Chronic pain is complex, and it can take a person some time to find the best pain relief methods that work for them. There are many options to try, such as hot and cold therapy, yoga, or drug treatments.
Chronic pain last months or years and happens in all parts of the body. It interferes with daily life and can lead to depression and anxiety. The first step in treatment is to find and treat the cause. When that isn’t possible, the most effective approach is a combination of medications, therapies and lifestyle changes.
Where do people have chronic pain?
Chronic pain can come in many different forms and appear across your body. Common types of chronic pain include:
Chronic pain may develop after an injury or due to a medical issue. Healthcare professionals define pain as chronic if it lasts longer than 3 months, or beyond the normal healing time for the underlying condition or injury.
Chronic pain can affect every part of a person’s life, from work and social life to sleep and mental health.
How is chronic pain diagnosed?
Pain is considered to be chronic if it lasts or comes and goes (recurs) for more than three months. Pain is usually a symptom, so your healthcare provider needs to determine what’s causing your pain, if possible. Pain is subjective — only the person experiencing it can identify and describe it — so it can be difficult for providers to determine the cause.
If you have long-lasting pain, see your healthcare provider. Your provider will want to know:
- Where your pain is.
- How intense it is, on a scale of 0 to 10.
- How often it occurs.
- How much it’s affecting your life and work.
- What makes it worse or better.
- Whether you have a lot of stress or anxiety in your life.
- Whether you’ve had any illnesses or surgeries.
What tests are used to diagnose chronic pain?
Your healthcare provider may physically examine your body and order tests to look for the cause of the pain. They may have you undergo the following tests:
- Blood tests.
- Electromyography to test muscle activity.
- Imaging tests, such as X-rays and MRI.
- Nerve conduction studies to see if your nerves are reacting properly.
- Reflex and balance tests.
- Spinal fluid tests.
- Urine tests.
10 ways to reduce pain
Whether your pain has just come on or you’ve lived with it for years, these tried-and-tested self-help steps can bring you relief.
Get some gentle exercise
Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain.
Activity also helps lessen pain by stretching stiff and tense muscles, ligaments and joints.
It’s natural to be hesitant if exercise is painful and you’re worried about doing more damage. But if you become more active gradually, it’s unlikely you’ll cause any damage or harm. The pain you feel when you start gentle exercise is because the muscles and joints are getting fitter.
In the long term, the benefits of exercise far outweigh any increase in pain.
Breathe right to ease pain
Concentrating on your breathing when you’re in pain can help.
When the pain is intense it’s very easy to start taking shallow, rapid breaths, which can make you feel dizzy, anxious or panicked. Instead, breathe slowly and deeply.
This will help you to feel more in control and keep you relaxed and prevent any muscle tension or anxiety from making your pain worse.
Talking therapies can help with pain
Pain can make you tired, anxious, depressed and grumpy. This can make the pain even worse, making you fall into a downward spiral. Be kind to yourself.
Living with pain is not easy and you can be your own worst enemy by being stubborn, not pacing your activities every day and not accepting your limitations.
Some people find it useful to get help from a psychologist or hypnotherapist to discover how to deal with their emotions in relation to their pain.
You can also find out more about talking therapies, also known as psychological therapies.
Shift your attention on to something else so the pain is not the only thing on your mind. Get stuck into an activity that you enjoy or find stimulating. Many hobbies, like photography, sewing or knitting, are possible even when your mobility is restricted.
Share your story about pain
It can help to talk to someone else who has experienced similar pain themselves and understands what you’re going through.
Pain Concern, Action on Pain and Versus Arthritis all have telephone helplines staffed by people with long-term pain, who can put you in touch with local patient support groups.
The sleep cure for pain
Many people with long-term pain find it difficult to sleep at night. But it’s important to try to stick to a normal sleep routine so you’ve got the best chance of sleeping through the night.
Sleep deprivation can also make pain worse. Go to bed at the same time each evening, and get up at a regular time in the morning and avoid taking naps in the day. If sleep problems persist, see a GP.
Keep in touch with friends and family
Do not let pain mean that you lose contact with people.
Keeping in touch with friends and family is good for your health and can help you feel much better. Try shorter visits, maybe more often, and if you cannot get out to visit people, phone a friend, invite a family member round for tea or have a chat with your neighbour.
Aim to talk about anything other than your pain, even if other people want to talk about it.
Relax to beat pain
Practising relaxation techniques regularly can help to reduce persistent pain.
