Chronic pain management and terminal illness

Chronic pain management

Quick links on this page:

• How might this affect me?
• What are the goals of chronic pain management?
• What causes me to be like this?
• What is your chronic pain like?
• Why is chronic pain control important?
• What help is available to me?
• Tips to help you manage pain
• Contacts

How might this affect me?

Chronic pain is difficult to define or describe. Generally, it means pain that does not respond to the usual forms of medical management, that is, it does not go away. Having pain that does not go away can create a number of problems. For example, simple movements seem more difficult and may make a person become less active. Sleep may be interrupted. A person may be less patient and may start running into problems at home, at work or both. A person may feel hopeless, depressed, frustrated or angry. All of these difficulties and others as well can be part of a chronic pain problem.

There are no easy answers for people with chronic pain. Coping with a chronic pain problem requires patience, hard work and a willingness to change how things are done. It also requires change and understanding on the part of the family, as well as the involvement of skilled health professionals.

What are the goals of chronic pain management?

• To provide education on chronic pain and disability management
• To increase activity level and help people remain active even though they have chronic pain
• To improve fitness level
• To improve mental health and well-being.

Individuals can achieve these goals by learning and implementing a variety of self-management strategies. These strategies do not take the pain away or cure the pain, but rather improve the patients' ability to manage pain levels and progressively improve activity levels at home and in the community.

What causes me to be like this?

Chronic pain can be caused by many things like an old injury or chronic illness. Chronic illnesses are ones that have no cure and may get worse over time, such as multiple sclerosis. Moving a body part over and over in the same way can also cause chronic pain. Often, chronic pain is caused by more than one problem. This makes it even harder to treat. And sometimes, there is no clear cause for chronic pain.

Chronic pain often falls into two groups.

• The first group of people have ongoing tissue damage like what happens with cancer, arthritis, or chronic diseases. Even typing at a keyboard in a bad position over time can cause damage and chronic pain
• The second group has no "new" tissue damage. This kind of chronic pain can happen from an old back injury that never goes away. Or, it may develop all of the sudden with no clear reason. With chronic pain, you may not want to move the painful part of your body at all. But, you may also have pain because you are not moving this body part.

What is your chronic pain like?

Caregivers want you to talk to them about your chronic pain. The more you can tell them about it the better. This may help them understand what causes it and how to treat it.

Keep a pain diary – Sometimes it may be easier to answer caregiver's questions by making a pain diary or book. A pain diary or journal will help you remember exactly what happened each day because it is all written down. A diary also helps track pain cycles. This will help you be more aware of when pain is bad and how to make it better. A diary answers caregiver's questions about your pain over time.

Caregivers will ask you to answer the following questions:

• Where does it hurt? Where does it not hurt? Does the pain move from one area to another?
• How would you rate the pain on a scale of 0 to 10? (0 is no pain, and 10 is the worst pain you ever had)
• How does the pain feel? Try to choose words that tell caregivers what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, or crushing? Or, is the pain stabbing, burning, dull, numb, or "pins-and-needles" feeling?
• When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?
• How often does the pain bother you and how long does it last?
• Does the pain affect your daily life? Can you still work in spite of the pain?
• Does the pain wake you from sleep?
• Do certain things or activities cause the pain to start or get worse like coughing or touching the area?
• Does the pain come before, during, or after meals?
• Does anything decrease the pain like changing positions, resting, medicines, or changing what you eat?
• Women: does your pain change during your menstrual cycle?

Why is chronic pain control important?

Chronic pain may affect many areas of your life. It can affect your appetite (ability or desire to eat), how well you sleep, your energy and your ability to do things. It can also affect your mood (how you feel about things) and your relationships with others. Chronic pain is complex, and sometimes it is hard to find its' cause. You may feel at times that it is impossible to get rid of your pain. This can cause a cycle of suffering, sleeplessness and sadness. If caregivers can help you control your pain, you will suffer less and enjoy your life more.

What help is available to me?

The best way to decrease chronic pain is to treat the cause of the pain. Almost all types of pain, including cancer pain, can be controlled. Successful pain management for chronic pain is more than just taking medicines. It may also include exercise, relaxation therapies and behaviour changes. Remember that there is no quick fix for chronic pain. Because chronic pain is complicated, it may be hard to get your pain to go away completely. But, it is possible to lower your pain level so you can live and be comfortable doing everyday things. Work with your caregiver to find the pain control treatments that are best for you.

