Taking control of chronic pain

Chronic pain reaches beyond the original source of pain andcan consume every waking moment. But with the right medications and self-helpstrategies you can get your life back.

When you’re in pain, you don’t care what kind of pain itis—you just want it to stop. But effective pain relief requires medicationstargeted to the specific type of pain. With chronic pain, traditional painrelievers are just part of the solution.

Acute vs. chronic pain

Acute pain is the sudden, sharp discomfort that arises froman injury, surgery, or a medical emergency like an inflamed appendix. Acutepain goes away after its source resolves or is successfully treated.

Chronic pain is more complex, and more challenging tocontrol. It typically involves pain that persists after an injury or ailmenthas healed. Chronic pain also may accompany ongoing acute pain. Arthritis pain,for example, can be both acute and chronic: The inflamed joints continue totrigger acute pain, but the constant flood of pain signals also alters how thebody processes pain messages.

How chronic pain develops

Pain researchers believe that overstimulation ofpain-sensing nerve cells in the spinal cord and brain makes themsuper-sensitive. These cells begin to react to even a light touch or slightmovement. The result is an onslaught of pain signals reaching the brain, plusan array of other symptoms. These may include muscle tension, reduced mobility,fatigue, and changes in appetite. The emotional effects—depression, anxiety,anger, and fear—are often the most difficult to cope with.

Depression is common and can make chronic pain worse.Research suggests that people with arthritis-related chronic pain anddepression experience more intense pain and greater disruption in their lives.For those with rheumatoid arthritis, depression is also associated with worsehealth and reduced functional ability.

Targeting multiple sources of pain

Treatments for arthritis-related chronic pain includetypical arthritis medications, such as acetaminophen (e.g., Tylenol) andnon-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Advil)and naproxen (e.g., Aleve). Steroid medications like prednisone may beprescribed if inflammation is severe. For those with rheumatoid arthritis,different types or combinations of disease-modifying anti-rheumatic drugs(DMARDs) and biologicals will likely be tried.

Antidepressants target other pathways involved in chronicpain. The so-called tricyclic antidepressants, such as amitriptyline (Elavil),are used primarily in nerve-related (neuropathic) chronic pain. Some evidencesuggests they may also help relieve symptoms of non-neuropathic pain related toarthritis. The anti-seizure drug pregabalin (Lyrica) has recently been approvedfor fibromyalgia.

Teresa Dews, MD, a pain specialist at The Cleveland Clinic,says people who have muscle spasms with their arthritis, particularly arthritisof the back, might be given a mild muscle relaxant for occasional use. She addsthat sleep medications or antidepressants can help people who have difficultysleeping because of their pain.

What about opioids?

Morphine-like drugs called opioids may be prescribed forchronic pain that hasn’t responded to other medications. These powerfulmedicines include morphine, oxycodone (e.g., OxyContin), hydrocodone withacetaminophen (e.g., Lortab or Vicodin), and acetaminophen with codeine (e.g.,Tylenol with codeine).

A non-narcotic medication called tramadol (Ultram), which isindicated for the management of moderate to moderately severe chronic pain foran extended period, is another option.

“When we consider opioids, we ask, How well does it helpwith the pain and how well does it help with function?” Dr. Dews says. “Somepatients on very high doses of opioid pain medications still have a significantamount of pain, and their function hasn’t really improved.”

She advises people with chronic pain to take ownership oftheir condition. This includes researching what pain treatments are availableand what they do as well as taking care to improve your overall health. Regularexercise, good nutrition, and achieving a healthy weight are important inrelieving chronic pain—and in keeping it from becoming worse.

If your pain doesn’t improve with standard treatments, askyour doctor for a referral to a pain specialist or pain clinic.

Info Box:

What You Can Do

The following strategies can help you take control of yourpain:

Relax. Try deep breathing, visualization, relaxation tapes, soothing music,prayer, or meditation (see “Mind Over Arthritis,” page 16).

Keep moving. If possible, try to walk every day and do gentle stretchingexercises to maintain flexibility and mobility.

Laugh. Surround yourself with upbeat people. Try to find the humor in difficultsituations. Watch comedies.

Stay positive. Focus on what’s good in your life. Try to turn negative thoughtsinto positive ones.

Distract yourself. Try to redirect thoughts about the pain. Find a hobby orother consuming passion to turn to.

Seek support. Join a support group. Tell family members and friends how theycan help.

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PATIENT STORY

“I can do this”

For Vickie Wunderlich, the pain started in her chest. Kneesand elbows began to ache. She shrugged it off as what happens when a recentlydivorced young woman totes two children under age three, lugs diaper bags andgroceries, and wears heels to work. “I was always juggling,” she says. Shethought she would “take a couple of aspirin and get over it.”

Then came the diagnosis: rheumatoid arthritis, the first ofthree inflammatory conditions that have attacked her body over the past threedecades, with flareups leaving her flat on her back. She also suffers fromlupus (an autoimmune disease affecting many organs) and Sjögren’s syndrome (animmune disorder that causes dry eyes and dry mouth).

Like a pharmacist, Vickie rattles off medications that haveeased her chronic pain and decreased inflammation. “Now with all the new drugsout, it has to keep getting better,” she says hopefully.

But it takes more than a prescription to get her through herday. At age 52, remarried and a grandmother of five, she has learned to manageher own pain, which five years ago forced her to leave her job at Boeing in St.Louis. “I closed my blinds and went into a severe depression. I wasn’t excitedabout a new grandchild I couldn’t pick up—I knew I’d be in pain.”

Determined to cuddle her grandchildren, she created aspecial story time while nestling in a big recliner. To share tips and learnmore, she volunteered with the local Arthritis Foundation office in Alton,Illinois, and now manages it.

She begins and ends her day with a warm bath and sleeps insilky pajamas to shift more easily in bed. She does water exercises and walksregularly to “lubricate” her joints. A warm paraffin dip soothes achy knees.

“I do whatever gives me comfort,” she says. “I’ve learned totake a deep breath and say, ‘I can do this.’”