Chronic Pain

18 Must-Know Pain Tips
By Maureen Connolly 
Published 4/17/2012 
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“Pain Is Mandatory. Suffering Is Optional.”
The author of this sage quote is unknown, but the words eloquently sum up what health and wellness docs and pain practitioners know to be true. “Being human means that we will experience pain — both physical and emotional,” says Jane Ehrman, MEd, CHES, a mind-body medicine specialist at the Cleveland Clinic’s Center for Integrative Medicine. “But how we choose to respond to pain is completely up to us.” And how you respond will be greatly helped by educating yourself about the arsenal of scientifically proven techniques and tools for managing pain that are completely at your disposal and within your reach.
Your Doctor Can’t Really Take Your Pain Away
“Many patients come to their doctor and say, ‘Doc, you need to take my pain away,’” says Teresa Dews, MD, vice chairwoman of the Cleveland Clinic’s Pain Management Department. “But I tell them that they are the ones who need to take their pain away — and that this starts with education and a holistic approach that involves looking at every area that they can improve for impact, including diet, stress reduction and exercise.”
Women May Be Hardwired to Feel More Pain Than Men
Hold on: We’re the ones who give birth and put up with sore breasts and painful periods every month. Actually, estrogen, the very hormone that allows ovulation, menstruation and pregnancy to occur, may be the culprit: “Many women report an increase in fibromyalgia-like pain before or during menstrual periods,” says Jianguo Cheng, MD, PhD, a professor of anesthesiology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. “Although the exact mechanism is still not clear, studies are under way to see if the estrogen receptor ER-beta, located in the spinal cord, or the increased levels of prolactin in the pain neurons might play a role in this pain magnification.” Men, meanwhile, may benefit from the hormone testosterone, which heightens their pain threshold.
Your Cultural Background Impacts Your Pain Threshold
“To some degree, our perception of pain is culturally learned,” says Riad Laham, MD, an anesthesiologist in the Cleveland Clinic’s Pain Management Department. “We are an indigenous society, and when it comes to pain there is certainly a learned psychosocial factor associated with how we react.” For example, Dr. Laham says that people in Japanese and Middle Eastern cultures tend to seek out treatment for pain-related conditions much more often than other cultures do, such as people of Irish or Scottish descent. As for biological differences among ethnicities that might account for this tendency, Dr. Laham says he’s not convinced. “For instance, often we see that second- and third-generation Japanese-Americans start to adapt and seek treatment for pain much less often than their first-generation counterparts,” he says. This isn’t to be confused with genetics, which docs now believe do factor into our pain experience.
Docs May Soon Be Able to Measure Genetic Predispositions to Pain
In the future, pain specialists hope to be able to better pinpoint who’s more likely to suffer pain and how. “The next wave in pain medicine is being more aware of genetic variability of pain and being able to measure that genetic predisposition and make appropriate recommendations on how to prevent and treat the pain that are more personalized to the patient,” says Dr. Dews.
Pasta, Bagels and Cookies Could Be Fueling Your Pain
Doughnuts, butter and white pasta might taste good, but you already know they’re no good for your waistline. Turns out saturated fats, trans fats, simple sugars and white flour can also set off a complex series of biochemical and hormonal processes that up your pain quotient. Left unchecked, these changes can lead to inflammation that can run rampant through your body, as well as arthritis (an inflammation of your joints), low back pain, and possibly the kind of allover pain that fibromyalgia sufferers report. “Nourishing your body with foods that reduce inflammation can really help you feel better much sooner,” says Amy Jamieson-Petonic, RD, director of wellness coaching at the Cleveland Clinic. Want to know more about which foods can help you fight inflammation? Check out the Cleveland Clinic’s Mediterranean-style food program, GO! Foods for You, which can help you lose unwanted pounds too.
Pain Can Be Your Ally
Instead of cursing and lamenting that achy tooth, out-of-whack back or searing sore throat, try reframing (and notice how the pain lessens in intensity too): “Remind yourself that acute pain is the body trying to talk to us,” says Ehrman. When your body sends out that personal SOS distress signal called pain, it’s saying (or perhaps screaming), ‘Hellooooo. We could use some help in here!’ A round of antibiotics to treat the strep bacteria that have invaded your throat, minor surgery to repair a decaying tooth, or a stress-relieving time-out to help your back might be just what your body ordered. Ehrman says that the real problems creep in when we refuse to listen: “We like to think that we’re Wonder Woman, but we wind up having to first trip over our cape and choke ourselves before it occurs to us that, you know what, maybe I should take it easy and listen to what my body has to say.”
