Beyond the Pill

As in many other countries around the world, 1 in 5 South Africans suffer from Chronic Pain – you are not alone! Researchers here in South Africa and around the world have found that there are many things you can do to reduce your pain and how it is affecting your life. Medication is useful for chronic pain management, but there are many other effective ways to reduce your pain and reclaim your life.

Step 1: Understand pain

Your body’s pain system is like a very sophisticated burglar alarm. The burglar alarm in a house or car only warns you once someone has broken into the house or car. The damage has already been done. The alarm system in your body is smarter than this, it tells you when someone suspicious is looking in the window! You’ve probably felt this when you have put your hand on something very hot – it HURTS! And you quickly pull your hand away. But, most of the time, you have pulled your hand away fast enough to avoid being burnt. The pain alarm system warns us that something is getting close to the danger point so that we have time to avoid damage. This means that pain is not a good way to tell whether or not there is damage, because it’s a warning, not a damage metre.

We refer to this pain alarm system as plastic, this means that it has the ability to change, to become less sensitive or more sensitive. It is useful for it to get more sensitive when we have an injury because then we look after the injured part. As we heal, the pain alarm system should return to being less sensitive again. In people who have chronic pain though, the pain alarm system gets very very sensitive. Now your pain alarm system is so sensitive that the alarm is going off, and you are feeling pain, when nothing dangerous is happening. This can be very difficult to live with, because not only is pain an unpleasant sensation and emotion, but it also interrupts our thinking and our mood and can make life quite miserable.

There is hope. Learning that your chronic pain is about an alarm system that has become too sensitive helps your brain start the process of reducing the sensitivity of the system. There is now so much scientific research showing that learning about pain reduces pain and suffering that all international guidelines for chronic pain state that we must make sure that people with chronic pain understand their pain. Some of the most important things to remember about pain are:

  • Hurt does not always mean harm. It is possible to have pain without injury or something being wrong.
  • There are physiological reasons why there is pain without injury.
  • Your pain is not imaginary, in your head or psychological.
  • Chronic pain is not a sign of ongoing damage in your body.
  • When the alarm system is over-sensitive, non-dangerous stimuli (e.g. stretching or pressure) may send signals which set off the pain alarm.
  • An increase in your pain (with or without exercise) does not mean a new injury.

Would you like to learn more about pain? Ask your health care professional to help you understand what has changed in your pain alarm system.

Step 2: Get active

One of the most important ways to reset your sensitive pain alarm system is by getting active, yes, you are in pain, but it is safe for you to start exercising.  Scientific Research tells us that EXERCISE is:

  1. SAFE and one of the best treatments for people living with chronic pain.
  2. VERY IMPORTANT to keep healthy and has a lot of good effects on:
  3. Nerves & Joints which are made flexible (well oiled) and less sensitive so you can move better with less pain.
  4. Muscles & Bones will build stronger tissue and old fluid which makes your nerves sensitive is pumped out of the tissues.
  5. Blood becomes thinner and your blood sugar stabilises, decreasing your risk of a stroke and diabetes.
  6. Heart & Lungs get stronger and are less likely to get diseased (eg. heart attacks)
  7. Immune System fights infections better so you get fewer colds and viruses.
  8. Endurance and Fatigue during the day improves – YES, exercising during the day makes you less tired AND YOU SLEEP better at night!
  9. Brain gets more oxygen and food, so your concentration and memory improve. The brain puts out more “happy hormones” so your mood improves.  It unlocks your brain’s own drug cabinet, so you feel less pain over time.  Your brain’s movement and sensation maps are improved so you move better and become more confident, courageous and in control of your life!

Exercise is medicine – so you need to think about the dosage when you start exercising. For people with chronic pain, it doesn’t matter what exercise you do, as long as you do it. It can be in a gym, in a park or in your bedroom. You can stretch, you can do aerobic exercise, or you can do strengthening exercise – it all makes a difference to the sensitive pain alarm. What is important is that you enjoy it and stick with it. Try to start with 20 minutes of moderate exercise two or three times a week. Research tells us this is enough to start making a difference to chronic pain. What is moderate? Well, if you can still talk but not sing while you are exercising, then you’ve got it right!

Steps to success with exercise:

  • Set a clear GOAL that is SMART (Specific, Measurable, Achievable, Realistic and Time-based)
  • Choose exercise or activity that you want to do and that is FUN!
  • Set a SPECIFIC TIME AND PLACE to do your exercise.
  • Decide how long you are going to stick to the plan before you think about changing it (6 to 8 weeks is a good time to work on things but set a goal for one week at a time)
  • Keep an EXERCISE DIARY to keep track of how you are doing.
  • START NOW – don’t wait! Begin gradually and proceed slowly.
  • REVISE YOUR PROGRAMME. At the end of the 6 – 8 weeks make a new plan for the next 6 weeks.
  • REWARD It is a reward to feel better and healthier but also give yourself a reward for achieving your goal, like eating a favourite meal, or visiting a friend or taking a walk somewhere special.
  • GET A BUDDY to join you and help you keep on track

Step 3: Manage Stress

Stress and pain are like terrible twins. When we feel our pain is out of control, we feel stressed. When we feel our stress is out of control, what happens to your pain? That’s right, it gets worse!

