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Pain Management Services at University Health System
Chronic Pain
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Managing Chronic Pain

A person's overall quality of life is made up of many factors. Among them are friends, family, work, recreational pastimes, and health status. People with chronic pain often spend less and less time with friends, family, work, and recreation, which means that their quality of life becomes more and more dominated by pain. This is illustrated in the following pie charts:

Meaningful and Enjoyable Activities

Many chronic pain problems are aggravated by strenuous activity and lead people into a pattern of ever-decreasing activity. Negative moods can also add to decreased interest and motivation to keep up "unnecessary" activities. People who have chronic pain and negative moods often continue to do chores, but give up the activities that give their life meaning and satisfaction. This pattern has to be changed if depression, stress, and chronic pain itself are to be conquered. By increasing meaningful and enjoyable activities, a person appropriately makes pain just one (small) part of his or her overall quality of life.

Relationships

Along with participating in meaningful and enjoyable activities, maintaining social contacts and open communication is a fundamental way to combat stress and depression. Chronic pain places stress on relationships. Friends and family may feel frustrated at not being able to understand someone's pain problem or how to help them. They may also try to help too much, thus adding to a person's dependency and passive patient role. Conversely, the person with chronic pain may increasingly avoid interactions with others to avoid relationship strain. Unfortunately, this only adds to the sense of isolation and despair.

As long as a person's life revolves around pain or other chronic illness, life will be relatively miserable. Taking control means putting back into life all the things that make it worthwhile, despite the pain. This includes maintaining relationships and keeping up meaningful and enjoyable activities.

Physical Reconditioning

Regular exercise is important when we are well, and it is critical when we have a chronic illness. Chronic pain and other illnesses place limitations on our physical functioning. When we are health, not being at the top of our personal potential for physical conditioning does not significantly restrict us. We ca be out of shape and still function in normal activities. This often is not the case, though, when we have a chronic illness. Here we need to pay extra attention to exercise, so as to retain a normal range of functioning and/or to avoid further physical decline. A person who has a chronic illness should be in the best physical condition possible. It is for this reason that physical therapy programs for chronic pain often provide training in home reconditioning exercises.

Rehabilitative Exercises

Stretching and strengthening exercises directed at restoring or maintaining physical functioning following an injury or hospitalization, or to counter disease, fall under the category of rehabilitative exercises. Following periods of disuse, muscle mass and tone are decreased, tendons can constrict-decreasing mobility, and problematic joints can become more stiff and painful. To counteract this, physical therapists prescribe particular rehabilitative exercises to stretch, strengthen, and ensure mobility of specific and general problem areas.

When rehabilitative exercises are followed regularly, then can often do wonders to counteract what many people fear is the beginning of a steady, downhill course. When you start these exercises, there will probably be some discomfort as areas not used to exercising are stretched and strengthened. Communication between you and the physical therapist is very important to ensure the best possible exercise program. You should discuss any concerns or questions about the exercises with your physical therapist or doctor.

When people have some physical problem such as pain or stiffness that varies from day to day, it's common to try to do too much on good days and too little on other days. You need to pace your activities and exercise sot that you gradually build up strength and mobility. This will allow you to avoid aggravating your condition. You should also use proper body mechanics when bending, lifting, or reaching to avoid worsening the condition. Physical therapy includes instruction on these points.

Depression

Persons with a chronic pain problem often show decreases in meaningful and enjoyable activities. Relationships and finances are often strained. Social contacts are reduced, and coping resources depleted. Not surprisingly, many chronic pain patients become depressed. And even though this depression is usually brought on directly by the pain, it nevertheless is a legitimate depression and legitimate problem. Depression greatly adds to the suffering or perceived pain intensity experienced by someone with pain. It also interferes with an individual's motivation and ability to keep full and moving ahead, despite pain.

Patients and doctors alike often confuse depression and chronic illness. This is because the consequences of chronic pain and the symptoms of depression look very similar. In fact, groups of chronic pain patients who are asked to generate a list of pain consequences and a list of symptoms of depression are usually surprised to find that the lists are virtually identical. It becomes impossible for patients to disentangle what part of their suffering, pessimism, and lack of energy is due to pain, and what part is due to depression.

Luckily, depression can be successfully treated even when the pain problem cannot be physically corrected. Additionally, as depression is relieved, not only does a person's mood improve, but also the person is actually better able to tolerate pain. Indeed, people typically express having less pain.

Stress

Ask most chronic pain patients what their most significant source of stress is, and they will usually tell you that it is pain. Pain, however, is not only something tat causes stress, it is also aggravated by stress. When someone is under stress, the muscles tighten, which puts added tension on joints and connective tissues. The nervous system becomes more active under stress, which can increase pain signals and pain sensitivity. These factors can greatly increase pain, causing more stress and concern. Stress also adds to depressions.

Managing stress and managing chronic pain go hand in hand. Strategies for decreasing both pain and stress include the following:

  • participating in regular exercise
  • maintaining meaningful activities and relationships
  • using direct communication
  • correcting negative thinking styles
  • using biofeedback
  • individual and group counseling
  • taking antidepressant medication
 

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