Pain Can Be Your Enemy
Acute pain can be as benign as the awful five-second ouch from a stubbed toe or as deadly serious as the crushing chest pain of a heart attack. With acute pain, the pain is typically short-lived and usually easily pinpointed and treated, if necessary. However, causes of chronic pain are not always easily solved and the pain can recur often. For example, Rheumatoid arthritis (RA), an autoimmune conditon that causes the body’s immune system to attack its own body tissue, can cause tenderness, stiffness and swelling in the small joints, especially in the hands and feet. RA affects about 1.3 million people in the U.S. and is two to three times more common in women, who tend to develop the conditon in middle age. Causes of chronic pain can also be unknown or stem from mental health conditions, such as clinical depression.
Head Pain Can Start in Your Pelvis
Pelvic distortion isn’t a term that we hear about all that much, but William Welches, DO, PhD, an osteopath in the Cleveland Clinic’s Pain Management Department, says he sees a whole lot of women between ages 20 and 50 with the condition. For any number of reasons, including childbirth, a fall or being rear-ended in a car accident, the pelvis gets out of alignment. The structural misalignment that starts in the pelvis, then extends to the hips and, left unchecked, eventually throws off the whole body, including the spine, neck and head — hence the headache. Women who suffer from pelvic distortion might not notice that they are out of alignment until they get headaches. Painful sex, urinary tract infections, and infrequent and painful bowel movements are also markers for the condition. Dr. Welches uses spinal manipulation to treat the condition.
Pain Relievers Don’t Work on Fibromyalgia Pain
When your body is aching all over, your first instinct might be to reach for a common pain reliever like ibuprofen. But if you’re suffering from fibromyalgia, a condition that affects an estimated 5 million Americans, 80 to 90 percent of them women, a nonsteroidal anti-inflammatory drug (NSAID) isn’t going to help. “Fibromyalgia sufferers don’t respond to traditional pain relievers like NSAIDs because their bodies lack the enzyme to metabolize them,” says Dr. Dews. Meds that have shown promise for treating fibromyalgia: Savella, which is in a class of drugs known as selective serotonin and norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs) like Cymbalta and Lyrica. Improving the levels of these hormones appears to diminish overall pain. “In addition to medication, diet and exercise must be part of the regimen when treating fibromyalgia,” says Dr. Laham. “Doing one without the other doesn’t work.”
Acupuncture for Pain Relief
This ancient healing technique from China entails having a practitioner gently insert a series of fine needles into various meridians along the body to help stimulate the flow of chi (pronounced “chee”). “The belief is that when chi, or energy, is stagnant there can be dysfunction downstream, which can include pain,” says Tanya Edwards, MD, a family physician who practices at the Cleveland Clinic’s Independence Family Health Center and the Center for Integrative Medicine. Acupuncture increases blood flow and circulation and is believed to release morphine-like endogenous endorphins, as well as the feel-good hormone serotonin. Dr. Edwards says acupuncture appears to have a cumulative effect on treating conditions like headache and back pain. “You might start with one treatment every three to four days, then every seven to 10 or 14 days, then once a month, and eventually once a quarter,” she says. Pain conditions that can benefit from acupuncture: back pain, migraine, tension headache, menopausal headache, neck disorders, fibromyalgia and rheumatoid arthritis.
Magnesium for Pain Relief
Magnesium is vital to normal functioning of your nerves and helps muscle tissue repair itself. When our diet doesn’t include enough magnesium-rich foods, such as leafy greens and pumpkin seeds, we can become magnesium-deficient, an issue for many Americans. “As a result of this magnesium deficiency, we can develop muscle and joint pain and also become hypersensitive to pain,” says Dr. Edwards. Since the average multivitamin has only 5 to 10 percent of your total magnesium requirements for the day, look to an individual supplement to make up the rest. “I tell people to start out taking between 400 and 1,000 mg. If your stools become too loose, cut back the amount until they normalize.” Magnesium supplements should be avoided if you have any abnormal kidney function. Pain conditions that can benefit from magnesium supplements include: headache, migraine, muscle pain and joint pain.
