How To Treat Chronic Pain
When you're from jogging a few miles or taking a weight-training class, you probably think of it as "good pain." And the truth is, most twinges and pangs are helpful ones. Whether simply uncomfortable or truly sharp, they're signs that your body is reacting to a trauma exactly as it should. "Pain is the body's alarm system," says Naileshni Singh, M.D., an associate professor of anesthesiology and pain medicine at the University of California, Davis, in Sacramento. It alerts us when something is dangerous or needs our attention.
The physical sensations are the result of nerve stimulation. If you could look inside your body after burning your finger, for example, you'd see your nervous system fully fired up. Sensory nerve cells at the injury site would be busy dispatching SOS messages up the spine to the brain, which would process them and send "ouch" signals back out. As the body repairs itself, those signals gradually subside. Luckily, we tend to recover from temporary distress-also known as acute pain-relatively quickly, within 30 seconds (for a stubbed toe) to three months (a sprained ankle).
Chronic pain is less linear. It develops when an injury or condition lasts longer than six months, or when the nervous system's wiring malfunctions and sends out "ouch" signals nonstop. You or someone you know is probably all too familiar with this particular kind of long-term suffering: About 25 million adults in the U.S. (more than one in 10) say they deal with chronic pain daily-from a creaky lower back to the debilitating side effects of diabetes or arthritis.
No matter the cause or type, there are ways to handle the pain thoughtfully-in the moment and over the long run.
1. At Home Treatment
Most pain recedes with rest and time, but the following tactics will help move it along. The exceptions are injuries that require immediate attention-a potential broken bone, a cut that calls for stitches-or aren't healing properly or as quickly as they should (see section 2).
START SANS MEDS
The brain may be our most powerful pain-management tool. Because the part of it that registers physical distress lives near the area that deals with mood and emotion, your outlook can directly affect how you process it, says Robert Jamison, Ph.D., an associate professor of anesthesiology and psychiatry at Brigham and Women's Hostital/Harvard Medical School, in Boston. Stress-reducing activities, like meditation and deep breathing, "distract from discomfort and may calm pain signals from the brain," says Traci Speed, M.D., an assistant professor of psychiatry at Johns Hopkins Medicine, in Baltimore. With practice, you will feel better physically and learn how to curb the negative emotions that can drag you down further. (There's an even easier strategy for on-the-spot relief: The next time you get a paper cut, try swearing. One U.K. study showed that the four-letter fix really does take out the sting.)
THEN GET MOVING
It may be tempting to skip exercise when your body is giving you grief, but with most aches, you actually benefit from low impact activities like walking, swimming, and yoga. Not only does the movement increase blood flow that boosts healing, but shoring up the muscles surrounding a tender spot can take pressure off the area. In fact, a 2013 study showed that core-building exercises like planks can reduce chronic lower back pain by as much as 77 percent.
GO OTC IF NEEDED
Heat wraps can help relax the hurting muscles and joints that accompany older injuries and arthritis. If the pain persists, use nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil and Aleve, for soreness or throbbing (like a stiff back); some headaches may respond better to acetaminophen (Tylenol). Consider topical creams, sprays, and patches, too, says Christopher Gharibo, M.D., a pain specialist at NYU Langone Health. Scan labels for menthol, capsaicin, or lidocaine, which assist by reducing pain signals or distracting nerves. If those don't do the trick, ask your doctor about combining an NSAID and acetaminophen: Studies show that when taken together, they can ease sprains, strains, and fractures as well as an opioid.
2. When to See a Doc
If pain lasts long enough to inhibit daily activities, or if any accompanying symptoms, such as swelling, warmth, or redness, persist after 72 hours, make an appointment-and be ready to answer these questions.
WHEN DID IT START?
Pinpoint when and where you first felt it. Did it come on suddenly or gradually? Did a specific incident (lifting something heavy, shoveling the driveway) trigger it?
WHAT IS THE EXACT SENSATION?
Words like dull, tender, tingling, sharp, and stabbing can reveal the root cause of an ailment. Nerve damage, for example, may feel like numbness or skin sensitivity, while stiffness and swelling can point to a joint problem. You'll also need to show your doctor exactly where it is, and which movements exacerbate and ease it.
HOW DOES IT AFFECT YOUR ROUTINE?
Traditionally, doctors have used a 0-to-10 scale to gauge patients' pain levels. That can be problematic, though: For various reasons-including genetics, mood, and personality-your four could be someone else's nine. Docs still use the scale to determine if therapies are working (did ibuprofen bring your level-nine hip agony down to a five?), but it's less important than hearing in detail how your pain is interfering with your life. Maybe it wakes you at night, or jolts you every time you pick up your kid. Share all those specifics.
WHAT ARE YOUR EXPECTATIONS?
While the end goal is to get you back to 100 percent, it isn't always feasible to nix chronic pain completely. Knowing what your objectives are-to play catch with the dog again, or return to running-will help your M.D. create a realistic, effective plan.
3. Next Steps
Depending on your ailment, your doctor may tell you to stay the course with at-home care. She may send you to physical therapy, or prescribe a more specific treatment. Muscle spasms, for example, respond well to corticosteroid injections, and some chronic pain is best managed by NSAIDs, a short course of oral corticosteroids, or a low dose of certain antidepressants. (You're less likely to walk out with an opioid prescription today, as they can be dangerously addictive. If you are advised to take one, ask your doctor if a low dose is adequate.) Surgery is typically a last resort. A recent study found that using it for shoulder problems had similar outcomes to a placebo's. If your M.D. suggests a non-emergency operation as a first line of treatment, seek a second (or even a third) opinion. There's often plenty you can do to take charge of your pain without going under the knife.