There are many types of relaxation techniques, varying from breathing exercises to types of meditation.
Ask a GP for advice in the first instance. There may be classes available locally or at your local hospital’s pain clinic.
What are Physical Techniques ?
Various physical methods can help relieve pain, including physical therapy, hot and cold therapy, massage, and acupuncture.
Hot and cold therapy
Hot and cold therapy is a common and safe technique to reduce pain.
Heat can help relax the muscles and dilate the blood vessels. It can also promote healing after an injury.
Cold therapy reduces blood flow and reduces inflammation that causes pain. It often involves applying an ice pack wrapped in a towel to the skin.
Massage is a type of soft-tissue manipulation. People may benefit from this technique when used with other pain management treatments, such as physical therapy and pain medication.
The benefits of massage include:
- increased flexibility
- reduced inflammation
- improved posture
- improved circulation
- reduced stiffness
A 2007 review on massage found that it may be effective for lower back pain. However, there is mixed evidence from examining its benefits for other chronic pain types.
Physical therapy involves physical techniques to strengthen and stretch the muscles and joints. It can relieve pain throughout the body, while the specific methods will vary by body part.
Therapeutic exercise can have long-term benefits for chronic pain, including helping people cope.
Techniques may involve massage, exercise plans, and red light therapy.
Acupuncture involves a practitioner applying thin needles to the skin at precise points in the body.
According to the National Center for Complementary and Integrative HealthTrusted Source, evidence suggests this technique could help people manage certain pain conditions.
This includes short-term relief from pain in the lower back, neck, knee, and osteoarthritis. However, there is little evidence to suggest it is effective over the long term.
The proposed benefits of acupuncture are:
- pain relief
- reduced inflammation
- reduced muscle spasms
Acupuncture is generally safe when performed by trained practitioners using sterile needles.
What is Mind-body Techniques ?
Methods that combine psychology and the body can help many people manage chronic pain.
Cognitive behavior therapy
Psychological treatments for chronic pain include talking therapies, such as cognitive behavioral therapy (CBT).
Psychological treatments aim to reduce the negative impact that chronic pain can have on a person’s mental health.
A 2013 review on the effectiveness of psychological pain management techniques concludes that CBT is effective at reducing pain immediately after treatment compared with using no strategies.
The review also found that there was no evidence that CBT can reduce long-term pain. However, the technique was useful for reducing anxiety around pain and for improving quality of life.
Yoga aims to relax, strengthen, and keep the body flexible through stretching, with specific poses focusing on particular body areas.
A 2010 study into yoga’s effects on chronic pain found that it did not decrease participants’ pain, but it did help them cope, and they were more in control of how their pain affected their everyday life.
However, other studies have found yoga to be effective in reducing pain.
Yoga is a safe and accessible pain management technique that people can try at home, using online videos, or in a class with an instructor.
Tai chi is an exercise therapy involving slow, continuous, fluid body movements combined with breathing and relaxation techniques. The method is also gentle on the joints and muscles.
Tai chi can improve strength and joint stability, and the concentration it requires can improve a person’s mood.
What is Relaxation Techniques ?
Dealing with chronic pain can be stressful for many reasons, such as not feeling in control regarding a person’s discomfort.
Relaxation techniques can help ease muscle tension, muscle spasms, aches, and pains. They can also release endorphins, which are the body’s natural painkillers.
A person can help reduce stress through relaxation, which can ease some of the burden of chronic pain while promoting better sleep.
Relaxation methods for chronic pain include:
- Deep breathing techniques: Slow and relaxed breathing methods, such as box breathing, help relieve tension.
- Progressive muscle relaxation: Involves tensing and relaxing each muscle group in turn, for 10 seconds each, from the head to the toes. Focus on breathing and avoid muscles that feel painful.
- Thinking calmly: Spend 5 minutes imagining a calming scene, such as a sunny afternoon in nature, surrounded by green trees and birdsong.
- Calming activities: Set aside time for relaxing activities such as having a warm bath, reading a book, or crafting.
What is Medication Therapies?
There is a wide range of medications to relieve pain. Each class and type of drug work differently, while some may be more suitable for certain people than others.
Acetaminophen helps many kinds of chronic pain. One brand name is Tylenol. It is also found in many over-the-counter and prescription pain medicines. If you’re not careful, you could take more acetaminophen than is good for you. Too much acetaminophen can cause liver damage, especially if you drink alcohol. Tell your doctor if you have to take more than 2 acetaminophen pills a day.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that reduce inflammation and pain. They are available in capsules, tablets, or as creams or gels for the skin.
