Thursday, October 6, 2011

Do’s and Don’ts for Chronic Pain Relief - Tips and Treatments to Feel Better Now

Living with chronic pain can knock you flat. One day the ache is a "4" and you're able to handle normal tasks; the next it's a "9," and all you want to do is lie down. But that's not the right move, chronic pain management experts say. There's a lot you can do for chronic pain relief...

About 50-75 million Americans live with chronic pain that lasts beyond the normal healing time. It can be triggered by an illness, an ongoing condition such as arthritis or cancer, or an injury.

“A broken bone is supposed to heal in about six weeks,” explains Charles Argoff, M.D., co-author of Defeat Chronic Pain Now! (Fair Winds Press), professor of neurology at Albany Medical College and director of Albany Medical Center’s chronic pain management program. “If pain lasts longer than that, it’s chronic pain.”

While you may not get complete chronic pain relief, you can take steps to control the problem.

“All types of chronic pain share common features,” Argoff says. “It’s usually more complicated to treat than acute pain, but it can be treated.”

Try these doctor-recommended tips to tame your troublesome aches.

1. Do consume anti-inflammatory foods and supplements.
Because inflammation can trigger pain, soothing foods and supplements can provide chronic pain relief.

“For example, curcumin – found in turmeric, the herb used in curry – is a great anti-inflammatory and can be eaten in food or taken in capsules,” explains Susan Blum, M.D., assistant clinical professor of preventive medicine at Mount Sinai School of Medicine and founder of the Blum Center for Health in Rye Brook, N.Y.

“Ginger [also] can bring chronic pain relief in food or as a supplement,” she says.
So can eicosapentaenoic acid (EPA), an omega-3 fatty acid found in fatty fish (like tuna and salmon), nuts, seeds and flaxseed oil. Or you can opt for 1,000 milligrams (mg) to 1,200 mg of fish oil supplements per day, says Alpana Gowda, M.D., co-author of The Complete Idiot’s Guide to Pain Relief (Alpha), chronic pain management physician and clinical instructor in pain medicine at Stanford University.

Some supplements, such as boswellia serrata, devil’s claw and magnesium, have pain-relieving properties too, Blum adds.

“I’ll often give patients magnesium supplements to relax muscles,” Blum says. “Foods such as whole grains, nuts, black beans and spinach are high in magnesium – but they don’t contain enough to get the job done.”

The key is getting the right magnesium supplement, she says.

“Magnesium citrate can cause loose stools and is often used to treat constipation,” Blum warns. “For muscle relaxation, I give magnesium glycinate – a chelated form that doesn’t have the bowel effect.”

If you have muscle pain, “soaking in a bath with Epsom salts can increase magnesium levels in the body, which promotes muscle relaxation,” Blum says.

Some people with arthritis pain or musculoskeletal pain use topical creams with capsaicin, a well-studied pain reliever derived from hot peppers.

But before starting any supplements, always consult your doctor.

2. Don’t skimp on H20.
“If you’re dehydrated, you’ll have a lot more muscle spasms and cramps,” Gowda says.

Being properly hydrated encourages chronic pain relief because water keeps joints and muscles lubricated, hydrated and plumper, easing flexibility.
Aim for 1.5-2 liters (about 6-8 cups) of water daily, Gowda advises.

Limit coffee and other caffeinated drinks, because caffeine is dehydrating.

Also eat water-rich foods – peaches, watermelon, grapes, citrus fruits, celery, cucumbers and broth-based soups – to boost your hydration level.

You'll know if your body is hydrated enough when your urine is clear, not bright yellow.

3. Don’t stop moving.
Chronic pain is no excuse to skip workouts. Pain may make you want to rest, but exercise can provide chronic pain relief.

“Exercise, aerobic or otherwise, has cardiovascular benefits and increases flexibility,” Argoff says. “It releases of endorphins, which naturally help with chronic pain relief and make us feel better.”

The key is doing the right exercises for your body and condition, so talk to your doctor before beginning any exercise program.

For example, if you have severe osteoporosis, it might be risky to lift weights. A low-impact workout, such as water exercises, might be easier on your bones, Argoff suggests.

Those with fibromyalgia or rheumatoid arthritis also may find chronic pain relief with less intense, milder activities such as walking and stretching.

