October 29, 2018
Pain Management: Is Medication Really the Only Option?
When pain happens, the first reaction is often a script for medication. Sometimes this can be very necessary too – after all, people have daily lives to get on with!
But while medication can bring temporary relief, what about in the longer term? If a person’s pain is ongoing, what is known about non-drug treatments and how they work for chronic pain?
Pain and its causes and effects
Pain can occur in just about any area of the body, and may be dull or sharp, acute or chronic. Causes may include illnesses, surgery, tissue damage or injuries.
Pain can lead to stress, distress, anxiety and ongoing fatigue, as well as increases in heart rate, blood pressure and cortisol levels.
Drug treatments for pain
The types of drugs used to treat pain include paracetamol, aspirin, anti-inflammatories, anaesthesia, and opioids such as morphine. Drug treatments work by altering brain chemistry and the pain messages that the brain receives.
However, medications can have side-effects, and sometimes may even be addictive. In addition, if a pain-sufferer becomes sedated from high-dose medications they might struggle to perform in their day-to-day lives. Drug treatments for pain can also lose their effectiveness over time once the body becomes accustomed to them and develops a kind of resistance.
This means that in cases of chronic pain, it may be necessary to balance medications with other treatments, to avoid an over-dependence on drugs.
Non-drug treatments for pain
These include the following:
- Heat treatment – reduces pain through blood vessel dilation.
- Cold treatment – works by narrowing the blood vessels, reducing inflammation, and numbing the pain.
- TENS (Transcutaneous Electrical Nerve Stimulation) – involves applying electrical stimulation to the skin to bring about a pain-relief response from the body.
- Massage – massage promotes mental and muscle relaxation and aids in recovery. It can be used to treat a range of conditions, including soft-tissue injuries and chronic back pain.
- Mindfulness meditation – promotes relaxation and focus, helping to reduce both emotional and physical pain.
- Psychological and behavioural therapies – these treatments can assist pain sufferers change the way they think about their pain.
- Exercise – can be used to treat a range of conditions as well as improve mood, wellbeing and fitness, and prevent muscle spasms. The best exercises for an individual pain-sufferer will depend on the situation. Examples include stretching, aerobics, Pilates, yoga, strength training and water exercises.
The science on exercise
A review in the British Journal of Pharmacology asserts that exercise can act as a ‘psychoactive drug’ through its effect on brain function. One of the main effects is the production of endorphins (feel good hormones) – which are known to alter pain perception, improve mood, promote quality sleep, and reduce the consequences of stress exposure.
According to a Harvard Health report, exercise is the ‘secret’ to the relief of joint pain acquired from old injuries, osteoarthritis, and repetitive strain. The report shows that limiting movement due to pain can weaken muscles and make the problem worse, and that regular exercise can be used to ‘tame’ physical pain.
So what does this mean?
In many cases, a combination of treatments is what will work best for pain sufferers. These may include physical therapies, medications, exercise and psychological therapy. It’s important that a professional is consulted to design a program that is tailored for the individual case.
Meta: Can exercise help alleviate chronic pain? Our latest article explores non-drug treatments to manage ongoing pain.
While a person suffering from pain may struggle to cope with everyday life, high doses of medications can lead to sedation – which may not help! Our latest article explores a range of non-drug treatments which can help to relieve pain and reduce dependence on medications.
A Vicious Cycle: How Depression and Chronic Pain Are Linked
Injury and chronic pain can change a life so dramatically that it can lead to major depression and all that goes with it.
There is even evidence of this link going back to the 1500s, when King Henry VIII, a seemingly happy and healthy person for a large part of his life, suffered a major change in his moods after a near-fatal fall from a horse in his 40s.
After the accident, the king could no longer participate in his favourite sports. He also suffered from severe leg ulcers, chronic pain, overeating, obesity and melancholy – and it certainly seemed that no matter what they did, all the king’s men couldn’t put Henry back together again!
Now of course we know a lot more about depression and how it can be treated to improve a sufferer’s quality of life. There is also evidence to suggest that when a person suffers chronic pain, how they perceive and think about their pain can affect how well they manage it and recover.
So what is chronic pain?
A report in the Medical Journal of Australia (MJA) says that pain is considered chronic when it lasts for more than a month after expected tissue repair, or for three out of the previous six months.
An injury can lead to what is called nociceptive pain – where the nervous system is functioning normally, and a throbbing, aching or sharp pain occurs due to body tissue damage. This type of pain often responds well to analgesic and anti-inflammatory drug treatments.
Depression is a mental disorder that can be short or long term. Beyond Blue describes depression as ongoing low mood and loss of interest for more than two weeks. Signs of depression include chronic sadness, guilt, low self-worth, fatigue, change in appetite, feeling unwell, and weight gain or loss.
So how is chronic pain linked to depression?
People with chronic pain due to injury may also end up suffering from reduced activity, decreased life-enjoyment, loss of meaning, feelings of grief or helplessness, decreased self-worth, substance misuse, anxiety due to uncertainty about the future and various other psychological symptoms.
According to the MJA, an individual’s thoughts and behaviours can influence their response to chronic pain. For example, people who catastrophise or continually dwell on or magnify their pain tend to have a poorer response to treatments and greater disability than those who have pain, but don’t focus on it.
Depression can also reduce pain tolerance, seemingly making the pain worse and possibly leading to more depression. This means that, for some people at least, chronic pain and depression just keep on feeding each other!
How can this be assessed and managed?
One of the main things to consider when treating a person suffering from chronic pain is to give them an overall assessment – one that includes their mental as well as physical wellbeing.
Patients found to be suffering from depression may need psychological therapies such as cognitive behavioural therapy (CBT) to help them to change the way they think about and perceive their pain, and possibly anti-depressant medication treatment as well.
According to the MJA report, a multidisciplinary approach can enable a greater sense of control and reduce catastrophic thinking, which in turn can lead to a reduction in both physical pain and depressive symptoms.
Meta: Chronic pain and depression commonly occur together. Here’s why depression shouldn’t be overlooked as a critical factor in pain management.
LinkedIn: Research shows that depression in chronic pain sufferers can exacerbate pain and impede recovery. Taking a multidisciplinary approach is important to treat both physical and psychological symptoms in chronic pain sufferers.