What is pain?
Pain is usually a protective mechanism that alerts your brain when your body is being harmed in some way. The nerves in that area send signals through the spinal cord to the brain. The brain locates the injury and triggers a healing process.
Pain signals may be triggered by:
- physical injury or damage to your body – for example, a sprained ankle or damage that occurs as part of a longer-term condition such as osteoarthritis
- chemicals produced within the body itself that can irritate the nerve endings – this may be linked to an infection, an overuse injury or a flare-up of a long-term illness such as rheumatoid arthritis
- damage to nerves that causes them to fire off pain signals to the brain without any physical cause, which sometimes happens in complex regional pain syndrome.
When we have an injury or tissue damage caused by an illness, the nerves in the affected part of the body become more sensitive than normal, so pain signals are triggered more easily and warn us if there’s any further threat to the painful area. Normally, as the injury heals, the nerves become less sensitive again and the pain signals lessen and then stop.
When pain interferes with our daily activities, pain-killing drugs may help by blocking or reducing pain signals to the brain even though they don’t affect the injury or damage directly.
Pain isn’t just a physical sensation – it can have emotional effects too, especially if the cause of the pain isn’t clear or it’s difficult to find effective pain relief. And our emotions or mood can in turn make the pain seem worse or better.
What is long-term pain?
Doctors define long-term (or ‘chronic’) pain as pain that’s lasted for more than 12 weeks or that’s lasted for longer than would be expected for the type of injury or level of damage.
Sometimes it’s possible to find a specific cause of long-term pain – for example:
- an underlying condition such as arthritis
- nerve damage or disease.
However, with long-term pain, the sensation of pain isn’t always directly related to the injury or damage that caused the pain in the first place. Sometimes messages between the nerves and the brain can become disturbed so that the nerves remain unusually sensitive and continue to fire off pain signals even after a physical problem has cleared up.
Because our bodies are ‘programmed’ to understand pain as a warning sign, our natural reaction is often to protect the affected area from further harm – perhaps by resting it completely, by using it less than usual or by supporting it.
After a time, lack of use leads to weakening of the muscles. As we become less fit, we tire more easily and become more prone to strains and sprains, resulting in further pain. This can easily become a vicious circle.
How can pain affect you?
Pain can make it difficult to get on with your everyday activities whether at home, at work or in your leisure time. It’s a natural instinct to try and protect whichever part of the body is painful and this can affect your everyday choices. You may try to avoid jobs that tend to increase your pain or you may turn down opportunities to do things you’d normally enjoy.
Pain isn’t just a physical sensation – it has emotional effects too. If you’ve had pain for months or years, it’s not surprising that it can begin to affect your mood and self-confidence. Living with long-term pain is very different from coping with a short spell of pain, especially if the cause of the pain is unclear and standard treatments aren’t helping.
Other problems linked to long-term pain may include:
- sleep problems
- reduced physical activity
- difficulty with everyday activities
- reduced involvement in family and social activities
- difficulty concentrating or remembering things
- symptoms such as fatigue or weight gain
- side-effects from medications
- missing work, difficulties at work, or having to retire early
- changes in your relationships or sex life.
If your healthcare team haven’t been able to identify the cause of your pain then you may also feel frustrated and let down. You may feel that other people don’t understand how much pain you’re in and you may even begin to ask yourself whether the pain is ‘real’.
Treatments for long-term pain
Relief for arthritis, joint and muscle pain
Most of the medicines used to treat pain from arthritis, joint or muscle pain fall into one of the following categories:
Try completing each of the following phrases.
However, other types of drugs may also be used in particular situations. All of the drug treatments below are designed to control symptoms – they won’t help to heal the damage or cure the underlying condition.
Finding the right pain medications is about striking a balance between the benefits and the possible side-effects. These will vary from person to person and will also depend on how long they’re used for. Stronger painkillers will also tend to have a greater risk of side-effects.
Depending on your own situation it may be advisable to limit the use of stronger pain medicines to times when the pain is particularly severe and to try some other pain management techniques as well to see what works for you. It’s also a good idea to review your medication from time to time to make sure you’re still happy with the balance.
Physical treatments for pain
Physiotherapists, osteopaths and chiropractors may use a variety of different manual techniques, including:
- manipulation and stretching
- technologies such as ultrasound, laser or interferential treatment
- exercise programmes to strengthen muscles and improve general fitness.
It's important to go to a qualified practitioner, preferably with the guidance of your doctor.
In some conditions, for example back pain, the Alexander technique may also help. The Alexander technique teaches awareness of posture and relaxation to reduce muscle tension.
Hydrotherapy (aquatic therapy) for long-term pain
Many people with long-term pain find exercise in warm water is a comforting and effective way of moving the joints fully and stretching and strengthening the muscles. The warmth of the water soothes pain and because the water supports your weight it reduces the stresses on your joints.
A lack of hospital therapy pools means that access may be limited. However, many facilities offer out-of-hours access on a paid basis – contact your local hospital for details.
Local swimming pools tend to be cooler than aquatic therapy pools, but exercise classes such as aqua-aerobics provide a safe and fun way of exercising. Alternatively, local hotels with spa or aquatic therapy facilities may provide swimming or aqua classes.
