What can I do about my chronic pain?
In this article will describe the many ways to help chronic pain. Let’s start with the basics.
1. Pain is poorly understood
Whatever the cause, pain is a perception ‘in the brain’. So treatment is about retraining the brain, if necessary by distracting it. So, let’s describe how you can live well with chronic pain.
2. How common is chronic pain?
Chronic pain is very, very (very) common. It affects up to one half of the population of the UK, up to 30 million adults. So it is surprising we know so little about it. Chronic pain affects more people than any other disease, including cancer, heart disease or diabetes.
3, What is chronic pain?
Chronic pain (sometimes known as long-term pain or persistent pain) is pain that lasts for more than 3 months.
Chronic pain can also be called ‘primary’. This means there is no clear underlying cause, or the pain is out of proportion to the underlying injury or disease – or the underlying cause has ‘gone’ but the pain persists.
It can be secondary to (caused by) an underlying condition (for example, osteoarthritis or rheumatoid arthritis, ulcerative colitis or endometriosis).
4. What is the commonest site of pain?
- Back pain
- Headache
- Joint pain.
5. Who gets chronic pain?
- Female gender – men are less likely to report or experience chronic pain
- Older people – 15% of people 16-25 years, 50% over 70 years
- Socio-economic status – people who are socio-economically deprived are more likely to experience chronic pain, and it is more likely to be severe and result in a greater level of pain-related disability
Employment status and occupational factors – chronic pain is more common in people who are unemployed, and manual workers.
6. Five things you can do for chronic pain
One. Exercise. Choose an exercise or movement that will not put too much strain on yourself. Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain. Activity also helps lessen pain by stretching stiff and tense muscles, ligaments and joints. In the long term, the benefits of exercise far outweigh any short term increase in pain. Try these flexibility exercises and sitting exercises – you can do them at home.
Good options include:
- Walking
- Swimming
- An exercise bike
- Dancing, yoga or pilates.
Exercise is good for pain, including dancing
Activity and stretching needs to become part of your lifestyle so you routinely do exercise a little and often. Try to be active every day, instead of only on the good days when you are not in so much pain. This may reduce the number of bad days you have and help you feel more in control.
Two. Go to work if you can. It is very (very) important to try to stay in work even if you are in pain. Research shows that people become less active and more depressed when they do not work. Being at work may distract you from the pain and should not make it worse.
Talk to your supervisor or boss if parts of your job are difficult to begin with, but emphasise that you want to be at work. If you have been off work for 4 to 6 weeks, discuss with your doctor, therapist or employer how and when you can return.
You could go back to work gradually. For instance, you might start with 2-3 days a week and gradually increase the time you spend at work. You could also agree changes to your job or pattern of work if it helps – a health and safety representative or occupational health department may be useful here.
Three. Relaxation and breathing
Relaxation – practising relaxation techniques regularly can help to reduce persistent pain. There are many types of relaxation techniques, varying from breathing exercises to types of meditation.
Breathing – concentrating on your breathing when you are in pain can help. When the pain is intense it is very easy to start taking shallow, rapid breaths, which can make you feel dizzy, anxious or panicked. Instead, breathe slowly and deeply. This will help you to feel more in control and keep you relaxed, and prevent any muscle tension or anxiety from making your pain worse.
Four. Keep in touch with friends and family – and distract yourself
This is good for your health and can help you feel much better – try shorter visits, maybe more often. And if you cannot get out to visit people, phone a friend, invite a family member round for a tea or have a chat with your neighbour.
Aim to talk about anything other than your pain, even if other people want to talk about it. Do not let pain mean that you lose contact with people. By shifting your attention on to something else so the pain is not the only thing on your mind.
Get stuck into an activity that you enjoy or find stimulating. Many hobbies, like photography, sewing or knitting, are possible – even when your mobility is restricted.
Five. Learn more about pain
Read websites, books and leaflets on pain, as there is a lot of information ‘out there’ if you are living with pain.
Self-help tips – The Pain Toolkit is a collection of helpful tips and strategies to manage persistent pain, developed by someone with long-term pain.
7. Five things the NHS can do for chronic pain
One. Try to remove the cause. This seems obvious. In other words, if you know the cause of your pain, get it treated – ideally removing it completely. An example is back pain due to a prolapsed (slipped) disc in your spine. For some patients, spinal injections or a low risk operation called a micro-discectomy is effective. For most, time is the best healer. Another example is fibroids (growths) in the womb.
You can ask your GP to refer you to the relevant specialist – e.g. neurosurgeon or orthopaedic surgeon for back pain, gynaecologist for fibroids.
The waiting times for surgery in the NHS are now very long. So you may want to think about going privately. After all, this type of thing is what money is for.
Two. Painkillers and pain clinics. If it is safe to use over-the-counter painkillers, then these can help to reduce your pain so you can be more active. But it is important to use painkillers carefully, as they have side effects. Paracetamol for adults is the simplest and safest painkiller. You could also try anti-inflammatory tablets like ibuprofen for adults as long as you do not have a condition (such as a stomach ulcer) that prevents you using them.
It is important to take painkillers at the recommended dose and to take them regularly every 4 to 6 hours; preferably to overcome a flare-up of your pain, or help get you through an impending activity. Do not wait until your pain is severe before you start taking painkillers, as they won’t work as well.
