When your body's in pain, it can be all-encompassing, affecting your work, activities, sleep, mood, and even your relationships. And when chronic pain -- whether from arthritis, deep-tissue injuries, or other causes -- goes on for a long time, it can get awfully discouraging. There are solutions out there, though, and reasons to be hopeful. Here are the top eight strategies for conquering chronic pain:
Why it's important: Chronic pain is among the most difficult problems to treat, because the solutions aren't always clear-cut, and in many cases there isn't one guaranteed fix. A lot of trial and error is often needed to figure out what eases the pain, and managing that process requires doctors to stay on top of the situation, remember what was said and done before, and be receptive when you come back and say, "No, that didn't help." Many people with ongoing problems such as arthritis report having to switch doctors two, three, or even more times before finding someone who really "gets it."
What to do: At every appointment, pay attention to whether the doctor is really listening to you, and whether he or she is proactive about ordering tests to find the cause of the problem -- and suggesting physical therapy, medication, or other forms of treatment tailored for you. If the treatment doesn't solve your problem, don't hesitate to go back, and pay even closer attention to how the doctor reacts to your "What next?" questions. It shouldn't be a problem to come in for repeat visits while you and your doctor try to get to the root of your pain and find a solution. If you start getting the feeling that the doctor is shrugging off your concerns, feels you've run out of options, or is sending the message that it's "all in your head," it's time to find another doctor.
Tip: You may also need to ask for a referral to a specialist or surgeon. Some medical practices now also provide referrals for acupuncture or osteopathy. If you can afford it, it may be worthwhile to go outside your regular medical network. Some chiropractors, osteopaths, and specialized sports clinics can provide potentially helpful treatments, such as prolotherapy, that may or may not be covered by insurance.
Why it's important: There are significant differences in how pain medications work and which work best for a specific problem. Even if you have a favorite, go-to choice for pain, you may need to try other options, depending on the physical effects, time of day, and other factors.
What to do: Get familiar with the most common pain medications and when to use them. Even if you've gotten relief from a particular medication in the past, pay close attention to any side effects and to whether the drug loses effectiveness over time. Even better, make an appointment with your doctor specifically to discuss medications, and prepare by making a list of everything you're taking, when you tend to take it, and how often. (Or, simply take all your medications -- both prescription and over-the-counter -- with you.) Be honest; the doctor can't help you if he or she doesn't have a clear picture of what's happening.
Tip: Make sure you know both the generic and the brand names of all the drugs you're taking -- both prescription and over-the-counter -- to avoid confusion and double-dosing. Doctors say they see a surprising number of overdoses caused by taking both the generic and brand-name version of the same drug.
Why it's important: For knee, hip, back, and other types of joint pain, physical therapy can be one of the most effective treatments -- but only if you're taught the right exercises and do them vigilantly.
What to do: To be truly effective, your physical therapy regimen needs to be individually tailored to your specific injury and other needs. All too often, those with chronic pain are referred to "one-size-fits-all" physical therapy programs, which can be unhelpful at best, and discouraging at worst. "People do a generic physical therapy course, then conclude that physical therapy doesn't work, and they're stuck with the pain," says Marc Lum, a senior physical therapist at Kaiser Permanente in the San Francisco Bay Area. "But a lot of time the problem is that the exercises just weren't the right ones, or the patient didn't stick with them long enough."
Tip: Ask to be referred to a physical therapist for one-on-one therapy, at least for one or two sessions. That way you'll have the individualized attention necessary to develop the exercises suited to your needs and to make sure you're doing them correctly.
What it's important: Joint pain is directly affected by pressure from physical activities. That means joints can't heal if they're repeatedly subject to the same pressures that caused the injury in the first place. If you have upper back pain and continue to sit at your computer in the same position you always did, your arthritic joints can't recover, much less heal.
What to do: Get an ergonomic consultation and make sure your desk, computer, and work area are set up properly so as not to strain your wrists, shoulders, and neck. It can also be helpful to figure out new positions to work. You might try sitting on an exercise ball or stool, or standing while using a laptop set on a high counter. Same thing with knee, wrist, hand, hip, and shoulder pain: Take a break from the activities that caused the injury, whether it's your weekly tennis game or a repeated work-related stress such as typing or bending over a workbench. Substitute an activity that puts less strain and pressure on joints and muscles, or find other ways to ease the burden such as trying new positions, using different equipment, or making adjustments to your physical environment to change the angle of movement.