Cognitive behavioural therapies (CBT)
Cognitive behavioural therapies (CBT) is a term used for a wide range of psychological approaches designed either:
- to manage the symptoms of health problems, or
- to change behaviour to improve your ability to function on a day-to-day basis.
All forms of CBT are based on the idea that our thoughts, beliefs, feelings, behaviour and the situations we’re in are all inter-connected. Our thoughts and beliefs can influence our behaviour; our behaviour can influence our feelings; and the situation we’re in can affect our behaviour. CBT includes assessing and understanding these connections and then finding ways to modify them to tackle the problem.
CBT isn’t right for everybody but it is a well-established approach that’s effective for improving people’s mood, health and ability to get on with their daily lives. It isn’t simply about talking or seeking advice, but about learning new skills that should help you to handle challenges in your life more effectively. For example, if fear of pain is causing you to avoid physical activity, then these methods can help in facing those fears.
Psychologists in particular often teach coping skills. These can include:
- relaxation techniques
- goal-setting and pacing
- ways of working on thoughts and beliefs and especially discouraging moods.
What can you do to deal with long-term pain?
Long-term pain can greatly affect your ability to carry out daily activities. You may find certain movements are particularly painful so you avoid them altogether. But it’s important to remain as active as possible as lack of use can lead to loss of strength and coordination. And trying some of the ideas below may help to minimise the pain relief medicines you need to take.
Self-help tips for long-term pain
Other pain-relief techniques that might help include:
- a heat pad, heated rice pad or a hot-water bottle
- an ice pack or a cold-water compress
- massage (with or without creams that create a sense of warmth)
- rest and good quality sleep – disturbed or unrefreshing sleep can increase pain, so speak to your doctor if you have this problem.
These techniques are often helpful after an injury and for sudden flare-ups of arthritis or back pain.
Is your pain management right for you?
Because nobody else can experience your pain or fully understand what it’s like to live with it, only you can decide what treatments or therapies are right for you. But that can be difficult if you’re feeling low or anxious or if you don’t know what support is available in your area.
Taking some time to think about what’s worked, what hasn’t and what your priorities are may help in making choices that fit in better with your way of life. A useful first step in forming a pain management plan is to think about how your pain affects your life.
Try completing each of the following phrases. "Since my pain began...":
- I spend more time thinking about
- I spend less time thinking about
- I spend more time doing
- I spend less time doing
What are you doing to manage your pain?
Below are some of the methods people use to deal with ongoing pain. Which ones have you tried?
- Taking drugs
- Distracting yourself
- Looking for information
- Modifying your home
- Taking time off work
- Trying to relax
- Using braces or aids
- Seeking a clear diagnosis
- Chiropractic treatment
- Seeing your GP
- Other alternative treatments
- Denying you have pain
- Asking for help with tasks
- Stopping painful activities
- Seeing another doctor
- Looking for the answer
- Pacing activities
These methods listed aren’t necessarily good or bad – some of them may work for some people, but that doesn’t mean they’ll be right for you. There may be other things on your list as well.
When you’ve thought about your own list, ask yourself the following questions about each method:
- Has doing it honestly helped your pain in a lasting way?
- Has it helped you to live the kind of life you want to live, especially in the long-term?
Weigh up the benefit you got from each method against the time and energy you put into it. Use this to decide:
- whether it’s worth trying a particular method more often
- whether to try something different.
Is your pain management working?
When we have problems, we automatically try to work them out. And sometimes we refuse to give up on a problem even though we’re not getting anywhere. At the other extreme, we sometimes feel confused or scared when we have problems and give up or do nothing. As you look at your pain-management methods, see if you notice yourself doing this.
Ask yourself the following:
- Do you feel that the ways you’re trying to manage pain are successful?
- Do they improve your life?
- Do you ever feel like you’re struggling and getting nowhere?
- Does trying to control pain actually stop you from doing what you want to do?
Seeking treatment for pain is useful when it works, but it can hold you back when it doesn’t, and can create a life focused on pain instead of on what you really want to do.
If you think some methods aren’t working, discuss this with your healthcare team. There may be some treatments that you need to continue to control a specific condition or others that shouldn’t be stopped suddenly. But beyond those you do have choices.
If you find yourself stuck in a trap, trying things that aren’t helpful or don’t suit your lifestyle, then try refocusing on your goals. Think about the circumstances that will get you there. Try not to let pain, fatigue or other symptoms distract you.
Try the following exercise to remind yourself that you can determine your own focus:
- Put your index finger in front of your face and stare at it.
- What looks clear and what looks blurry?
- Shift your focus beyond your finger. What looks clear and what looks blurry?
Which view shows you more of what is around you and gives you a more complete picture?
Sometimes we focus on one issue that feels close, like the finger. These issues don’t always affect us in the same way if we look at a wider view.
As you do this exercise, don’t think about it too much or try too hard to figure it out. It’s enough to simply notice what the experience is like of switching focus and seeing what’s in front of you in a different way.
These exercises won’t always help you to find the right answer, but they might help you feel more confident about letting your experience be your guide and using the quality of your life as a measure for the success of pain management methods.