If a 2-week course of over-the-counter painkillers does not work, ask for help from your GP or pharmacist.
Stronger and longer term pain killers. As well as these drugs, there are other groups of painkillers, that may be classed as ‘controlled drugs’ and care needs to be taken when prescribing and taking them. These include opiates – e.g. codeine (weaker), tramadol (strong) and morphine (very strong). They are all addictive and cause constipation that can be a major problem.
Avoid ‘self-medication’ with alcohol and recreational drugs
Some people with long term pain, start to try to control it with alcohol and/or recreational drugs. These can help in the short term. And so it is understandable to use some to create some time with a loved one (say for a dinner out). But it is best not to take a lot of them frequently.
Pain clinics
Ask your GP for advice in the first instance. If you find you are having difficulty managing your pain, ask the GP for a referral to a local specialist pain clinic. They are usually based a your local hospital. You will see a senior doctor, either a consultant or a registrar. Pain clinics offer a wide range of treatments and support. They aim to support you in developing self-help skills to control and relieve your pain.
Treatments may include:
- Painkillers
- Pain-relief injections
- Pain modulating drugs – e.g. gabapentin, pregabalin and amitriptyline
- TENS machines. These work by giving you a ‘distraction pain’, as the brain cannot compute (perceive) two pains at the same time. A cheap and cheerful ‘TENS machine’ is an elastic band around the wrist. It works in the same way as a TENS machine
- Alternative medicine – acupuncture may helpful. You may have to pay for this
- Counselling and psychological therapy.
Three. Physiotherapy. Physiotherapy will help you to move better, relieves your pain, and makes daily tasks and activities easier – like walking, going up stairs or getting in and out of bed. But for some people, a chiropractor or osteopath, or occupational therapist, can help as well. Together these health professionals provide what is called ‘physical therapy’.
Physiotherapists can give you advice on the right type of exercise and activity. Occupational therapists can support you with environmental changes that can help you remain in work and function better at home. Your GP may be able to refer you for physical therapy on the NHS, although physical therapy is only available privately in some areas. In others, there is direct access to an NHS MSK ‘first contact physio'(therapist) without the need for GP referral: Find physiotherapy services in your area.
Your GP may be able to also refer you for exercise referral classes, and some areas have specific classes for lower back pain.
Four. Mental health. Mental health issues can make the pain worse, making you fall into a downward spiral. Why? Pain causes anxiety/depression, which makes the pain worse – which, in turn, makes you more anxious/depressed.
Counselling
This can really help with pain. Your GP can refer you to an NHS counsellor called an IAPT. Or, in some areas, you can refer yourself to one directly.
Anti-depressant drugs
These drugs can be really effective at improving your mood (and hence the pain). They can also help you sleep. For example, there is a drug called Duloxetine, that is very good for people with long-term nerve pain, but is also used as an anti-depressant – two drugs in one!
Psychiatrist
If your mood is not improving, ask your GP or IAPT counsellor to refer you to a psychiatrist (doctor). There will be one at your local mental health hospital. Pain can make you tired, anxious, depressed and grumpy. So, be kind to yourself.
Five. Sleep. A good nights sleep is one of the most effective treatments for pain. It is not known why. Sleep deprivation can also make pain worse. Many people with long-term pain find it difficult to sleep at night. But it is important to try to stick to a normal sleep routine; so you have got the best chance of sleeping through the night.
Go to bed at the same time each evening, after a bath. Do not have a mobile phone in your bedroom. Keep it dark. And get up at a regular time in the morning and avoid taking naps in the day. If sleep problems persist, see your GP – and consider asking for sleeping tablets. Low dose Quetiapine is very good.
Pain Concern has produced this useful leaflet on getting a good night’s sleep.
8. Long-term outlook
- Gradual improvement or goes away completely in 1o% of people. In this group, most substantial improvement occurs within the first 3–6 months
- Persistent mild (25%)
- Persistent moderate (20%)
- Fluctuating between mild and severe (30%)
- Persistent severe (15%).
In the last group these features are more common: comorbid disease, sleep difficulties, catastrophising, poorer mental health, and chronic widespread pain.
9. Complications
- Disability – if poorly controlled, chronic pain can lead to significant disability
- Depression and anxiety. Referral to a psychiatrist or psychologist may be necessary. 50% people with chronic pain also suffer from depression. Antidepressants like SSRI tablets (see Duloxetine above; it also improves pain) may help
- Medicine misuse. 25–30% of people taking opiates. They are rarely helpful and cause constipation
- Sleep impairment. Low dose quetiapine may help (see above)
- Adverse effects from medication (e.g. nonsteroidal anti-inflammatory drugs, NSAIDs)
- Reduced quality of life — daily living, family and social relationships, and employment can be negatively affected by chronic pain.
10. Anything else I can do?
Yes, lots. Hopefully reading this page will help you, by giving you ideas.
Charities
Specialise in specific conditions, such as arthritis or fibromyalgia, may also offer more targeted pain management advice.
Take a pain management course
Self-management courses are free NHS-based training programmes for people who live with long-term chronic conditions such as arthritis and diabetes; to develop new skills to manage the condition (and any related pain) better on a day-to-day basis.
Summary
We have described what you can do about your chronic pain. Two things – exercise or moving more, and continuing to work if you can – are key to managing chronic pain, to help lead a fuller life.
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