By Margaret Caudill- Slosberg, M.D., Ph.D., M.P.H.

Chronic pain affects more than 50 million Americans.  It can be associated with chronic diseases such as rheumatoid arthritis, or defined as the presence of pain that persists a month or more beyond what is considered normal for recovery from an injury or illness.  Chronic pain can go on for years and it is important for the sufferer to learn skills to manage the pain. As a caregiver, you may experience chronic pain yourself, or you may have witnessed chronic pain in your loved ones.

What Causes Chronic Pain?

Arthritis, nerve damage, cancer, diabetic neuropathy, carpal tunnel syndrome, sciatica, shingles, phantom limb pain, and coronary artery disease are just some of the conditions associated with pain. Sometimes pain persists for reasons that aren’t clear. This sort of pain is thought to be related to a "broken" pain system and generally doesn’t respond well to medications normally used for acute pain.

Depending upon its severity, chronic pain can be devastating, especially if the person suffering has no confidence that she/he can control or manage it. Seeking medical advice about what’s causing the pain is the first step. Once a reversible cause has been eliminated, and serious possibilities like cancer or infection have been ruled out, you can begin to deal with the realities of your particular problem through a variety of techniques.

De-stressing

Be aware that holding one’s breath and increased tension can increase pain. Mini-relaxations can be helpful for frequent de-stressing throughout the day. Techniques include taking a deep, abdominal (diaphragmatic) breath and blowing out through pursed or unpursed lips slowly to the count of ten. Some healthcare professionals use the phrase, “smell the flowers, and blow out the candles,” to illustrate how we should inhale and exhale.

Repetitive Relaxation

Focusing on a word, phrase or your breath for 10 to 20 minutes, once or twice a day, preferably first thing in the morning or before you go to sleep, can be helpful in balancing the stress caused by chronic pain and/or illness. Relaxation tapes, prayers, or activities such as yoga, meditation or Tai Chi can help relax the mind and body. Visualization and hypnosis techniques may help decrease pain symptoms or assist with relaxation—a calming response that can be learned.

Create a Flare-up Plan

Chronic pain sufferers will have flare-ups, a worsening of their pain. Preparing for those flare-ups helps get through them.  

Writing down your detailed pain treatment plans or regimens for the "everyday" pain and the flare-up pain can instill confidence that you will get through them. Make the plan detailed, post it on the refrigerator or some other place in plain sight, and it will help you take back control. 

As an example, you could describe the following plans in detail:

• Medication: What medication and dose
• Call a friend: Who and their phone number
• Watch a movie: Which one and where to get it
• Stretch: Which exercises
• Lie down: Where, how long and what to do (take deep breaths, think happy thoughts)

Pacing Activities

People in chronic pain will need to find different ways of doing everyday activities.   A good example is a person with back pain who determines that standing increases pain after 15 minutes, and sitting for 20 minutes brings it back to baseline. They can then rearrange their daily activities to alternate standing for 15 minutes with sitting for 20 minutes.

Aerobic Exercise

Being in pain doesn't mean you should neglect overall health and well-being.
For people in pain, water exercises can be especially relaxing because you lose about 70 percent of gravity's effect in water. Since movement is so much easier in water, there's a tendency to exercise longer and harder. It's always best to start out low and slow, and make sure the person in pain is supervised.

Journaling

Writing can be very therapeutic. The narrative repair is a technique of writing about stressful or traumatic events. Research is beginning to uncover the powerful healing effects of putting words on paper.

The narrative repair brings coherence or meaning to a traumatic or life-changing experience. Bringing meaning to the pain experience can be an important step to healing or decreasing long-term disability.

Reference: Managing Pain Before It Manages You, Rev. Ed. 2002, Guilford Press, NY, NY.