“Walking is [easier] on joints, such as ankles, knees and hips, [than] running or even biking, and walking on a flat path is something most people can do quickly and immediately,” Gowda says.

4. Don’t work out too hard.
“If your body isn’t used to regular exercise, the pain can flare for a couple of days, and you’ll have to miss out on conditioning because you can’t move,” Gowda explains.
That’s why you should use a heart rate monitor to gauge how hard you’re exercising, she advises. To find your target heart rate zone, first consult your doctor, then use a monitor to maintain pacing.

“If you aren’t trying to lose weight, you want your heart rate at a comfortable level,” Gowda says. “But most people overshoot rather than undershoot it.”

To calculate your heart rate without a monitor, take your pulse. Count the number of heartbeats in 10 seconds and multiply that by six.

5. Do stretch.
Stretching is crucial for chronic pain relief because “it actually relaxes muscles and decreases tightness in various body parts,” Gowda explains. “This reduces pain and discomfort.”

For example, tight hamstring or hip flexor muscles might trigger back pain. Relax those areas and you’ll decrease back pain.

Those with carpal tunnel syndrome, a condition in which nerves between arms and fingers become compressed, benefit from stretching wrists and hands.

Have upper-back, shoulder or neck aches? Stretching the upper back, shoulder and chest wall muscles might bring chronic pain relief.

“[I] advocate 20 minutes of stretching daily,” Gowda says. “That can be hard to do, but the easiest way is to go to a physical therapist [who will] start you on a home exercise program.”

Though it costs money and isn’t always covered by insurance, 1-3 sessions can jump-start you into a proper, problem-specific home-stretching program, she says.

6. Do get enough sleep.
Skimp on sleep and you’ll not only be cranky and groggy, but you’ll also feel more aches and pains.

“A lot of the neural pathways are interconnected, so if you lack sleep, the same pain pathways are activated,” Gowda explains.
One way to get a good night’s rest: Establish proper sleep hygiene. This includes not watching TV in bed, not working in your bedroom, turning in and waking at the same time and avoiding naps during the day.

7. Do try alternative remedies.
Guided visualization is a very effective chronic pain relief technique, according to a 2010 study at the Indiana University School of Nursing in Indianapolis. Significant improvements in pain and mobility were reported in osteoarthritis patients who used guided imagery compared to those who used relaxation or a “sham intervention” called planned relaxation.

“Purchase CDs (at iTunes or www.healthjourneys.com) geared toward pain relief,” Blum says.

“These visualizations can be put on your iPod, and you can close your eyes, listen to the music and voice and go to a lovely pain-free place that reduces stress that makes the pain worse.”

Other chronic pain relief options include meditation, biofeedback, relaxation, cognitive behavioral therapy, breathing and even just enjoying yourself with recreational activities.

8. Do try acupuncture.
A 2007 study at the Technische University in Munich found that after six months of acupuncture pain treatment, almost half of 2,564 patients felt “significant improvements in ability to function,” and the average number of days with pain decreased by half.

Another 2007 study of 5,690 patients at the Pain Treatment Unit in Spain found acupuncture reduced the use of anti-inflammatory and pain-relieving drugs at a success rate of 80%. Most of the patients were women experiencing back pain.

9. Don’t sweat the small stuff.
Stress aggravates pain.

“You may tighten or clench your jaw or raise your shoulders and be in a very guarded position when you’re stressed out,” Gowda says.
“These things can actually change the neural pathway firings in the brain, keeping you more susceptible to pain and heightening your perception of [it],” she adds.

10. Do get support – literally.
Splints and supports are great tools for chronic pain relief, especially when you’re suffering from carpal tunnel syndrome, tennis elbow, knee pain, back pain and foot pain, because you can target the specific area of pain. They support muscles, protecting the area of injury or positioning the body so further injury doesn’t happen.

“A physician must diagnose the injury, because you need to have the proper splint/support, and it needs to be fitted and worn correctly,” Gowda explains. “If not, these things can actually cause more damage.”

For more expert advice and information, visit our Pain Health Center.

How Bad Is Your Back Pain?
So your back hurts? You may need to see a doctor but have just been avoiding it, thinking it will get better. On the other hand, your back pain may be more normal than you suspect.

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