However, NSAIDs may cause issues with the stomach and the cardiovascular system in some people. Talk with a doctor before beginning treatment with NSAIDs.
Opioids can treat moderate-to-severe pain and are generally only appropriate for short periods, as they can be addictive.
CDC guidelines recommend people should only use opioids when the benefits outweigh the risks.
There is a lack of evidence that this treatment works for chronic pain, as people typically use opioids for short periods.
Some antidepressants, such as amitriptyline, can help with pain relief.
Amitriptyline is an antidepressant that, at lower doses, people also use for chronic pain, such as diabetic neuropathy and fibromyalgia.
It can take 2–4 weeks for a person to feel the effects of the medication.
Side effects of amitriptyline can include:
- dry mouth
Your doctor may want you to try an anticonvulsant medicine. It may help reduce some types of chronic pain, such as low back pain. Examples of anticonvulsants are:
- gabapentin (Neurontin)
- carbamazepine (Tegretol)
- phenytoin (Dilantin)
- pregabalin (Lyrica)
- topiramate (Topamax)
Like antidepressants, your doctor may start you on a low dose of anticonvulsants. This helps prevent or reduce side effects. The doctor may increase the amount over time. Contact your doctor right away if you have suicidal thoughts. Minor side effects may include:
- nausea or vomiting
- loss of appetite
- weight gain
- itching or swelling
Medications for epilepsy interrupt pain messages to the brain.
Types include gabapentin (Gabarone®) and pregabalin (Lyrica®).
These medicines can ease nerve pain and fibromyalgia.
Healthcare providers in the United States can currently prescribe the following antispasmodic skeletal muscle relaxants:
- Carisoprodol (Soma®, Vanadom®).
- Chlorzoxazone (Lorzone®, Parafon Forte DSC®, Relax-DS®, Remular S®).
- Cyclobenzaprine (Fexmid®, Flexeril®).
- Metaxalone (Metaxall®, Skelaxin®).
- Methocarbamol (Robaxin®).
- Orphenadrine (Norflex®).
Antispastic skeletal muscle relaxants that providers can currently prescribe in the U.S. include:
Two skeletal muscle relaxants have both antispastic and antispasmodic effects. They include:
- Tizanidine (Zanaflex®).
- Diazepam (Valium®).
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Beta-blockers slow down the heart and stop hormones, such as adrenaline, from working. Some people use them to treat migraines.
A study shows that beta-blockers at low doses can temporarily improve chronic pain in females with fibromyalgia and temporomandibular syndrome.
However, beta-blockers may not be suitable for everyone. Consult with a doctor before using them for chronic pain.
Medicinal cannabis and cannabidiol (CBD) are increasingly common pain treatments.
In addition, cannabis for medicinal purposes may not be legal everywhere. High doses can trigger side effects, so it is best to check with a health professional before using cannabis CBD for pain relief.
Sedatives to help with anxiety or insomnia
Trigger Point Injections
Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. During this procedure, a healthcare professional, using a small needle, injects a local anesthetic that sometimes includes a steroid into a trigger point (sterile salt water is sometimes injected). With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief.
Trigger point injection is used to treat muscle pain in the arms, legs, lower back, and neck. In addition, this approach has been used to treat fibromyalgia, tension headaches, and myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment.
Onabotulinumtoxina (Botox) is a toxin that blocks signals from the nerves to the muscles. It can also be injected to alleviate chronic migraine headaches. The procedure involves multiple injections around the head and neck every 12 weeks and may alleviate pain for up to three months.
When standard medicines and physical therapy fail to offer adequate pain relief, you may be a candidate for a surgical implant to help you control pain. When they are used, which is rare, there are two main types of implants to control pain:
- Intrathecal Drug Delivery. Also called infusion pain pumps or spinal drug delivery systems. The surgeon makes a pocket under the skin that’s large enough to hold a medicine pump. The pump is usually about one inch thick and three inches wide. The surgeon also inserts a catheter, which carries pain medicine from the pump to the intrathecal space around the spinal cord. The implants deliver medicines such as morphine or a muscle relaxant directly to the spinal cord, where pain signals travel. For this reason, intrathecal drug delivery can provide significant pain control with a fraction of the dose that would be required with pills. In addition, the system can cause fewer side effects than oral medications because less medicine is required to control pain.
