By Sara Lindquist, MD, Director of Healthcare Integration, Juniper
Chronic pain is one of the most common reasons adults seek medical care. It can limit mobility and daily activities, produce anxiety and depression, and reduce quality of life. Chronic pain has the added potential of setting in motion dependence on opioids. According to the CDC, approximately 20 percent, or 50 million, adults in the US suffer from chronic pain.1
One of the best things you can do for yourself if you experience chronic pain is to learn techniques that help you manage it on a day-to-day basis. Living Well with Chronic Pain is a six-week class offered by Juniper designed to teach you some techniques you can use. People with pain who participate in this class report having more energy, less pain, less dependence on others, and improved mental health. They are more involved in everyday activities and are more satisfied with their lives.
What is chronic pain?
Chronic pain differs from acute pain. Acute pain usually results from a direct injury. It’s a survival mechanism that alerts us that there is a problem and that we need to either move away from the source of danger (such as a hot stove), seek medical care (such as for a broken bone), or take a break and rest (such as with postoperative pain after a surgery). As the body heals, the pain diminishes, and we can resume our normal level of activity.
Chronic pain is different. With chronic pain, the cause is not always apparent. Sometimes chronic pain can be due to an underlying medical problem or chronic illness such as arthritis, nerve damage from diabetes, or angina related to heart disease.
In some cases, there’s no known cause for the pain. Chronic neck or back pain, fibromyalgia, chronic pelvic pain, or chronic headaches often fit into this category. Sometimes chronic pain starts as an acute injury but does not go away after the usual time for healing and recovery. Chronic pain is defined as pain that lasts longer than three to six months.
Chronic pain can vary in intensity from day to day and is often unpredictable. As a result, the emotional response to chronic pain is different from that of acute pain. Chronic pain often leads to feelings of frustration, hopelessness, and helplessness. It can cause additional symptoms such as fatigue, poor sleep, anxiety and depression, muscle tension, restricted movement, and sometimes loss of functioning. These symptoms and responses can create a vicious cycle, further limiting recovery and healing. The good news is that in many cases, we can break the cycle.
Treatment for chronic pain can include both medicines and activities. No single treatment works for everyone, and treating chronic pain takes a bit of patience. It is essential to work with your healthcare provider to find the right mix of treatments for you. Communication about what helps and doesn’t help is critical.
Treatment options include:
- Physical therapy to learn exercises and stretches
- Learning techniques for the self-management of pain and response to pain
- Medications to relieve pain, improve sleep, and improve mood.
- Working with a counselor
- Relaxation therapy
- Massage therapy
- Injections (shots) of numbing or pain-relieving medications into the spine or area of pain
Medications used to treat pain include non-opioid pain medicine such as non-steroidal anti-inflammatory drugs (NSAIDS), acetaminophen (Tylenol), or aspirin. NSAIDs are medications such as ibuprofen (Motrin or Advil) or naproxen (Aleve). Opioid medications have been used to treat chronic pain, although the use of opioids to treat chronic pain conditions is controversial (more on that in a moment). In addition to standard pain medications, there are a variety of other medicines that can be effective in helping to manage pain.
Use and misuse of opioids
As you may know from the news, the misuse of opioid-type medications has been declared a public health emergency in this country.
Misuse of opioid prescriptions is use other than for what the medication was prescribed. The opioid epidemic began in the 1990s when healthcare providers began prescribing opioid medications for pain at greater rates—before it was clear that these types of medications were indeed highly addictive. (Notably, according to the CDC, although the number of opioids prescribed and sold for pain has increased, the amount of pain that Americans report has not similarly changed.)
As a result of increased prescribing, misuse of both prescribed and non-prescribed opioid medications has become widespread. Following this trend has been an increase in deaths due to opioid overdose. From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.2
In 2017, prescription opioids were involved in more than 35 percent of all opioid overdose deaths, and overdose rates from prescription opioids significantly increased among people older than 65 years of age. On average, 46 people die every day from overdoses involving prescription opioids.3
Opioid pain medications work by acting on areas in the brain that are responsible for our experience of pain as well as our reward and pleasure responses. This correlation contributes to the misuse of opioid pain medications in the treatment of chronic pain. Prescription opioids are associated with many potential side effects, even when used as prescribed. These side effects4 include:
- Tolerance—meaning you might need to take more of the medication for the same pain relief.
- Physical dependence—meaning you have symptoms of withdrawal when you stop the medication.
- Increased sensitivity to pain.
- Nausea, vomiting, and dry mouth.
- Sleepiness and dizziness.
- Low levels of testosterone can result in lower sex drive, energy, and strength.
- Itching and sweating.
Physical dependence and addiction are two different issues that stem from opioid use and are frequently confused. Physical dependence is what results from the chronic, regular use of opioid pain medications, even when taken as prescribed by a health care provider. Addiction is a term used to describe the result of the repeated misuse of opioid medications for their analgesic effects and rewarding properties.
To avoid these issues, work closely with your healthcare provider and be open to trying new treatments or combinations of treatments to help manage chronic pain. You will also want to set realistic goals for your treatment. Even if you can’t completely get rid of your pain, you might be able to control it enough to do the things you want to do.
Managing chronic pain
You can take steps on your own to feel better, including 5
- Use a heating pad or an ice pack on the painful area. Check with your doctor first to see if this is okay for use with your particular condition.
- Practice relaxing. Learning about different methods to relax your body such as breathing techniques can be very effective in the management of your symptoms.
- Stay as active as possible. It is important to maintain activity to maintain function. Walking, swimming, tai chi, or biking are all effective in helping to ease muscle and joint pain.
- Address feelings of helplessness, hopelessness, depression, or anxiety. Chronic pain and depression often go together. Getting anxiety or depression treated can help improve your symptoms of pain.
Consider attending a self-management class such as Living Well with Chronic Pain. The course is an evidence-based program that addresses techniques such as those listed above and allows the opportunity to dig deeper into how chronic pain is affecting your life and what you can do about it.
Living Well with Chronic Pain stresses the following points as you work through your pain:
- You are not to blame. However, you are the one who is responsible for taking action to manage your pain condition.
- Don’t do it alone. Isolation is one of the side effects of chronic pain. Coming together with other individuals in a similar situation as you, such as in Living Well with Chronic Pain, can be very helpful in your recovery process.
- You are more than your pain. Your pain does not define you. It is essential that you cultivate areas of your life that you enjoy.
- Illness can be an opportunity. Challenges such as chronic pain can provide opportunities for personal growth.
Juniper offers Living Well with Chronic Pain classes across the state of Minnesota. Find a class near you at yourjuniper.org.
Chronic pain often necessitates a change in lifestyle. You can take charge of how you approach the challenge of chronic pain, and self-management programs such as those offered by Juniper can help.
1Morbidity and Mortality Weekly Report/September 14, 2018/Vol.67/No.36/pp.1001-1005.
2www.cdc.gov/drugoverdose/data/prescribing.html“Key Messages” tab
3www.cdc.gov/drugoverdose/data/prescribing.html“Overdose Deaths” tab