COPING-Strategies for effective pain management

 

Practical strategies for managing pain

 


 

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On this page, practical strategies for managing pain are discussed, such as learning to relax, managing sleep, and the practical benefits of exercise.


learning to relax 

 

The ability to relax is absolutely essential in managing pain, as in essence - relaxation and pain are at opposite ends of the wellness spectrum.  

 

It is generally accepted that there is a direct relationship between pain and anxiety.  Anxiety can easily increase the severity and intensity of the levels of pain experienced, as well as also causing physical tension, which in itself can generate pain.  As a result, 'relaxation therapy' is among the most commonly prescribed psychological treatment methods for chronic pain sufferers. 

 

Although it can be very hard to relax when faced with chronic pain, with practice it becomes easier and more effective.  Being able to let go of tension can often produce a sense of wellbeing, which can reduce the level of pain intensity.  One easy and practical way to reduce levels of tension is by practicing deep breathing exercises.

In essence breathing is related to the body's panic alarm, and whenever air intake becomes slightly restricted, heightened levels of anxiety soon follow.  Heart rate and blood pressure subsequently increase, which if left unabated can lead to a state of extreme agitation or panic. Conversely if attention is paid to taking slow, deep controlled breaths, a calming effect will occur on the body.

Most people do not breathe effectively so that the body 'relaxes' with each breath.  It is normal for the body to draw in air from two areas of your lungs, however if a stressful situation exists, short gulps of air from the upper part of the lung are drawn in.  These short breaths stimulate the bodies 'fight or flight', adrenaline response, which increases the heart rate in preparation for any forthcoming stress.

Concentrated, slow and deep breathing from the diaphragm or abdominal area causes a lowering of the blood pressure and slows down the heart.  By making a conscious effort to breathe both from the upper then from the lower part of the lungs, a higher state of relaxation can be achieved. 

Deep breathing is part of a behavioral approach to treating chronic pain. Chronic pain sufferers must accept the fact that the pain has changed their life forever, and that they need to make personal changes along with it.  Denying these changes is counter productive and can easily result not only in more pain, but a lower quality of life for the sufferer and their family. 

 

The use of relaxation tapes has proved to be beneficial for chronic pain sufferers.  For details of how to purchase recommended Amazon.co.uk music, please click here.

 

Research as shown those practice relaxation exercises at least 5 times per week do show long-term benefit in both physical and psychological wellbeing.  Combining frequent use of relaxation techniques with other pain management strategies can allow chronic pain sufferers to gradually achieve reductions in the medication they take. 

 


Exercise  

Not too long ago, it was common practice for people with chronic pain to be told by medical staff to avoid physical activity because of the concern that it could damage joints, muscles and increase levels of discomfort.  Thankfully research has shown that exercise can actually help reduce pain and improve health.

When people become inactive, they lose muscle tone and strength, and subsequently their cardiovascular system works less efficiently.  This inactivity increases the risk factors of heart attack and stroke due to high blood pressure and high levels of cholesterol.

Exercise can have a beneficial effect on any structural problem in the body which is causing pain.  In cases of lower back pain, regular exercise and strength training can help build up the Erector spinae muscles, which will provide a natural brace for the back and therefore potentially reduce stress on bones and can contribute to pain reduction. 

 

Exercise can also have an effect on the actual experience of pain.  During physical activity the body releases endorphins that can block pain signals from reaching the brain. The more endorphins that are produced by the body, the less the need to rely on external forms of pain management, such as medications.  

Participating in a regular exercise programme can provide benefits of:

  • Increased levels of energy.
  • Potential improvement in the quality of sleep.
  • Weight loss and reduced stress on joints.
  • Potential increase in bone mass and the potential risk of injury.
  • Reduction in levels of stress.  

The key to achieving many of these benefits is to include flexibility, strengthening and aerobic (cardio-vascular) exercises into the regular exercise programme.

Flexibility. Flexibility exercises include simple stretching movements. Such exercises keep joints moving through their full range of motion.  They also prevent muscles from shortening and tightening, which can increase the risk of injury. 

Strengthening. Strength training helps in the development of stronger muscles. Stronger muscles make it easier to carry out life's daily activitiesStrength exercises also help to preserve and increase lean muscle mass, which helps to burn more calories and therefore is beneficial in weight loss and in reducing stress on joints.