Tip: Joint pain in the knees, hips, and shoulders can benefit greatly from being stabilized either with an elastic brace or bandage or by wrapping the offending joint with inflexible sports tape. A physical or sports therapist can teach you how to wrap a painful area so the joint is stabilized and doesn't cause pain with movement.
Why it's important: Many chronic ills, such as arthritis, are inflammatory diseases, and a number of lifestyle factors -- especially diet -- contribute to inflammation. The reason so many health gurus advocate cutting out sugar, white flour, and processed foods such as chips is that they're high on the glycemic index. Eating them floods your bloodstream with sugar, fueling the inflammatory process.
What to do: Eat a diet high in antioxidants to build up resistance to oxidative stress, which causes inflammation at the cellular level. Foods high in antioxidants include most fruits and vegetables and some spices -- the richer the colors, the higher the density of protective phytochemicals. (Other clues include a strong smell, such as in garlic or onions, or strong flavors, such as in chili peppers and broccoli.) That's why doctors and dieticians recommending eating a mostly plant-based or Mediterranean diet, which centers around fruits, vegetables, lean protein, and healthful fats such as olive oil.
Tip: If you're not a veggie lover, make combination juices and smoothies with vegetables pureed and mixed with fruit juice to mask the flavor.
Why it's important: One of the biggest mistakes you can make is to continue with "business as usual," not realizing that every ache, pain, and twinge is trying to tell you something. Just don't stop moving. It might seem intuitive to avoid exercise when you're in pain. But exercise, done right, eases stiff joints, increases blood flow to affected areas, strengthens the muscles that support the joints, and can even curb pain flare-ups. Exercise also helps you sleep more deeply, lifts your mood, and helps you lose weight, which in the long run will reduce pressure and pain.
What to do: If hiking and climbing hurts your knees but you can't give up your favorite pastime, get hiking poles and learn to use them. If you love to run but it's taking a toll on your joints, try buying new running shoes designed to reduce impact, or switch to a combination of walking and short sprints, which is much easier on the joints than the pounding action of ongoing running. If you wake up in the morning stiff and achy, your back is letting you know that it wants to move, and that lying in one place all night (flat on your back tends to be particularly troublesome) isn't working. Get extra pillows and position them around yourself until you feel the strain ease. And if you wake in the middle of the night, change sides or otherwise shift around so the pressure isn't affecting all the same places all night.
Tip: If exercise or activity routinely leaves you sore, talk to a physical therapist about how best to treat it. Many experts recommend elevating the affected area and applying ice to prevent inflammation immediately after exercise. Other say that although ice is usually the best therapy immediately after injury, it's helpful to use heat therapy for chronic pain -- before exercising or after ice treatment -- to ease stiffness, relax muscles, and increase blood flow to the area.
Why it’s important: No matter what parts of the body are causing pain, the way one thinks about and responds to pain plays an important role in how one experiences pain. Cognitive-behavioral therapy (CBT), which is also used in the treatment of depression and anxiety, can help people develop more constructive ways of coping with daily pain.
What to do: Ask your doctor for a referral for cognitive-behavioral therapy. This type of therapy may be also available within a multidisciplinary pain center. If your insurance doesn’t cover this type of treatment, an alternative is to get a workbook on using CBT to help with chronic pain. Several such workbooks, usually written by experienced therapists, are available through online booksellers or even public libraries.
Tip: You can also consider learning to practice mindfulness, which teaches people to observe their own thinking processes. A study of people with chronic back pain who were enrolled in a multidisciplinary pain-management program found that practicing mindfulness was linked to lower levels of disability, anxiety, and depression.
Why it’s important: It’s common for people to suffer from both chronic pain and depression. In fact, an estimated 56 percent of those with chronic pain are affected by depression. People who suffer from both problems tend to suffer from more disability and higher healthcare costs; studies have also suggested that pain medications work less well in people with depression. Although pain can contribute to depression symptoms, treatment of depression can improve function and quality of life in those with chronic pain.
What to do: If you find yourself often sad or unable to enjoy things, or you have any other symptoms of depression, be sure to pursue further evaluation from a doctor. Depression can be treated with psychotherapy or medication; using a combination tends to give the best chance at remission.
Tip: If you’re already being treated for depression, make sure you get regular follow-up appointments to check on your symptoms, and adjust your treatment if indicated. This is especially important if your symptoms haven’t fully gone into remission.