The Truth About Pain Management and Treatment Separating Fact From Fiction for Chronic Pain Patients

Is pain inevitable? What’s the best way to treat it? There’s a lot of misinformation about pain management out there. If you or someone you care about is a chronic pain patient, you need to know these myths and facts... With more than 12 million American women reporting chronic pain, it’s no surprise that a lot of information – and misinformation – gets traded around about the debilitating condition. That can be dangerous, because “many people who need help may not get the right treatment,” says James K. Fortman, M.D., an anesthesiologist and pain management specialist at the University of Cincinnati Academic Health Center. Chronic pain – defined as pain that lasts for more than 6 months – can be mysterious, and it often leaves medical experts and researchers scratching their heads as they try to understand and treat it. One reason is the myriad causes of pain. Chronic pain may result from an injury, infection or surgery. Or there may be an underlying reason, such as arthritis joint inflammation. Or pain can also develop after your body has healed from an injury. But some women experience chronic pain without any past injury or apparent damage to the body. “We may never truly understand pain altogether,” Fortman says. “But the newest research is trying to figure out the pathways [it takes].” Pain management researchers are investigating why some people are more prone to pain than others. The latest breakthroughs use functional MRIs (magnetic resonance imaging), brain scans that measure activity by mapping changes in blood flow, to identify which areas are stimulated when someone feels pain. This, in turn, can help doctors better target medications and treatments. Because finding the right pain management solution or treatment takes time, some patients become discouraged and give up hope. “Some patients start to think there’s not much they can do,” says Patrick Dougherty, Ph.D., a professor in the Department of Pain Medicine with the Division of Anesthesiology and Critical Care at the University of Texas MD Anderson Cancer Center in Houston. “They hurt all the time, but no one has been able to figure out the cause,” he says. So they turn to girlfriends or relatives for pain management tips, sometimes getting wrong information. Read on to find out what’s really true about common chronic pain beliefs. Pain management myth #1: Wet weather can worsen pain. There’s anecdotal evidence that the winter months can be rough on chronic pain patients. But studies conflict about whether changes in temperature, humidity and barometric pressure actually trigger joint aches and pains or migraines. “Some people with pain relating to inflammation, or who have hardware in their body, can feel worse in damp, wet weather,” says Naum Shaparin, M.D., director of Pain Services with the Department of Anesthesiology at Montefiore Medical Center in New York City. Though the level of chronic pain in chilly, wet weather varies among patients, doctors say that patients with joint or nerve injury pain report more problems during cold and rainy months. “Changes in barometric pressure can affect pain,” Fortman says. “Some people say they can use the joint pain in their knees to predict a storm.” Pain management myth #2: Bed rest is the best treatment for a chronic pain patent. Your parents may have told you that the best cure for chronic pain is staying in bed, but doctors no longer recommend this. Staying active will help you get better faster, they say. “Normally, I encourage anyone with pain to try to find ways to be active,” Dougherty says. “Even if you have back pain, get some light exercise. Inactivity tends not to help.” So stretch your muscles and continue to do activities that give you pleasure. “Exercise helps you maintain a healthy weight and avoid putting extra pressure on your back and knees, which can lead to a worsening of pain,” Fortman says. “Daily physical exercise will prevent your pain from getting worse,” he says. Besides, you’ll probably feel happier and more energetic if you exercise. “Exercise increases the body’s natural ability to fight off pain by releasing endorphins,” Fortman explains. Other benefits of exercise for women include: Improved sleep Prevention of bone loss Increased energy Less anxiety Increased muscle strength Aquatic therapy helps people with chronic pain. “Try swimming in a pool with warm water to relax your muscles,” Fortman advises. “Use the resistance of the water instead of weights.” Water therapy can help you transition to exercises on dry land, including stretching, yoga, light weights or some low-impact cardio. However, avoid exercising right after an injury, such as a sprained ankle. Also, women with arthritis should avoid high-impact or overly strenuous forms of physical activity that could advance the joint disease, Dougherty says. Pain management myth #3: Depression worsens chronic pain. Depression and chronic pain do often go hand in hand, but “it’s not clear which leads to which,” Dougherty says. Pain over a long period can wear you down emotionally, which, in turn, can lead to more physical pain, he says. Also, it can be depressing for chronic pain patients to think that they’ll have to live in pain for the next 30 years, Fortman adds. Conversely, depressed people can develop pain. In fact, some chronic pain patients experience a cycle of depression and pain, where depression causes sleep disturbances, lack of energy and lessens physical activity, which may make pain much worse. But just because there’s a connection between pain and depression doesn’t mean that the pain is all in your head, doctors say. It’s important to report depressed feelings to your doctor, Dougherty says. Because depression in chronic pain patients is often undiagnosed, it may go untreated. Effective medications and psychotherapy can help relieve depression and make chronic pain more tolerable, doctors say. Pain management myth #4: Expect pain as you age. Many think that pain is just a sign of aging, and you have to grimace and bear it. But that’s not the case. It’s true that some degeneration is likely to occur as we age, and wear and tear on joints is inevitable, but getting older doesn’t necessarily lead to pain, Shaparin says. “It’s not uncommon that we have more pain as we get older, but pain is certainly not a requirement of being older,” Dougherty says. “No matter what your age, you don’t need to settle for chronic pain.” If you take care of yourself, maintain a healthy weight and lifestyle, engage in aerobic exercise and strengthen core muscles, you’re less likely to experience back pain and other ailments later in life, Fortman says. Pain management myth #5: Taking opiates leads to drug addiction. With nearly 2 million Americans dependent on or abusing prescription pain relievers, it’s no surprise that many chronic pain patients worry that taking opiates will turn them into drug addicts. However, taking an opiate for chronic pain doesn’t cause addiction, doctors say. When opiates are prescribed and taken under a physician’s direction, the likelihood of addiction is very low, Fortman says. That’s because many doctors take precautions, he explains. For example, Fortman screens patients for a history of alcoholism or pain medication abuse. He also finds out whether they smoke or have underlying psychiatric disorders that could place them at higher risk of opiate addiction. Plus, he does random drug tests to make sure patients are taking their medication properly, and he looks out for people who may be “doctor shopping” for drugs. Opiates can be highly effective for many types of pain, including fibromyalgia, severe neck pain and chronic back pain. People who use drugs for pain relief may become dependent, but it’s rare in those who have no history of addiction, according to the National Institutes of Health. Drug addiction is characterized by a compulsive craving and use of a drug. Drug dependence, in which the body becomes used to the presence of a drug, can occur with the prolonged use of some pain relievers. “We rotate patients among different types of opiates to avoid the possibility that a chronic pain patient will become physically dependent on one medication,” Dougherty says. Patients’ psychological well-being is also monitored, he adds. Pain management myth #6: Chronic pain just has to be endured. Although finding the right treatment for chronic pain can take time, most patients are able to find remedies that help them manage, if not eliminate, their pain, experts say. “The key is to reach out [to doctors] and find strategies that work best for you,” Fortman says. “Whether the pain can be cured often depends on the source,” he says. “If it’s inflammation due to pancreatitis, it may not go away. But in other cases, strengthening the muscles in pain can help the body heal itself.” If doctors can identify the causes of pain, it can be easier to treat, Dougherty says. In some cases, such as post-stroke pain, it’s permanent, because of nerve injuries to the brain that occur in a stroke. “You can’t restore the nervous system back to the baseline,” he says. The focus should be on finding the treatment that improves your quality of life, doctors advise. “You want to return to daily living,” Shaparin says. “The goal isn’t always to be pain-free, but instead to control the pain so that you can function, go to work, enjoy your family and your hobbies and get back to living.”