Aerobic. Aerobic exercises works the heart, lungs and muscles, by increasing the heart rate, blood pressure and need for oxygen.  Such exercise helps the body work more efficiently and can reduce the risk of cardiovascular disease, including heart attack, high blood pressure and high cholesterol. Aerobic activity also increases stamina so that fatigue is lessened during daily activities.

 

 

If you decide to begin an exercise programme:- It is easy to do more harm than good by over exercising or by poorly exercising.  Join a reputable gym, which provides induction, exercise programmes and regular reviews.  

Before you get started

It would be a sensible precaution for any chronic pain sufferer to talk with their GP before starting any type of physical activity program. 

It is particularly important to see your GP if you:

  • Have high blood pressure
  • Have diabetes or heart, lung or kidney disease
  • Are a man age 40 years or older or a women age 50 or older and haven't had a recent physical examination
  • Have a family history of heart-related problems before age 55
  • Are unsure of your health status
  • Have previously experienced chest discomfort, shortness of breath, dizziness or loss of consciousness during exercise or strenuous activity

 

If you are starting an exercise programme, these tips may help:

  • Set simple and achievable goals.  People who can stay physically active for 6 months usually end up making exercise a regular habit.

  • Pace yourself. Initially, do a little bit at a time and then rest.  When you first start you may experience DOMS (delayed onset muscle soreness) from exercising muscles that are not used to exercise.  But after a few days muscle strength and joint flexibility improve and chronic pain may begin to lessen in severity. 

  • Add variety to prevent boredom.. For example, try alternating walking with swimming.  On days when the weather is pleasant, perform stretching exercises outside.

  • Exercise with others. Performing activities with people who have similar fitness levels can make exercise more rewarding and enjoyable. 

  • Be flexible. If you're especially busy on a certain day then adapt exercise to accommodate your schedule.

  • Track your progress. Record what you do each time you exercise, how long you do it and how you feel during and after exercising.  This can remind you that you're making progress. 

  • Reward yourself. Work on developing an internal reward that comes from feelings of accomplishment.  After each activity session, take 2 to 5 minutes to sit down, relax and savour the beneficial feelings that exercise provides.  

Reference- Edward Laskowski, M.D., a physical medicine and rehabilitation specialist and co-director of the Sports Medicine Center at Mayo Clinic, Rochester, Minn.


 

Problems with sleep are a common feature of chronic pain.

Often sleep problems or difficulties can be aided by using a diary to effectively ‘manage’ sleep.  Therefore a journal tool has been provided, which can be pasted and printed out.   This should be kept for 7 days.   However, to be effective this needs to be accurately completed, as this information can help in evaluating sleep habits and to begin to appreciate how they may be related to chronic pain.

Sleep journal - please paste and print in any word processor.

Did you consume any alcohol, caffeine or medication yesterday?  If so, what was it?  How much? and when did you take it? (Please note)  The later you consume alcohol or stimulants – the likelier you are to find your body over stimulated and less likely you are to sleep..............…......................

………………………………….........…………………………………………………………………...……..

 

Did you take a nap yesterday?  If so, how long did you spend asleep?  How long did it take for you to drop off? (Please note) The closer you nap to bedtime, the likelier nighttime sleep will be disturbed...………………………………….................………………………………………………………

………………………………………………………...........……………………………………………………

How many drinks did you have after 6pm (Please note)  The greater the volume, the more likely sleep will be disturbed!.……………………………………………………………………….................…..

 

How would you describe your mood yesterday and how well did you cope? (Please note)  There is a direct correlation between sleeping badly and depressive thoughts and feelings.....…..………...........

……………………………………………………………………………………………………..…..........…..

How long did it take you to fall asleep last night?…………………………………………….........………

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How long did it take to fall asleep last night? ………………………………………..................…………

……………………………………………………………………………………………..........……………….

 

How many times did you wake up during last night? ………………………………………....................

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For how many hours did you sleep last night overall? ………………………………………...................

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What time did you wake up this morning? ………………………………...............………………………

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How did you feel when you woke up this morning? …………………………………………...................

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There are several minor remedies which can potentially alleviate some problems relating to sleep.

  • Refrain from consuming alcohol, nicotine or caffeine after 2pm.
  • Try to use the bed solely for the purpose of sleep and sex.
  • Reduce fluid intake close to bedtime. 
  • Go to bed at the same time each night.
  • Get up in the morning at the same reasonable time in the morning.
  • Attempt to follow relaxation exercises and breathing exercises when you are in bed.
  • If you need to take a nap during the day, do so, but not so late that it might interfere with nighttime sleeping.