What a pain! W
e have all experienced pain – whether it be child birth, a broken bone or touching a hot pan. It’s unpleasant but usually temporary. Pain killers, rest and sometimes even an operation can take these pains away and we feel better. But imagine if you have pain every day , for weeks, months or even years. Chronic or persistent pain, defined as pain that lasts for longer than three months, affects 28 million people in the UK, with back pain, fibromyalgia, arthritis and headaches amongst the commonest causes. Pain’s purpose is to keep us safe - it teaches us what is dangerous and what not to do again. It forces us to rest until something is healed. In chronic pain, however, those pain impulses can keep coming, long after the injury or problem has healed and our bodies can start to feel pain from the slightest stimulus, such as gentle touch or walking a short distance. We are starting to realise that this type of pain is less to do with what is injured, and more to do with a faulty pain pathway. Patients with chronic pain are often at their wits end, desperate for something to take away their suffering. The understandable answer for them is invariably more painkillers. These are often prescribed for acute pain – from straightforward paracetamol and ibuprofen to stronger opiate based prescription drugs like codeine, tramadol and morphine. These drugs can be invaluable for short term pain relief, but not only can these drugs stop working in the longer term, they can also make things much worse. As well as unpleasant side effects such as nausea, constipation, and drowsiness, in the longer term opiate medication can lead to addiction and tolerance, so a person requires bigger and bigger doses to have the same effect, eventually resulting in very little pain killing effect but potentially a lot of long term side effects. However, we do not recommend stopping these medications abruptly, as this can lead to withdrawal side effects. Your doctor or
HEALTH & BEAUTY pharmacist can help with planning a slow reduction. Many patients really want to come off these long term medications, but are fearful that there will be nothing to replace it with. In my experience, most will notice very little difference in their pain levels when they wean off their medication, as the tablets have long stopped being effective. In fact long term opiate medication use can actually increase pain levels in the long term. So what can you do to help persistent pain?
Top Tips 1. Relaxation – stress causes muscle tension which exacerbates pain. Meditation and mindfulness are great ways of helping reduce stress levels and also help distract from pain. 2. Exercise – it may feel like this is the last thing you can manage but gentle exercise such as Tai – Chi can make a huge difference to muscle strength and pain levels. 3. Get outside – Being close to nature has huge therapeutic benefits. Whether it’s getting out to go for some sea air, onto the moor for countryside and views or even just a walk to the bottom of the street or garden, try and get outside as often as possible. 4. Pace yourself – listen to your body’s stop signals. Better to do a small thing each day than try and cram it all into one and spend days afterwards paying the price. 5. Sleep – a good night’s sleep can improve pain levels considerably. See resources below for help with this. 6. Get Help – there are so many resources out there now to help. I have listed some here but do speak to your GP if you are struggling, especially if you want help with reducing medication. www.bodyreprogramming.org www.paintoolkit.org www.torbayandsouthdevon.nhs.uk/services/ pain-service/reconnect2life/ www.nhs.uk/every-mind-matters/ mental-health-issues/sleep/
Dr Rachel Tyler is a doctor at Stirling Road Surgery, St Budeaux
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