The most common reason why we feel stressed in our lives is a feeling of a lack of control. We tend to feel that things are stressful if we don’t have any control over them. We feel stressed about where we live if we don’t feel safe there – those who commit crimes against us are also out of our control. In the same way, we may feel stressed when we have a chronic illness like chronic pain or diabetes or high blood pressure. If you feel that your illness is out of your control and there is nothing you can do to affect it, this makes you feel stressed.

Stress is not always bad. We know that stress can be useful too. For many people if we feel some stress, we might feel under pressure to perform better. You might feel stressed because your family is coming to visit, but this stress makes you tidy up your home – a good effect of the stress.

Sometimes we wish for a “stress-free” life. But, we know that if there was no stress in our lives, if we did not have to do anything all day long, this would not be good for us either. If I lay in bed all day and did not do anything, my muscles would get weak, my joints would get stiff and I would become ill. We need some stress in our lives to keep us healthy. The important thing is to keep the amount of stress at a level that we feel we can manage. This is why we talk about stress management, not stress elimination!

So how can we manage stress in this stressful world we live in?

First it helps to take some time to write down and identify the things that are stressing you. Then, think about whether you can look at the problem in a different way, sometimes our thoughts and feelings make the situation feel worse than it is. Then, make a plan! Plan things over time carefully, make sure you have time to at least do some relaxation or exercise even when you are very busy. Do not leave things for the last minute. Get HELP from friends / people you trust, family and friends and support groups are a great way to decrease stress. And then get active. Not just with exercise but with other activities that are important to you and that you enjoy. This could be a hobby you haven’t done in a while, listening to music, calling a friend, or making something.

Finally, one of the best ways to manage stress is relaxation or mindfulness.  Relaxation and mindfulness can help us to concentrate, and it can help us to unwind. Relaxation is a very useful way to manage stress and some of the symptoms of chronic diseases such as pain.

Good times to practice relaxing are when:

  • You feel you are getting tense or irritable or you are worried
  • You feel you are in pain
  • You want to go to sleep

Relaxation and mindfulness help to calm down the nervous system – so it’s a good idea for people with chronic pain whose pain alarm system is too sensitive.

Just relaxing sounds easy, but many of us struggling to relax. There are many free apps and websites you can visit with guided relaxation tools. Why not search for some and try them out?

Step 4: Sleep!

If you don’t sleep well, what happens to your pain? And if your pain is severe, how easy is it to sleep? Paying attention to sleep is an important part of treating pain! If you are not sleeping well, the pain burglar alarm will get more and more sensitive.

We all need different and need different amounts of sleep. Some people only need 5 hours, whilst others need 8 – 10 hours of sleep a night. We have been learning how to fall asleep and sleep well since we were babies. If you do not sleep well, following these steps will help you to learn how to fall asleep and sleep well. Remember that like learning anything new, this will take time. It might take up to 3 months to learn to sleep well if you have been struggling with sleep for a while.

Suggestions for Improving Sleep

  1. Have a bedtime routine: try to go to bed at around the same time every night and always do the same things before getting into bed. A bedtime routine could be to lock the house, get undressed, wash your face, clean your teeth, get into bed and do a relaxation session.
  2. You can’t sleep because of worrying: write down your problems or the things that are worrying you, then write down the next step that you think could help sort out the problem. If you wake up during the night worrying about the problem, remind yourself that you’ve gone over it and you have a plan. If you wake up with a new worry, write down that problem to deal with in the morning. Practice your relaxation to take your mind off the worry. If you still can’t sleep, it may be better to get up and do something relaxing like reading, watching TV, listening to relaxing music or doing relaxation.
  3. Your bed and bedroom are for sleeping / relaxing: try not to use your bedroom during the day. Do not watch TV in bed. If you are not asleep within 30 minutes of going to bed, get up and do something else. Do not lie in bed and worry that you have not fallen asleep. This will only make you feel stressed and lessen the chance of falling asleep.
  4. Have a morning routine: get up at the same time every day, even if you don’t feel like it. Our bodies like to work on regular patterns to fall asleep and get up at the same time every day.
  5. Avoid drinks containing caffeine for at least 6 hours before going to sleep (drinks like coke, tea or coffee).
  6. Never use alcohol to help you sleep. It might make you feel relaxed at first, but once this wears off it is likely to make you feel jumpy and you are likely to wake up during the night.

Step 5: Get started

It doesn’t matter which step you start with to begin resetting your sensitive pain alarm system. Pick one of the steps listed, set a SMART goal and get started. These steps have been scientifically shown to reduce chronic pain and help people reclaim their lives. While your medication helps to turn the volume of the pain down, getting your life back takes action. Let’s go!

Professor Romy Parker
BSc(Phys); BSc(Med)(Hons)Ex.Sci(Phys); PG Dip (HPE); MSc(Pain); PhD(Psych)
Director: Pain Management Unit
Dept of Anaesthesia and Perioperative Medicine
University of Cape Town and Groote Schuur Hospital

This contribution was submitted by a key opinion leader and is not the intellectual property of Pharma Dynamics

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