• Specially trained caregivers and pain clinics are good ways to start working with really bad chronic pain. Sixty percent of patients who use pain clinic programmes are better 1 year after treatments. These programmes have many kinds of health caregivers who help with the physical (body), emotional (mind) and spiritual parts of chronic pain
• Always tell your caregiver if the pain gets worse. Ask your caregiver if you want more information on any of the following pain control treatments.

Medicines

• Anti-Anxiety Medicine – This medicine may be given to help you feel less nervous and relax. It may be given by IV, as an injection, or by mouth
• Anti-Depressants – This medicine is often given to decrease or to prevent the symptoms of severe depression. It can also be used to treat certain kinds of chronic nerve pain. It is given as an injection or by mouth
• Anti-Convulsant – This medicine is given to control seizures. It can also be used to treat certain kinds of chronic nerve pain and may help control your mood swings. It is given by IV, as an injection, or by mouth
• Muscle Relaxants – You may need medicine to help your muscles relax. This medicine can be given by IV, as an injection, or by mouth. Muscle relaxants can make you feel dizzy or weak. Call you caregiver if you need help getting out of bed
• Pain medicine – Affects the nervous system so you feel less pain. Your caregiver will tell you how much to take and how often. Take the medicine regularly as directed by your caregiver. Do not wait until the pain is too bad. The medicine may not work as well at controlling the pain if you wait too long to take it. Tell caregivers if the pain does not go away or comes back
• Steroids – Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling. There are many different reasons to take steroids. This medicine can help a lot but may also have side effects. Be sure you understand why you need steroids. Do not stop taking this medicine without your caregiver's OK. Stopping on your own can cause problems.

