Chronic Pain

Excerpted from
Ask a Nurse
By Geraldine Bednash Ph.D., RN, FAAN, American Association of Colleges of Nursing (AACN)

Chronic pain is pain that continues over the long term. Chronic pain can be the result of many different conditions, including arthritis, back problems, cancer, headache, and occupational injuries such as carpal tunnel syndrome. Obviously some of these conditions are very serious. So if you're experiencing chronic pain, seek professional attention to determine the cause. Also, be aware that chronic pain can contribute to depression, notes Tracy Call-Schmidt of Salt Lake City.

Treatment: Treatment depends in large part on the cause and severity of the pain. Over-the-counter and prescription medications are available to counter pain on different fronts. These include analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) of varying strengths and narcotics, which are available only by prescription. Tracy Call-Schmidt advises seeking out a pain management clinic. "They are best equipped to help you," she says.

Self-care: Self-care for chronic pain also depends on its cause and severity. Certain types of pain require professional management. For other types of chronic pain, however, over-the-counter medications, exercise, rest, alternative therapies, and other self-care techniques may provide relief.

• Ease muscular pain with regular exercise, preceded by stretching and followed by stretching and rest. Stretching can not only help alleviate existing pain but prevent future pain.

• Reduce swelling with ice or an Ace bandage. Heat, in the form of a warm bath or a heating pad, can also be helpful.

• Counter pain caused by inflammation, including arthritis pain, with ice and heat.

• Exercise. This, too, can be helpful for arthritis pain. It improves range of movement, takes your mind off the pain, and releases endorphins, the body's natural painkillers.

• Get adequate rest, suggests Paula Siciliano of Salt Lake City. This can include taking naps during the day and establishing regular waking and sleeping hours.

• Increase your intake of omega-3 fatty acids to help reduce inflammation, suggests Kathy Niemeyer of Allendale, Michigan.

• Try relaxing with a hot bath, a good book, and a glass of wine at night, Siciliano suggests.

• Consider massage, spinal manipulation, or myotherapy. These modalities can ease some types of muscular tension and pain, says Kathy Niemeyer. Acupuncture and acupressure, magnetic field therapy, (use of magnets to relieve pain, primarily muscle and joint pain) and transcutaneous electrical nerve stimulation (TENS-a treatment that involves administering pulses of low voltage electrical current to an area) may also help control pain.

Over-the-counter treatment: A variety of analgesics (pain-relieving drugs) are available over the counter, including acetaminophen, aspirin, and other NSAIDs. See "Arthritis" for more information on analgesics and NSAIDs. Counterirritants, too, can help ease some types of chronic pain. See "Arthritis" and "Back Pain" for more information.

Alternatives

Acupressure

Acupressure is an ancient Chinese technique that uses the fingertips, thumbs, knuckles, and palms to stimulate nerve endings called acupoints on the surface of the skin. It began thousands of years ago in China, probably as a combination of acupuncture and massage. Western acupressurists often attribute the pain relief associated with the technique to the release of endorphins, the body's natural painkilling chemicals.

Acupressure is performed by practitioners who are trained in this therapy. Some medical doctors, chiropractors, massage therapists, and other licensed health care practitioners are also acupressurists. Acupressurists have undergone about 1,200 hours of training and instruction at an approved institution; upon completion of such a program, certification is granted. No state has laws or licensing stipulations governing the practice of acupressure at this time.

Acupuncture

Acupuncture is an ancient Chinese healing art in which very thin needles are inserted under the skin along what are known in Chinese medicine as meridians, paths along which chi (the vital, organizing force of the body) flows. These meridians, or paths, are sets of invisible lines thought to resemble the nervous and circulatory systems. Little was known about this technique in the United States until the early 1970s, when an American journalist traveling in China required an emergency appendectomy. According to his reports, acupuncture significantly reduced his postsurgical pain. After he wrote about his experience, American doctors began to travel to China to observe acupuncture for themselves. Since then, acupuncture schools, practitioners, and professional organizations have been established in the United States.

Acupuncture is performed by acupuncturists, who must undergo formal academic training to receive certification from the National Certification Commission for Acupuncture and Oriental Medicine. Some medical doctors and other licensed health care practitioners are also acupuncturists.

Licensing stipulations and regulation of this practice are not uniform in all states. Some states limit the practice to licensed medical practitioners, and in more than half the states and the District of Columbia, acupuncturists must be certified in order to obtain a license to practice.

Biofeedback

Biofeedback uses the conscious mind to control involuntary body functions (those we do not consciously control), such as respiration, brain activity, and blood pressure. Proponents of biofeedback believe that the way the body responds to stress profoundly influences physical health; thus the aim of the technique is to control these responses to stress-decreased body temperature and increased blood pressure, for example-by training the body to relax. The application of biofeedback to health disorders is not new. For many years, especially in Eastern cultures, yogis have been able to control involuntary body reflexes such as respiration and heartbeat.

The techniques used to train someone in the use of biofeedback have become very sophisticated. It's now possible to monitor brain impulses, for example, and make them audible to the person who is using biofeedback. By monitoring this electrical activity-or, for that matter, other functions, such as blood pressure and heartbeat-and listening to a series of "beeps," the person can learn how to control his or her responses.

Biofeedback is taught by biofeedback therapists, many of whom are licensed health care practitioners such as nurses, physical therapists, internists, and psychiatrists. Most biofeedback therapists have completed a program of formal academic training at an institution accredited by the Biofeedback Certification Institute of America in Boulder, Colorado.

Chiropractic

Chiropractic is the healing art that emphasizes spinal manipulation and joint alignment. The basic idea of making adjustments to the spine, as well as manipulation of other soft tissue, such as joints and ligaments, began as early as 2700 B.C. in China. Now the third largest health profession in the United States (after medicine and dentistry), chiropractic has tenets that are accepted by many medical and health practitioners. Based on the premise that if left untreated a misaligned spine may eventually lead to pain and other symptoms, chiropractic employs hands-on treatment or instruments to manipulate or straighten misalignments in the spine and joints.

Chiropractic is performed by chiropractors, whose training consists of 4,200 hours of classroom, laboratory, and clinical experience at an institution accredited by the Council on Chiropractic Education Commission on Accreditation. Upon completion of such a program, certification is granted. All states have statutes that recognize and regulate the practice of chiropractic. To find a chiropractor in your area, ask your health care provider for a referral or check the Yellow Pages under "Chiropractors."

Massage Therapy

Massage therapy is the healing art that uses manipulation of muscles and other soft tissues of the body to create a feeling of relaxation, ease mental and physical tension, alleviate aches and pains, improve circulation, and generally reinvigorate and stimulate the body. Developed 3,000 years ago in China, early Eastern forms of massage evolved into techniques such as acupressure.

Massage can be performed by the person herself or by someone else, such as a massage therapist, who is trained in one or more of the various forms of massage therapy. Massage therapists have completed a training program at one of the many massage schools in the United States. Be aware, though, that the extent and quality of training at these schools varies widely. In half the states and the District of Columbia, the practice of massage therapy is regulated, and massage therapists must meet certain standards that these states have established. In the remaining states, massage therapists do not need a license or certification to practice.