By Nora Stern, MS PT, Providence Rehabilitation Services, Portland, Ore.
Pain is complex, and the best treatment is different for each person. The one thing I emphasize to all of my patients is that your active participation in your treatment can make an enormous difference.
Opioid pain medicines, once the go-to treatment for all kinds of pain, can be very effective for coping with short-term, acute pain – after an injury or surgery, for example. However, for pain that continues long after tissues have healed – or in the absence of an injury – painkillers are proving to be less helpful. In fact, as explained in the recent post Prescription painkillers: 10 things you need to know, they often make pain and daily life worse.
The good news is that, as we learn more about how pain works, we’re also discovering that there are many things we can do to improve pain and to function better – without painkillers. All of the tips that follow are things that you can do yourself. Your health care team will support you.
Understand your pain
Pain research has come a long way in the last 20 years. One interesting finding is that simply learning to understand pain differently can reduce your pain.
Here are a few key things to understand, based on the most current neuroscience research:
- Many different things contribute to the pain experience, which means there are many different things you can do to have an impact on that experience.
- When you injure yourself, the pain that you experience serves a protective purpose: it stops you from doing further damage to the injured part of your body. But when pain continues for months or years after an injury has healed, it usually has less to do with anything harmful going on in the body, and has more to do with your system getting too good at protecting you.
- The brain is part of the pain process. Passive treatments, like painkillers, can relieve pain in the short term, but are less likely to retrain the brain and nervous system to manage pain on your own. Taking an active part in your pain management is essential to change your pain experience.
Quiet your stress
Many people who live with chronic pain also live in a state of chronic stress, caused either by their pain experience or by other things in their lives. Chronic stress, itself, releases pain-producing chemicals that can worsen pain, in addition to interfering with sleep. Learning to quiet your stress response can help you reduce your pain.
One technique is to focus on your breathing. When you lengthen your exhale, you move your system from the stress response known as fight-or-flight to the more relaxed state known as rest-and-digest. Try these simple breathing exercises. Other helpful techniques include meditation, progressive muscle relaxation, yoga, tai chi and qi gong – learn more about these relaxation techniques. Sometimes, relaxation techniques change pain very quickly; in other circumstances, it takes a couple of weeks of daily practice to feel a change. Give it some time.
Tune into your body
Your brain carries around a map of your body that changes with use and disuse. When you stop moving or using a part of your body – because you’re bracing, guarding or protecting it from pain – that part of your body map becomes less distinct, which can cause you to feel as though your pain has moved or spread. A relaxation technique called body scan can help you tune back into the parts of your body that you’ve been ignoring and bring things back into focus.
You can do a body scan while sitting, lying down or walking. The idea is to focus your attention progressively on each part of your body, from your toes to your head, really tuning into each part. Yoga is another practice that increases body awareness; it also helps you become aware of small adjustments that might make you more comfortable and help you move more fluidly. Simply beginning to move again, and noticing sensations in your body besides pain, can help retrain the sensory map, as well.
Treat underlying conditions
Your brain takes every threat into account. Depression, anxiety, post-traumatic stress disorder, poor sleep – these all add to the threat level in your nervous system, piling on to make pain more persistent. Working with a physician or mental health specialist to treat these conditions can help reduce pain, in addition to shoring up your ability to take other steps to manage your pain.
Realize that pain doesn’t necessarily equal harm
For a long time, we’ve thought: if it hurts, don’t do it. But in a persistent pain condition, pain and harm often have little to do with each other. In persistent pain, since your system has gotten too good at protecting you, feeling pain when you move is usually not an accurate indication of harm.
Learning to separate pain from harm can help you get past fear avoidance – that is, avoiding movement out of fear that it will harm you. That’s important, because it’s not movement, but the lack of movement, that weakens your resilience and increases pain. Getting past the fear and moving more, in any way you can, is one of the best things you can do.
Ease back into movement
Getting moving again not only changes your brain – it also changes the tone of your muscles, enhances your immune system, improves sleep and contributes a host of other benefits, all of which can help reduce pain.
If you’ve been avoiding movement for a long time because of persistent pain, get coaching from your doctor or a physical therapist to help you reintroduce activity gradually. Understand that you may feel a little sore, but assuming that you and your doctor have done all the detective work to rule out tissue or structural issues, you’re safe. Minor discomfort does not mean that you are injuring yourself.
That doesn’t mean you should ignore the pain and blast full speed ahead – you need to be gentle with a sensitized system. Honor that sensitivity without being overly afraid of it. Start slowly to give your system time to adjust. Stay below your flare-up zone (pain that lasts for several days after activity) so you can decrease your sensitivity, and gradually and gently increase what you can do, appreciating the small gains that you make.
To learn more about how pain works, Stern recommends this short video.
Also, Providence offers a monthly Online Pain Education Class that can help you learn more about taking an active role in managing your pain.
If you’d like help from a Providence physician, physical therapist or behavioral health specialist, find one here.
Nora Stern, MS PT, program manager for the Providence Persistent Pain Project, works on innovation in pain education and treatment for Providence Health & Services, and serves as program manager for the Persistent Pain Program for Providence Rehabilitation Services. Nora also serves on the Oregon State Pain Commission.