The New Rules of Pain Relief
By Christina Frank
"The art of life is the art of avoiding pain," said Thomas Jefferson—and that was back when a stiff shot of brandy passed for an analgesic. More than two centuries later, we still haven't figured out how to avoid pain entirely. The National Institutes of Health (NIH) estimates that as many as 76 million adults suffer from chronic aches due to arthritis, back pain, headaches, nerve pain and other wince-inducing conditions.
We all have our go-to pain remedies. Headache? Pop a couple of ibuprofen. Back pain? Call the chiropractor. But a major review of current research published in the Cochrane Library looked at the effectiveness of common pain medications and confirmed that people have widely varying thresholds for pain and that there is no one-size-fits-all remedy. To break out of your pain-relief rut, get up to speed on new options that may be right for you. (It’s always best to consult with your doctor before making a change to a pain-relief regimen, especially if you have diabetes or kidney disease.)
Pain and Lifestyle
Pain is often so distracting and limiting that it seems like only a miracle could make it go away, but sometimes the simplest adjustments can change your life, at least when it comes to musculoskeletal pain. "Body mechanics, footwear and how you carry weight makes a huge difference," says Perry Fine, M.D., president of the American Academy of Pain Medicine. "You’d think pain would be a powerful motivator, but people are people," he says. "They don't want to compromise on fashion." If you must wear high heels, at least save them for the office and wear comfortable walking shoes to and from work.
Likewise, trade a heavy purse or briefcase for a backpack, which distributes weight more evenly across your frame. "You also have to face that getting older means accepting limitations," says Dr. Fine. "You can still ski, for example, if that's something you enjoy, but you're going to have to take it more easily in your 50s than you did in your 20s, or you'll pay the price." Which is not to say that you should avoid physical activity entirely or coddle yourself when pain strikes.
Regular, low-impact exercise, like yoga or Pilates, keeps ligaments stretched and muscles warm and loose. (One recent study done in Norway found that people who exercise as little as an hour a week have a lower risk of developing back, shoulder and neck pain.) Dr. Fine is also a fan of stretching to preempt pain. "If everyone took three minutes each hour to do some simple stretches, the number of people suffering from neck and back pain would be greatly reduced," he says.
Re-Think Traditional Pain Relief
Ibuprofen, acetaminophen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are reliable pain-relief methods, but there are new alternatives. Topical NSAID patches available by prescription provide localized relief of muscle and joint pain without the gastrointestinal side effects of oral meds. Opioid drugs, used for severe pain, now come in more effective long-acting versions and, in future, in formulas combined with other medications.
Certain serotonin and norepinephrine reuptake inhibitors (SSRI/SNRIs), commonly used to treat depression, also relieve physical pain due to fibromyalgia, migraine headaches or back pain. By increasing the levels of neurotransmitters, they appear to inhibit the transmission of pain signals.
A relatively new medical specialty—called Interventional Pain Management (IPM)—employs minimally invasive techniques for age-related spinal stenosis and persistent chronic headache pain.
These procedures can involve injecting medications in and around the spine, ablating nerves with heat, or implanting spinal-cord stimulators. A newer procedure—known as “mild,” minimally invasive lumbar decompression—removes excess tissue to relieve pain caused by spinal stenosis."These are very exciting new treatments," says Standiford Helm II, M.D., president of the American Society of Interventional Pain Physicians. "They are very effective, yet they don’t put as much stress on the body."
Mind-Brain Therapies to Reduce Pain
"Alternative and mind-body therapies can be as effective as any drug if done correctly," says Dr. Fine. Though the mechanism isn't clear, it's long been known that people with chronic pain can get into a vicious cycle—where pain makes them feel fragile and vulnerable, and those feelings then exacerbate the pain.
Research suggests that meditation can relieve physical pain and the anxiety and depression that often accompany it, and a recent study found that people suffering from fibromyalgia may benefit from practicing tai chi, which combines meditation, deep breathing, slow movements and relaxation.
"Fifty to 80 percent of people with chronic pain are depressed or have anxiety disorders at some point while they have the pain," says Steven P. Cohen, M.D., a pain specialist at the Johns Hopkins University School of Medicine. Cognitive behavioral therapy (CBT), a psychological technique based on changing one's maladaptive behavior and perception of circumstances rather than trying to alter them, can be an effective treatment. "Learning to understand and master your response to pain is critical," says Dr. Cohen. "It's so important to have the locus of control be within yourself."
Adapted from our sister publication, Diabetes Focus (Spring 2012)