Massage for Pain Relief
We know massage feels good, but here’s why it’s so good for chronic pain conditions. Toxins, such as pain-causing lactic acid, can build up in your muscles; when the muscles are stimulated by massage, this forces the toxins out into the bloodstream so your body can rid itself of them, says Dr. Edwards. At the same time, massage helps bring oxygen- and nutrient-rich blood to muscles and tissues and stimulate the release of the mood-boosting hormone serotonin. Pain-related conditions eased by massage: fibromyalgia, arthritis conditions, headache, back strain and repetitive motion disorders (carpal tunnel syndrome).
Omega-3 Fatty Acids for Pain Relief
Inflammation hurts — everything from the kind that results when you smash your pinkie toe into the corner of the coffee table to the type associated with rheumatoid arthritis. Chronic inflammation — which can result from things like chronic stress and a diet high in saturated fats, trans fats, simple sugars and white flour — can worsen already existing chronic-pain conditions, such as back pain and arthritis. Make sure your diet includes omega-3-rich foods like tuna, salmon, sardines and walnuts, which can help fight inflammation. You can also cover yourself with a daily omega-3 DHA fish oil supplement. Pain conditions eased by omega-3s: back pain and arthritis.
Exercise for Pain Relief
Got pain? Get moving! When we move our bodies, we release endorphin-boosting hormones, such as serotonin, which improves mood and diminishes pain. Meanwhile, exercise increases blood flow to vital organs, muscles, joints and tendons and can further reduce pain. The best all-around exercise that is literally at your feet? Walking. In addition to reducing pain, a regular walking routine can add years to your life, help you lose weight, boost your mood, improve sleep, lower your risk of heart disease and cancer, and keep your bones and brain healthy! For optimum benefits, Cleveland Clinic docs recommend 10,000 steps a day. Pain conditions eased by exercise: fibromyalgia, back pain, rheumatoid arthritis, osteoarthritis and premenstrual syndrome.
Pain Relievers
When it comes to treating chronic pain conditions, docs are relying more on medications traditionally used to treat conditions like depression and anxiety. Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) show lots of promise in treating patients with fibromyalgia. And the COX-2 inhibitors that were regularly prescribed to treat conditions including rheumatoid arthritis received a great deal of negative press in 2004 due to their potential to cause vascular problems, but they are now being revisited. “The truth is that these [vascular] problems occur in just a fraciton of patients and that the benefits of COX-2 inhibitors for people in chronic pain may well outweigh their risks,” says Dr. Stanton-Hicks. Celebrex is currently the only COX-2 inhibitor available in the U.S.
Vitamin D for Pain Relief
“I’ve found vitamin D to be hugely instrumental in helping my patients with pain relief,” says Dr. Edwards. She says her patients with fibromyalgia often have very low levels of vitamin D. “Once they start on a vitamin D supplementation regimen, the pain often significantly diminishes or goes away,” she says. (Vitamin D is also crucial to the absorption of magnesium, a mineral that can reduce pain.) According to the June 2009 issue of The Israel Medical Association Journal, several reports indicate that vitamin D may have a role in chronic widespread pain syndromes. Yet it’s still not known how or if vitamin D deficiency is related to pain or how vitamin D may, if at all, prevent pain. A simple blood test can measure your vitamin D levels. Talk to your doctor about how much vitamin D you should be getting. Pain conditions eased by vitamin D: There are no specific conditions vitamin D is indicated for, but supplementing if you’re D-deficient appears to improve pain-related conditions.
Yoga for Pain Relief
When you’re in pain — especially your back — yoga may be your ticket to pain relief. A study from the May 2001 journal Clinical Rheumatology reported that after reviewing seven randomized clinical trials involving participants doing yoga to treat low back pain (the number-one reported pain condition in the U.S.), researchers concluded that in five of the seven trials, yoga led to a significantly greater reduction in low back pain when compared to education, conventional therapeutic exercises or typical care. The other two trials showed no significant difference. None of them showed a downside, so get busy with your downward dogs, but consider seeking out therapeutic, restorative or chair yoga to start. Yoga’s gentle stretching and movement helps increase blood flow and strengthen muscles, including your core, all of which help heal and strengthen the back. “Yoga also equips you with basic tools, such as mindfulness of the breath and relaxation,” says Judi Bar, lead yoga therapist of the Lifestyle 180 Program at the Cleveland Clinic’s Wellness Institute. “Once there is consistent breath practice, the mind-body connection allows you to employ these tools anytime to help control and treat the pain that one can experience with back issues or chronic disease.” Pain conditions eased by yoga: chemotherapy-related pain, fibromyalgia, back pain, rheumatoid arthritis, osteoarthritis and headache.

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