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By Christopher V. Flores, M.D.
Lately, the safety of many pain prescription medications has been challenged in clinical studies and by the U.S. Food and Drug Administration. Merck & Co. withdrew Vioxx from the marketplace after it was linked to heart attacks. Pfizer pulled Bextra for similar reasons. There have even been concerns about over-the-counter, anti-inflammatory medications like naprosyn (Aleve).
In reality, almost every prescription drug has down sides and potential risks. Most of us are aware of the side effects upset stomach; their use can lead to tolerance, requiring increasing doses to bring about pain relief; and they can become addictive.
With drugs like Vioxx, many pain sufferers felt lucky that they had alternatives to narcotic prescriptions. However, with the recall of Vioxx and Bextra and continuing questions about the safety of Celebrex, many of us feel forced to make a choice between risking our overall health with medication or living in pain.
Luckily, there are clinically proven ways to beat the pain of arthritis, headaches, lowback pain, and other conditions without drugs. Not surprisingly, relatively simple changes like getting enough sleep, exercising, and eating right can make a big difference in our perception of pain.
Pain, pain go away.The Importance of Sleep
Pain is a leading cause of insomnia, according to the National Sleep Foundation. In the foundation’s 2000 Sleep in America Poll, 20 percent of responding adults reported that pain disrupts their sleep a few nights a week or more. This sleep disruption in turn compromises mood, energy level, behavior, and safety.
Research suggests that pain while awake can cause sleeplessness and, in turn, poorquality sleep can exacerbate pain. Poor sleep generally results in increased attention to or perception of pain. Patients with chronic pain often find themselves in a vicious circle of increasing pain and sleeplessness, one amplifying the other.
There are several drug-free approaches to getting a good night’s sleep, including scheduling regular, predictable bedtimes; avoiding heavy meals and exercise just before bedtime; limiting intake of caffeine and other stimulants; removing the television or other distractions from the bedroom; and using light to regulate internal sleep rhythm. For some people, simply making sure the bedroom is cool and completely dark helps them get to sleep, and going outside into the sunlight soon after awakening helps them set their biological clock.
Specialized techniques, taught through cognitive behavioral therapy, also aid goodquality sleep. A study of 60 chronic-pain patients in Canada found that seven weekly sessions of cognitive behavioral therapy improved sleep quality. The therapy includes progressive muscle relaxation, guided imagery, biofeedback, and medical hypnotherapy. Many clinical psychologists and behavioral therapists are comfortable teaching these skills and techniques.
Unfortunately, not all kinds of insomnia can be treated with lifestyle changes or cognitive behavioral therapy. Insomnia resulting from severe depression, obstructive sleep apnea, or periodic limb movements in sleep usually requires the evaluation and intervention of a physician.
Pain, pain go away.Exercise is Key
Exercise, especially aerobic exercises like walking and running, have been shown to increase levels of endorphins in the blood. Endorphins, a variety of chemical neurotransmitters, effectively ease pain and depression.
A variety of clinical studies have demonstrated benefits of exercise for several chronic pain conditions, such as osteoarthritis, low-back pain, and fibromyalgia. If you suffer from chronic pain and are not participating in any type of regular exercise program, it will almost certainly help you to start one.
Before beginning any new exercise program, you should first consult your physician for specific guidance on how long and how vigorously to exercise.
In general, you should begin with stretching exercises and gentle, low-impact activity such as walking, bicycling, or swimming. You should start your exercise program slowly because, at the beginning, exercise may make your pain worse. Some muscle soreness is normal when you’re starting to exercise, but sharp pain may be a sign that you have overworked your muscles or joints.
Yoga and tai chi have shown benefits in treating chronic pain and arthritis. These activities increase strength, improve balance and coordination, increase range of motion and flexibility, and aid in stress reduction and relaxation as well.
For exercise to help, you must do it regularly. The goal is to get started and keep going, to gain relief from pain, and to improve sleep.
Pain, pain go away.Diet and Pain
We don’t know for sure if following a particular diet can decrease all types of pain, but some painful conditions can be set off by certain foods. For example, red wine and cheese can trigger migraines; and spicy, fatty foods can worsen the pain of irritable bowel syndrome.
A nutritionally balanced diet helps the body heal and stay strong and provides the energy you need to remain physically active. A diet with a reasonable calorie level will also help to maintain your weight. It is clinically proven that obesity worsens the pain and clinical course of arthritis and low-back pain.
Limiting alcohol intake aids in restoring a healthy sleep cycle and also avoids initiating or worsening depression associated with chronic pain.
“Alternative” Therapies
You may also want to consider complementary or alternative medicine. There is no strict definition of what constitutes complementary medicine, and perceptions change over time. Often, treatments that are labeled “alternative” today become mainstream tomorrow. Long considered an alternative therapy by the medical community, acupuncture is increasingly considered mainstream medicine as more research supports its benefits.
At this time, alternative therapy includes homeopathy, aromatherapy, massage, Reiki, Rolfing, or herbal therapies. Although these approaches have not been subjected to rigorous clinical testing and most doctors are hesitant to endorse or advise these treatments, many patients experience great bene- fit from some of these therapies; and many of these methods are used to treat painful musculoskeletal conditions.
Most of these approaches are virtually risk-free and, aside from the expense, patients who have not found relief with traditional medical intervention should look into alternative approaches. If there are any concerns about a specific therapy, you should consult your physician before committing to a questionable or expensive treatment regimen.
If you suffer from chronic pain, it may be well worth your while to try out some of these safe and effective alternatives to prescription medications. You may find that you don’t need to take as much prescription medicine — or that you can stop it altogether.
Christopher Flores is a board-certified family physician, currently holding a faculty teaching position at the University of California, Davis, College of Medicine.
Target your pain relief.
There are a variety of well-accepted, drug-free pain-relief methods that you may try with your doctor’s approval. As with the treatment of sleep disorders, behavioral therapists can assist with relaxation and biofeedback training.
Muscle aches:
Applying cold or hot packs can be very helpful, especially if inflammation is present.
Muscle tightness and spasms:
Massage therapy is beneficial to many patients with chronic muscle and back pain.
Pain related to stress or anxiety:
Relaxation techniques help reduce stress and muscle tension. You can learn to concentrate on a calming memory or image while breathing slowly and deeply. Progressive muscle relaxation techniques can give you control over your body’s reaction to stress.
Headaches and irritable bowel pain:
Biofeedback training teaches you to be aware of your body’s physiology and response to pain. You learn to recognize physical changes (such as higher skin temperature and heart rate) and you acquire “mind-over-matter” skills to control the physical changes, decreasing your pain level.
Pinched back muscles:
Transcutaneous electric nerve stimulation uses a pager-sized device to administer tiny electric currents to the area of pain, blocking and minimizing the body’s pain sensations.
Arthritis pain:
Physical therapy helps build muscles that support weak, painful joints. Deep heat applied with a method called diathermy can relieve muscle and joint pain.
Repetitive motion tendonitis and muscle strain:
Occupational therapy teaches you to manage work and daily-living tasks in ways that don’t cause pain and to focus on things you can do comfortably. Ergonomics refers to the science of healthy workplace engineering. It is most commonly applied to computer work areas, but just about any workspace can benefit from an ergonomic evaluation.
Low-back pain, arthritis, and migraine headaches:
Acupuncture can help relieve a variety of pain conditions. It may be combined with electric stimulation. |
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