Other non-drug pain control treatments

• Acupuncture – Is based on the belief that life forces move through the body in specific paths. These paths are called meridians. With acupuncture, a needle is put into the meridian that runs to the area where you have pain. This needle blocks the meridian which stops or decreases the pain
• Aromatherapy – Is away of using good smells to help you relax and decrease pain. Candles, oil burners and massage oils are all ways that smells are used. Scientists are learning that good smells may change your mood and help you relax. It may also help your brain makes special chemicals called endorphins. Endorphins are a natural body chemical like morphine that decreases pain
• Biofeedback – Teaches your body to respond in a different way to the stress of being in pain. Teaching your body to relax helps make the pain less. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed. But, often you may not need any machines. Learn to take your pulse. Then take it while making your mind think about "slowing down" your pulse. This can work with breathing, temperature, and blood pressure too
• Breathing exercises – Are another physical way to help your body relax. Teaching your body to relax helps make the pain less. Breathing in and out very slowly is all you do. Women have used breathing exercise for many years to decrease the pain of childbirth. A fun way to practice breathing slowly is to blow soap bubbles. You know you are doing a good job when you get very large bubbles. Remember to practice when you are not having pain. This helps it work better when you are having pain
• Distraction – Teaches you to focus your attention on something other than pain. Try playing cards or games, watching TV, or taking a walk. You can also visit with friends, paint, pet animals, and write out your feelings. Using planned activities helps to manage the boredom that chronic pain and illness can cause. It may also cause you to relax and keep you from thinking about the pain
• Environment (your surroundings) – Being in a quiet place may make it easier for you to deal with the pain. Avoiding bright lights or loud noisy places can also help control your pain. Making sure your home is not too hot or too cold may also decrease pain
• Guided imagery – Teaches you to put pictures in your mind that will make the pain less intense. With guided imagery, you learn how to change the way your body senses and responds to pain. Imagine floating in the clouds or remembering favorite place. Guided imagery seems to especially help people with chronic lower back pain
• Heat and cold – Can help decrease pain. Some types of pain improve best using heat while other types of pain improve most with cold. Caregivers will tell you if hot and/or cold packs will help your pain. Also, remember that a long warm bath may help calm you and let your muscles relax. A cool shower on a very hot summer day may do the same thing
• Individual Therapy – This is a time for you to meet alone with your therapist. During this time you and your therapist may talk about how to cope with your chronic pain
• Family Therapy – These are times when your caregivers will meet with you and your family. Together, you will talk about how your family may help you cope with your chronic pain at home
• Physical therapy – Can be helpful with pain that was caused by not moving one part of your body. Stretching the muscles and making them stronger around the injured area can help the pain go away
• Laughter – It has been said that "10 minutes of belly laughter gives 2 hours of pain-free sleep!" Laughter helps you breath deeper and your stomach digest food. It lowers blood pressure and may cause your brain to make endorphins. Laughter can also help change your moods. It helps you relax and let go of stress, anger, fear, depression, and hopelessness. These are all parts of chronic pain
• Massage – Is often used to help a person become more relaxed. Have someone gently massage your back, shoulders, and neck. Massage can be even more effective if you also use guided imagery, breathing exercises or music
• Music – It does not matter whether you listen to it, sing, hum or play an instrument. Music increases blood flow to the brain and helps you take in more air. Scientists are learning that it increases energy and helps change your mood. Music also may cause your brain to make special chemicals like endorphins. Endorphins are a natural body chemical like morphine that decrease pain. People who use music often say it decreases their need of medicines for pain and anxiety
• Radiation – Can be used to decrease the size of a cancer tumor that is pressing on nerves and causing pain. Radiation can also help decrease bone pain
• Self-hypnosis – Is a way to change your level of awareness. This means that by focusing your attention you can move away from your pain. You make yourself open to suggestions like ignoring the pain or seeing the pain in a positive way. It is not known exactly how hypnosis helps pain. But, hypnosis can give long-lasting relief of pain without affecting your normal activities. Self-hypnosis gives you better control of your body. You may feel less hopeless and helpless because you are doing something to decrease the pain
• Surgery – May be done to stop chronic pain. Caregivers may do surgery to cut the nerves to the painful area. The goal of this surgery is to stop the pain without losing feeling or movement in the area. In some people the pain can come back after surgery or the pain may even be worse. For these reasons, surgery is usually not considered until all other pain control treatments have been tried
• TENS – Short for transcutaneous electrical nerve stimulation. A TENS unit is a portable, pocket-sized, battery-powered device which attaches to the skin. The TENS unit uses mild, safe electrical signals to help control pain
• Touch energy therapies – Come from very old beliefs that life forces or energy move through the body in specific paths. Touch therapies believe disease may cause these paths to become blocked. The therapies use touch to help unblock these paths, and allow the energy to flow normally. Making the paths unblocked may help you relax and decrease pain
• Spinal cord stimulation – Is a nerve stimulation technique that is similar to TENS. The difference is that in SCS an electrode (a metal wire) is put near the spinal cord during surgery. SCS also uses mild, safe electrical signals to help control pain.

Tips to help you manage pain

• Get started on an exercise programme – Talk to your caregiver before you start exercising. Together you can plan the best exercise programme for you. It is best to start slowly and do more as you get stronger. Exercising increases your flexibility (ability to bend and move) and strength. This improves overall fitness, decreases risk for further injuries, and helps control pain
• Set pain management goals and follow through on them – Pick your greatest pain problems and set goals to focus on each one
• Check your progress – Use a chart or log to mark your progress as you meet each goal
• Write yourself a contract – By making a contract with yourself, you can keep promises to manage your pain. A pain control contract works just like other legal kinds of agreements in your life. You set up pain goals, and dates to meet those goals
• Plan each day – Use a schedule or a "to-do" list for exercise and other activities. This will help you to meet your goals
• Keep your environment healthful and stay positive – Get rid of things in your home that might cause you to go back to unhealthy habits. Make sure your house shows your positive attitude. This will keep your spirits up and help you work with and manage your pain
• Seek and accept support – Support from friends, family, and your caregivers can help keep you on track and help on difficult days
• Work as a team with your caregivers – Keep your caregivers updated on your progress. This way you can work together to overcome problems when they happen
• Prepare for difficult situations – Make a list of trouble areas with your pain and create a plan. Planning will decrease surprise when something happens. You will be prepared and that will decrease your stress
• Reward yourself – Treat yourself to something you like each time you reach a goal or complete a pain strategy or plan. This will strengthen your positive attitude and successes.

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