take the mind away from focusing on the source of your pain, such as your back pain.

Dissociation

As the name implies, this chronic pain technique involves mentally separating the painful body part from the rest of the body, or imagining the body and mind as separate, with the chronic pain distant from one’s mind. For example, imagine your painful lower back sitting on a chair across the room and tell it to stay sitting there, far away from your mind.

Sensory splitting

This technique involves dividing the sensation (pain, burning, pins and needles) into separate parts. For example, if the leg pain or back pain feels hot to you, focus just on the sensation of the heat and not on the hurting.

 

Tips to assess and treat acute-on-chronic pain

Opioid tolerance complicates treatment of acute pain, but hospitalists have to know how to ameliorate acute pain in patients who are already on opioids, Molly A. Feely, MD, FACP, told attendees at the Internal Medicine Meeting 2019 hospital medicine precourse.

“Patients with chronic pain need appropriate pain management, too,” she said. Dr. Feely, who is an assistant professor of medicine and program director of the hospice and palliative medicine fellowship at Mayo Clinic in Rochester, Minn., noted that her “Pearls for Pain Management in the Opioid-Tolerant Population” apply only to chronic pain patients whose acute pain is expected to resolve, not to cancer patients with progressive pain.

The first challenge in treating these patients’ pain is evaluating it. “How many of you are frustrated by pain scores?” she said to laughter from the audience.

Pain scores are not designed to be compared across patients, but they can be helpful to assess patients’ current pain in light of their previous reports. “When you look at individual patients, their pain scores have consistency over time,” said Dr. Feely. “How many of you have patients who are at 8, 9, or 10 all the time? I have lots of those patients. I think ‘Great!’ [if] today’s an 8. That’s a good pain score day for that patient.”

This understanding should also guide pain goals, which can be based on patient perspectives but must also be realistic. “If he tells me that he’s hoping for a 3, but he’s only been at an 8 for a year and a half, we need to set expectations,” she said. “Our inpatient goal should be consistent with that which we have achieved in the outpatient setting.”