Do-it-yourself pain relief

by Debra Wood, RN

Natural pain relief More than 50 million Americans suffer from chronic pain. Pain medication may offer short-term relief, but many chronic pain sufferers find they can gain long-term control over their pain through heat or cold application, music, relaxation, exercise, and by having a positive attitude.

"For the vast majority of people who have chronic pain, there just arent any pharmacologic or physical interventions that can totally eliminate the pain," says University of Washington (Seattle) pain management expert Dennis C. Turk, PhD.

"Pain is a chronic condition, just like hypertension or diabetes," Dr. Turk explains. "When you have a chronic condition, you need to do more things for yourself. Its going to last a long time. Its best to help yourself and learn to self-manage and control your pain."

In addition to traditional pain relievers, non-drug methods of pain relief can help you gain that control. Some techniques—such as imagery and the use of hot and cold—relax the muscles, help you sleep, and distract you from symptoms. Others such as music, movies, and recorded comedy routines, take your mind off your physical complaints, as does losing yourself in a good book.

While some remedies require little expertise or help from others, some may require instruction from a professional. Dr. Ronald Glick, director of the University of Pittsburgh Pain Evaluation and Treatment Center, recommends that patients seek advice from a chronic pain specialist who can coordinate all aspects of management, including physical therapies and psychological techniques.

While these pain relief techniques help many people with chronic pain, they are not cures for pain.

"The most important thing about heat and cold is that it gives a sense of control," Dr. Turk says. "They are things you can do yourself to help relieve the pain, which can immediately reduce the emotional stress."

Direct application
"Heat and cold can be quite helpful for people with musculoskeletal conditions," says Dr. Turk. "Something as simple as a bag of frozen peas wrapped in a towel can be a useful self-management technique that relieves muscle tension in the back, neck and shoulders."

Most of us are familiar with holding an ice pack on a twisted ankle or lying on a heating pad for a sore back, but hot and cold treatments can be used in other ways. Moist heat, which is often more effective than dry heat, can be applied with a warm towel or a soak in the tub. An elastic bandage can hold an ice pack in place. A small paper cup filled with water and kept in the freezer becomes an excellent tool for localized cold massage, while iced washcloths can cover a larger area.

Timing
Apply heat or cold therapy for periods not to exceed 15 minutes, and allow the area to return to normal body temperature before reapplying the therapy. Some people obtain added relief by alternating heat and ice. Others use heat before exercising and ice after.

Skin protection
Always place a towel between the cold or heat and the skin. Never lie directly on a heating pad, and if it feels too warm, take it off. Dont combine heat with pain-relieving salves, such as mentholated ointments and aspirin creams.

The "relaxation response," a term coined by Herbert Benson, MD, of the Mind-Body Institute in Boston, is an array of beneficial physiologic effects associated with focused relaxation, many of which tend to mitigate the perception of pain. For best results, make relaxation a part of your daily routine.

There are a number of ways to invoke the relaxation response, and many audiotapes are available to help. One popular approach is to assume a comfortable position, take several deep breaths, and then focus on your breathing, or a word or sound, while passively avoiding intruding thoughts.

Muscle relaxation exercises
Progressive muscle relaxation is a self-healing technique that can be effective for both muscle spasm pain and stress reduction. "Relaxation skills are useful in reducing muscle tension, and can help reduce frustration and some of the stress," says Jennifer Markham, PhD, at the University of Pittsburgh pain clinic. Progressive muscle relaxation involves focusing your attention on each muscle group until it feels heavy and relaxed, usually beginning in the feet and gradually progressing upward.

Imagery exercises
Imagery, which often accompanies the management of pain through relaxation, allows you to visualize what it would be like to "let the pain go." If you know what is causing the pain—for instance a pinched nerve—picturing the spinal disk space opening and freeing the trapped nerve might help. By calling on a variety of senses, you can take yourself to a favorite place, like the beach or the mountains. Music, nature sounds and instructional tapes make it easier for beginners to escape to a mental paradise.

"Relaxation techniques redirect your thinking from physical pain and onto something else," says Penney Cowan, founder and executive director of the American Chronic Pain Association. "Imagining the beach, the sun on your face, and the warmth, of the sand helps divert your mind from how much your head is hurting."

Biofeedback
Biofeedback offers a measurable response to relaxation and imagery techniques. Through the use of sensors connected to a computer, you receive visual or auditory cues that indicate an increase or decrease in muscle tension, heart rate and skin temperature. Using this feedback, you train yourself to control body functions that you normally dont even think about. Biofeedback seems particularly useful in chronic pain or other conditions associated with muscle spasm or tension, like some headaches.

Although you may not feel like getting off the couch because you hurt so much, exercise done within the confines of your physical limitations does decrease pain. Why? The reasons are complex, but one prominent theory is that exercise releases endorphins—natural pain relieving chemicals in your brain.

"Exercise is absolutely critical," says Dr. Turk. "The type of exercise will depend on the condition, but as a general rule of thumb, the more active you remain and the more you use your muscles, the better off youre going to be."

A physical therapist can tailor an initial exercise plan based on your capacity to exercise, and then gradually make recommendations for increasing how much you do and for how long. Pain experts recommend pacing activities. Overdoing it on good days can come back to haunt you later. Its fine to cut back on your exercise during a flare-up of your pain, but its important to resume your exercise routine as soon as you feel better.

How you think about your aches and discomforts, your level of anxiety and depression, your expectations, and your ability to cope determines how much pain you feel. Cognitive behavior modification techniques help change unhealthy attitudes and habits that can develop when pain is chronic.

Concentrate on your abilities and find pleasure in the things you can do rather than dwelling on activities that have become difficult because of your pain. Communicate with family members and explain how youre feeling. Dont expect loved ones to read your mind.

"Psychology helps people begin to understand they do have some control, even if they dont have a magic wand to make the pain go away," says Dr. Markham. "When they realize they have some control [over their pain], it gives them hope."