CHRONIC PAIN

What is Chronic Pain?

“Chronic pain” means pain that has lasted for a long time, longer than 3 months. It persists even though the initial injury has healed. There are many causes for chronic pain and some of them are very complicated. With chronic pain, it is important to remember that ‘hurt’ does not necessarily mean ‘harm’.

Please take the time to watch these videos below:

Expectations – Can Chronic Pain be Improved?

You are in charge of setting your goals for managing chronic pain.

And feeling better with chronic pain is entirely up to YOU and your self-management. Doctors and physiotherapists can help, but the main work is up to you.

With chronic pain, even if your pain does not 100% resolve, there are ways to help so that you can get back to enjoying and living your life!

Examples of realistic goals may be something like:

Moving Better
Being able to do daily activities.
Getting back to activities or hobbies you enjoy.
Improving your pain level by 30%.

TREATMENT – WHAT CAN YOU DO TO FEEL BETTER?

PHYSICAL ACTIVITY

is the absolute most important and most effective way to improve chronic pain.

Physical activity does not necessarily mean vigorous athletic sports. It can be whatever types of activity you enjoy and are able to do.

The key is to simply get moving.

Do not torture yourself by pushing too hard. Simply get moving as much as tolerable. With time, you will find that pain will gradually improve and so will your abilities.

NOTE: there is big a difference between “PAIN” versus “HARM”.

Just because something hurts does not mean you are causing more harm or injury by getting moving.

Think of it as ‘shaking the rust off some rusty joints’ and getting things moving again.

TREATMENT GUIDELINES:

The following summary is from the PEER Simplified Chronic Pain Guideline:

Guideline Summary

2-page summary of side effects, costs, etc.

Full Article

Full 12-page article of the chronic pain guidelines

NOTES:

Physical Activity is the most important for arthritis and chronic low back pain.
“Intra-articular corticosteroids” refers to joint injections (also referred to as “cortisone shots“).
“SNRIs” refers to a medication called Cymbalta (aka “duloxetine“).
“Oral NSAIDs” means anti-inflammatories like naproxen or ibuprofen.
“Topical NSAIDs” refers to cream or gel anti-inflammatories like over-the-counter Voltaren gel.
“TCAs” refers to a type medication like amitriptyline or nortriptyline.
“Gabapentinoids” refers to medications like Gabapentin or Lyrica.
“Acetaminophen” is the same as Tylenol.

Pain Treatment Calculator Tool

This calculator is a tool that shows the potential benefits and possible harms associated with different treatments for pain. Additionally, it highlights key things to consider when choosing treatment, including the most common side effects or cost.

CLICK HERE

Exercise, Stretching, and Physical Activity:

See a formal physiotherapist, massage therapist, or chiropractor.
Choose activities that you find fun and can stick with.
Start slow, and gradually increase your activity as tolerated.
Consider yoga! (you do not have to be a super flexible. Anyone can do yoga. There are even lots of free YouTube videos).

Dr. Furlan Videos

An entire playlist of videos on exercises for chronic pain by Dr. Andrea Furlan.

Gentle Movement Videos

An entire playlist of videos on gentle movements and relaxation.

Pain & Exercise Handout

A short handout explaining how much to exercise with chronic pain.

Mindfulness & Meditation:

Mindfulness and relaxation can be key in improving chronic pain.

What is Mindfulness?

Try the Calm App

Calm is one of the most popular smartphone apps for Mindfulness.

2 “MUST READ” Books:

(1) “The Mindfulness Solution to Pain” by Dr. Jackie Gardner-Nix

(2) “Managing Pain Before it Manages You” by Dr. Margaret Caudill

Medication Options:

Medications can help chronic pain, but medications alone will not be able to cure your chronic pain.

Too often, patients are in search of a perfect medication or dose that will work magically to cure their chronic pain. Unfortunately, this is not possible.

It is crucial to follow all of the other advice on this page, and not just expect that medications alone will solve your pains.

SNRIs – like Cymbalta (aka “duloxetine“), has been proven to be one of the most most effective medications for treating chronic pain.

NSAIDs – this stands for “Non-Steroidal Anti-Inflammatory Drugs”, also known as “anti-inflammatory” medications. Examples include Naproxen and Ibuprofen (Advil or Motrin).

Voltaren gel – this is a type of anti-inflammatory gel that you rub on your skin. It is available over-the-counter.

Gabapentinoids – these are medications like Gabapentin or Lyrica. They can help take the edge off chronic pain.

TCAs – stands for “TriCyclic Acid” medications. They are “nerve pain” medications like Amitriptyline and Nortriptyline.

Acetaminophen – also known as Tylenol. Some people find it helps a bit and it’s generally very safe to take.

What about Opioids?

Opioids are strong pain medications like morphine, codeine, hydromorphone, oxycodone, and fentanyl. Even Tylenol #3s are opioids because they contain codeine.

Opioids used to be prescribed very commonly and generously for chronic pain.

HOWEVER, research now shows that opioids generally DO NOT PROVIDE ANY BENEFIT IN THE LONG TERM, AND ONLY CAUSE HARMS AND SIDE EFFECTS.

In fact, when opioids are taken long term, they actually end up causing patients to have MORE PAIN.

Also Remember:

Smoking Cessation – science and studies have proven that smoking causes people to feel more pain. Click here for more help and suggestions on quitting.

Be Social – People with chronic pain tend to avoid the fun activities they used to do. This only ends up worsening chronic pain. Remember, it’s important to get moving and be social. It is crucial to spend time with your family and friends doing the things you enjoy!

Avoid Alcohol and Drugs – Just like smoking, if you want to improve your pain, you should avoid alcohol and drugs. They only make things worse.

Sleep Well – Poor sleep worsens chronic pain. If you have trouble sleeping, click here for more information on sleep advice.

If you would like to dive further into other resources for Chronic Pain, please also explore this “Tame the Beast” website.