Pain Management

Pain Management, it’s not always about pills.

Pain management is a complex and lifelong challenge for many people. The most obvious answer to the pain problem is painkillers right? Pain meds often come with some nasty side effects and can be highly addictive. I’m not saying pain killers are all bad (they aren’t) and I’m not saying everyone who uses them will get side effects and become an addict (they won’t) but maybe, pills aren’t always the answer.

As many of my regular readers will be aware, I have chronic pain. I actually thought constant pain was normal until I was 19, it’s the only ‘normal’ I’ve ever known. This post will be written from the dual perspective of pain patient and Occupational Therapist. Most of these suggestions are safe for everyone but please check with your healthcare provider before making drastic changes to your pain management regime.

So, how else can we deal with pain? Here are my top suggestions for pain relief, many of which can be done at home or on the go!

Pacing

Prevention is always better than cure. Pacing is a fantastic way to minimise daily pain and prevent flare-ups1. In short pacing involves taking regular little breaks, fidgeting and avoiding long blocks of repetitive activity. Pacing can be used very effectively to help prevent pain from ‘over doing it’. Learning to pace can be a little tricky and it does take some work to get used to but stick with it!

Posture

Poor posture leads to pain2, I think a lot of chronic pain patients learn this the hard way! Improving posture is not a quick fix, it can take weeks, months or even years of hard work to fully correct wonky posture but it’s definitely worth the work! Improved posture can reduce pain, prevent injuries, improve digestion and as an added bonus it can make you look a little thinner3.

Exercise4

This one can be a little controversial. I know all too well how hard it can be to exercise with pain but getting moving can actually be very effective pain relief. If the pain is caused by functional problems like low muscle tone, wonky joints or muscle imbalances exercise can be great in the long run. In the short-term, exercise produces all sorts of happy hormones and endorphins which can reduce pain significantly.

Distraction4

Simply put; doing something fun, meaningful or relaxing can help take your mind off pain. I particularly enjoy reading. If you are prone to getting caught-up in exciting activities then maybe set yourself a timer, pacing is important with fun stuff too!

Mobility Aids

Crutches, walking sticks, wheelchairs and scooters can all be used to pace yourself and rest painful joints. Just because you start the day on wheels doesn’t mean you have to stay on wheels. I often wheel around and sit in my wheelchair because it’s much more comfortable and supportive than standard public seating. Sitting in my wheelchair helps me avoid back pain but I can’t sit in it all day without needing to fidget, so I walk around in breaks and just leave my chair behind. You can get some odd looks for simply abandoning mobility aids but in all honesty, who cares?! I’ve often explained the way I use mobility aids to ‘normal’ people and after a brief conversation most people think it makes perfect sense.

Hot and cold

Most people know that you apply ice to an acute injury like a sprained ankle5 but you can do it for chronic injuries too6. Most people will have a preference for either heat or cold to ease pain so it’s worth experimenting a little to see what suits you. Generally speaking, ice reduces inflammation and swelling6. Heat eases muscle cramps and soothes stiffness7. I personally find liquid heat much more effective, a bath works better than a heat pack but that’s not quite as convenient if you’re at work or on the go!

TENS8

Tens units are funky little devices that use electrical impulses to block pain signals, basically you stick little electrodes either side of the bit that hurts and adjust the electricity to suit you. TENS usually feels tingly or a little like pins and needles, I personally prefer this to pain but some people simply don’t like the way it feels. Many pain clinics and some GP practices and pharmacies will rent out TENS units for you to try so it’s worth asking about.

Massage6

Massage can sometimes be done all by your lonesome (especially if you’re hypermobile) but if you’re looking for back pain relief you might need to recruit a friend or family member. I find massage releases the tension in my muscles and the heat generated by massage is wonderfully relaxing. Massage can also help relieve puffy ankles (Healthcare professionals can teach you how to do this) which eases leg pain. If you can’t reach and there’s nobody available to help there are all sorts of knobbly squiggly gadgety things on the market available to do the job. I have a trigger point foam roller and a small battery-powered massage thingie too.

These are my most often used methods of pain relief, I’m sure there are more and I’d love to hear from you if you have any other techniques..

Remember, these techniques can all be combined including the use of pain killers. I might use my TENS while pacing myself and using mobility aids. I can distract myself with a good book while soaking in a hot bath. Since learning and implementing these techniques regularly I’ve found myself reaching for pain killers much less often. I usually try some or all of these techniques before deciding that pills are needed.

I hope some of you have found this useful and I’d love to know what you think.

Questions and comments welcome,

Ciao for now!

JBOT

Reference List

1.
Birkholtz M, Aylwin L, Harman RM. Activity Pacing in Chronic Pain Management: One Aim, but Which Method? Part One: Introduction and Literature Review. The British Journal of Occupational Therapy. 2004;67(10):447-452. doi: 10.1177/030802260406701005
2.
Common posture mistakes and fixes. NHS Choices. http://www.nhs.uk/Livewell/Backpain/Pages/back-pain-and-common-posture-mistakes.aspx. Accessed March 26, 2017.
3.
What are the Benefits of Good Posture? PhysioWorks. http://physioworks.com.au/FAQRetrieve.aspx?ID=31641. Accessed March 26, 2017. [Source]
4.
Blomqvist K, Edberg A-K. Living with persistent pain: experiences of older people receiving home care. J Adv Nurs. 2002;40(3):297-306. doi: 10.1046/j.1365-2648.2002.02371.x
5.
Bleakley C. The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials. American Journal of Sports Medicine. 2004;32(1):251-261. doi: 10.1177/0363546503260757
6.
Nadler S. Nonpharmacologic management of pain. J Am Osteopath Assoc. 2004;104(11 Suppl 8):S6-12. [PubMed]
7.
French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. French SD, ed. Cochrane Database of Systematic Reviews. January 2006. doi: 10.1002/14651858.cd004750.pub2
8.
Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Nnoaham KE, ed. Cochrane Database of Systematic Reviews. July 2008. doi: 10.1002/14651858.cd003222.pub2
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