Chronic Pain Management: Other management techniques

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Exercise regularly

Patients with a variety of pain problems are told to rest, and in fact the best response to many acute injuries is rest. However, prolonged rest and inactivity is almost always detrimental. This is because prolonged rest, even in healthy individuals, leads to significant protein and calcium loss, decreased efficiency of the cardiovascular system, and even changes in the nervous system and immune function. In short, as human animals we are built to move and regular, vigorous movement is essential to keep the systems of our body functioning.

It is interesting to note that several recent studies by Dr. Wendy F. Sternberg and colleagues from Haverford College in Pennsylvania have scientifically documented what many of us already believed; vigorous exercise leads to decreased pain sensitivity (probably by activation of our own pain control system described above).

The opposite is probably also true, namely that very low activity levels increase pain sensitivity and therefore increase the level of discomfort in patients with an ongoing pain problem.

Regular exercise is also an excellent way to help decrease depression and anxiety, and help with weight loss. You will need to pace activities if you have a pain problem that makes exercise difficult.

Swimming, walking, and riding an exercise bicycle are safe ways to increase fitness and decrease stress. As discussed below, several traditional forms of exercise such as yoga, tai chi, or chi gong may also be of significant benefit for patients with pain.

Be positive but realistic

Research on coping has shown that catastrophizing or focusing only on the worst possible outcome is a common roadblock to patients taking positive control over their problems. In pain management we often ask patients to challenge common but irrational automatic thoughts such as, “I will never be able to … again,” or “My life is now meaningless.” It is also not helpful to tell oneself that “Everything will be fine” because that may not be true.

Instead, substitute a more positive and rational thought such as, “I am having a difficult time but I have survived similar bad periods” or, “There are still some options to try.”

In a similar way, you should more clearly define what in your life you can and cannot control. Increased worry and focus on things we cannot control is usually not productive. Instead, efforts should be aimed at those aspects of our condition we can influence or change.

Try to improve sleep

People with chronic pain report sleep as their number one problem. While there are a variety of medications that help improve sleep temporarily, most (with the exception of some of the antidepressant medications) are not useful on a chronic basis. Sleep hygiene is critical for anyone with sleep problems. This includes:

  • Having a period of time of relaxation before going to bed
  • Keeping a specific wake up time even if you did not sleep well during the night
  • Not staying in bed for more than 20 minutes without sleeping (get up and do something relaxing until you feel sleepy again)
  • Turning the clock away so when you awake you cannot focus on the time
  • Using the bed only for sleep (or sexual activity) and not for reading, watching TV, or eating
  • Avoiding food or drinks with caffeine for at least 4 hours before bedtime

Daytime activities also affect sleep, so regular exercise and avoidance of napping can greatly improve nighttime sleep.

Seek out social activities and support

Unfortunately, many people with chronic pain withdraw from their social world and even their family. This is often a gradual process that needs active attention to reverse. Many times it is necessary to force oneself to participate in social events even if you do not feel like it.

Complementary and alternative medicine (CAM)

CAM generally refers to modalities, practices, techniques, and systems of healing that are used together with (“complementary to”) or instead of (“alternative to”) conventional medicine.

Among the modalities that are usually included as CAM are:

  • Chiropractic
  • Acupuncture
  • Massage therapy
  • Mind-body techniques (e.g., biofeedback, guided imagery, yoga, and meditation)
  • Some forms of nutritional therapy
  • Dietary supplements (including herbs)
  • Homeopathy
  • Naturopathic medicine
  • Various forms of energy healing
  • The indigenous healing systems of the many ethnic groups in the United States

Over the past decade, several nationwide surveys have documented a substantial and growing usage of CAM practices and products by the American public. These surveys have found that most CAM users seek out conventional medical treatment first, and then turn to CAM practitioners. Most people appear to use CAM in conjunction with, not as a replacement for, conventional medical therapy, and many seek out care that integrates the best of a variety of approaches.

Up to 42% of the population may use CAM methods. And even higher use of CAM therapies have been found among people with chronic and life-threatening conditions and chronic pain. For example, a study at a major cancer center indicated that 69% of patients included CAM approaches as part of their cancer care.

Scientific study of CAM techniques is still in its infancy. For example, in 1997 the National Institutes of Health issued a consensus statement on the use of acupuncture, one of the most common CAM modalities. While there have been hundreds of studies using acupuncture, most were of such poor scientific quality that the panel could only find clear evidence for the effectiveness of acupuncture on various forms of nausea and only one pain condition (postoperative dental pain). Acupuncture is thought to stimulate our internal pain control system and production of endorphins, but this has also not been clearly demonstrated.

Many other CAM modalities have been reported to have significant benefit for chronic pain but even less scientific data exists to inform patients regarding their efficacy and safety. It is clearly time to embark on serious study of ancient and alternative medical approaches using the tools of modern science. It is promising and exciting that recent data on mind-body interactions support the fundamental basis of most CAM approaches, namely that the mind, brain, and body are best treated as an integrated whole.

Efforts are underway to promote the development of new models of medical care and provide a scientific basis for integrative medicine. At present, decisions on whether to try CAM techniques for pain control or which techniques might be most appropriate must be made by each person without the benefit of clear scientific data.

If you are considering a CAM approach, it will be important to gather as much information as you can about the methods and especially the provider. As with any provider, look for his or her credentials, number of years experience, and ask direct questions on what to expect and possible side effects from the treatment.

Adapted from, “An 8-Step Approach to Chronic Pain Management”– IFFGD Publication #140 by Bruce D. Naliboff, PhD, Clinical Professor of Medical Psychology in the Dept. of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA; Co-director, UCLA Center for Integrative Medicine; and Chief of the Psychophysiology Research Laboratory, West Los Angeles VA GLA Health Care, Los Angeles, CA

5 Things You Should Know About Yoga

Yoga typically combines physical postures, breathing exercises, and meditation or relaxation. Researchers are studying how yoga may be used to help improve health and to learn more about its safe use. If you’re thinking about practicing yoga, here are 5 things you should know:

  • Studies suggest that yoga may be beneficial for a number of conditions, including pain. Recent studies in people with chronic low-back pain suggest that a carefully adapted set of yoga poses can help reduce pain and improve function. Other studies also suggest that practicing yoga (as well as other forms of regular exercise) might have other health benefits such as reducing heart rate and blood pressure, and may also help relieve anxiety and depression.
  • Studies show that certain other health conditions may not benefit from yoga. Research suggests that yoga is not helpful for asthma, and studies looking into yoga and arthritis have had mixed results.
  • Yoga is generally considered to be safe in healthy people when practiced appropriately. However, people with high blood pressure, glaucoma, or sciatica, and women who are pregnant should modify or avoid some yoga poses.
  • Practice safely and mindfully. Everyone’s body is different, and yoga postures should be modified based on individual abilities. Carefully selecting an instructor who is experienced and is attentive to your needs is an important step toward helping you practice yoga safely. Inform your instructor about any medical issues you have, and ask about the physical demands of yoga.
  • Talk to your health care providerse about any complementary health practices you use, including yoga. If you’re thinking about practicing yoga, also be sure to talk to your health care providers. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Adapted from The National Center for Complementary and Alternative Medicine’s “5 Things You Should Know About Yoga.” (Accessed 01/19/018). This article is not copyrighted.

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.

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