- Spinal Cord Stimulation Implants. In spinal cord stimulation, low-level electrical signals are transmitted to the spinal cord or to specific nerves to block pain signals from reaching the brain. This method being especially used for back and limb pain. In this procedure, a device that delivers the electrical signals is surgically implanted in the body. A remote control is used by the patient to turn the current off and on or to adjust the intensity of the signals. Some devices cause what’s described as a pleasant, tingling sensation while others do not.
Two kinds of spinal cord stimulation systems are available. Partial and totally implanted units. The unit that is more commonly used is fully implanted. The latter system’s antenna and transmitter are carried outside the body, while the receiver is implanted inside the body
Transcutaneous electrical nerve stimulation therapy, more commonly referred to as TENS, uses electrical stimulation to diminish pain. During the procedure, low-voltage electrical current is delivered through electrodes that are placed on the skin near the source of pain. The electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that “scramble” normal pain signals. TENS is not painful and may be effective therapy to mask pain such as diabetic neuropathy. However, TENS for chronic low back pain is not effective and cannot be recommended, says the American Academy of Neurology (AAN).
Bioelectric therapy relieves pain by blocking pain messages to the brain. Bioelectric therapy also prompts the body to produce chemicals called endorphins (endorphins are also released by exercise) that decrease or eliminate painful sensations by blocking the message of pain from being delivered to the brain.
Bioelectric therapy can be used to treat many chronic and acute conditions causing pain, such as back pain, muscle pain, headaches and migraines, arthritis, TMJ disorder, diabetic neuropathy, and scleroderma.
Bioelectric therapy is effective in providing temporary pain control, but it should be used as part of a total pain management program. When used along with conventional pain-relieving medications, bioelectric treatment may allow pain sufferers to reduce their dose of some pain relievers by up to 50%.
When you are in pain, you may have feelings of anger, sadness, hopelessness, and/or despair. Pain can alter your personality, disrupt your sleep, and interfere with your work and relationships. In turn, depression and anxiety, lack of sleep, and feelings of stress can all make pain worse. Psychological treatment provides safe, nondrug methods that can treat your pain directly by reducing high levels of physiological stress that often aggravate pain. Psychological treatment also helps improve the indirect consequences of pain by helping you learn how to cope with the many problems associated with pain.
A large part of psychological treatment for pain is education, helping patients acquire skills to manage a very difficult problem.
In the past decade, many people have found relief for their pain in mind-body therapies, acupuncture, and some nutritional supplements. Others use massage, chiropractic and osteopathic (bone) manipulation therapies, therapeutic touch, certain herbal therapies, and dietary approaches to alleviate pain. However, there is little if any scientific evidence supporting these therapies for pain relief.
Therapeutic Touch and Reiki Healing
Therapeutic touch and reiki healing are thought to help activate the self-healing processes of an individual and therefore reduce pain. Although these so-called “energy-based” techniques do not require actual physical contact, they do involve close physical proximity between practitioner and patient.
In the past few years, several reviews evaluated published studies on the efficacy of these healing approaches to ease pain and anxiety and improve health. Although several studies showed beneficial effects with no significant adverse side effects, the limitations of some of these studies make it difficult to draw definitive conclusions. Further studies are needed before these approaches for pain treatment can be recommended.
Dietary supplements, such as fish oils and SAMe, also show some evidence of benefit, although more research is needed.
It has been difficult to draw conclusions about the effectiveness of herbs, though there are a few, such as white willow bark, devil’s claw, cat’s claw, ginger, and turmeric, that have some evidence supporting their use. If you decide to use herbal preparations to better manage your pain, tell your doctor: Some herbs may interact with drugs you are receiving for pain or other conditions and may harm your health.
Dietary Approaches to Treating Pain
Some people believe that changing dietary fat intake and/or eating plant foods that contain anti-inflammatory agents can help ease pain by limiting inflammation.
A mostly raw vegetarian diet was found helpful for some people with fibromyalgia, but this study was not methodologically strong. One study of women with premenstrual symptoms suggested that a low-fat vegetarian diet was associated with decreased pain intensity and duration. Weight loss achieved by a combination of dietary changes and increased physical activity has been shown to be helpful for people suffering from osteoarthritis.
Still, further research is needed to determine the effectiveness of dietary modifications as a pain treatment.