Chronic pain can begin with an injury or a problem such as a bulging disk in the spine. It can be associated with complex syndromes such as fibromyalgia. Or you may experience it as headaches, back pain, joint pain, nerve pain, or a myriad of other localized symptoms.
Stop Back Pain Before It Starts
Prevent pain
by Hallie Levine SklarFrom Health magazine
You don't have back pain...yet. Want to keep it that way? Try these techniques to prevent the pain long before it begins.
Sit pretty
You don’t need a fancy ergonomically designed office chair, but you should have one that provides good support so that your back is curved like an S, not a C, says Jeffrey Goldstein, MD, director of the spine service at the New York University Langone Medical Center.Every half hour, get up and walk around for a few seconds to take some of the stress off your back.
Stand tall
Imagine a line coming down through your body from the ceiling, says physical therapist Renée Garrison.Your ears, shoulders, hips, and knees should all stack up along that line, with your head stacked directly atop your neck, not jutting forward.
Wear soft soles
"If your shoe has little cushioning, every time your foot strikes concrete, you’ll jar the bones and muscles in your low back," says Raj Rao, MD, vice chairman of the department of orthopedic surgery at the Medical College of Wisconsin. (That holds true for flats as well as heels.)Look for a shoe with a cushioned sole, or buy an insert like Spenco For Her Women’s Q-Factor Cushioning Insole ($8 and up; amazon.com). When you’re at home, pad around in thick flip-flops or well-cushioned sneakers.
Don’t smoke
A 2010 review of 40 studies found that smokers have more low back pain than nonsmokers, possibly because smoking reduces blood flow to the spine, says Dr. Rao.Learn how to lift
You know to hoist heavy objects using your legs, not your back. But what about a very light object?Answer: Lean over it, slightly bend one knee, and extend the other leg behind you. Hold onto a chair or table for support.
How People in Pain Can Revive Their Sex Lives
One of the most difficult things about chronic pain is the profound impact that it can have on your sex life. But if you think you are the only chronic pain sufferer with intimacy issues, think again. "It's a silent epidemic," says Clifford Gevirtz, MD, medical director of Somnia Pain Management in New Rochelle, N.Y. "People are embarrassed to talk about it, but they are suffering." But experts say that many are suffering needlessly: "There is a lot of help available," he says. "They just have to have the courage to ask."
Finding the root cause of sexual dysfunction
Chronic pain affects sexuality on several levels. At the most basic level, pain itself can inhibit sexual activity. Kerrie Smyres, a 31-year-old writer in Seattle who blogs about her daily headaches, says that the pain in her head often hurts too much for sex. Despite the cliche, it's true that headaches can be a major obstacle to intimacy. In a small 2007 survey by the National Headache Foundation, 69% of respondents said they had avoided sex because of a headache.
The last thing a chronic pain sufferer needs is more discomfort. But when sex increases pain and patients avoid sex, a vicious cycle can start. "If avoidance continues, a major fear becomes associated with a sexual activity," says Todd Sitzman, MD, a past president of the American Academy of Pain Medicine. "That lack of intimacy can have detrimental effects on relationships."
How emotions play a role
The alchemy of pain, sex, and relationships is complex. "Typically what I see is a combination of factors," says Geralyn Datz, PhD, a pain psychologist and behavioral medicine specialist in Hattiesburg, Miss. "The person has chronic pain, and intercourse may be physically uncomfortable." But she says often a person can feel emotionally unwilling or just feel bad about themselves.
Self-esteem can also plummet, says Datz: "You can imagine how someone who used to be the head of the household and is now relegated to the couch isn't feeling interested in intercourse or intimacy—their self esteem is dramatically affected."
Anticipation or fear of pain is another common problem: For Smyres, orgasms can sometimes trigger migraines, which "doesn't give me a whole lot of incentive," she says.
How emotions play a role
The alchemy of pain, sex, and relationships is complex. "Typically what I see is a combination of factors," says Geralyn Datz, PhD, a pain psychologist and behavioral medicine specialist in Hattiesburg, Miss. "The person has chronic pain, and intercourse may be physically uncomfortable." But she says often a person can feel emotionally unwilling or just feel bad about themselves.
Self-esteem can also plummet, says Datz: "You can imagine how someone who used to be the head of the household and is now relegated to the couch isn't feeling interested in intercourse or intimacy—their self esteem is dramatically affected."
Anticipation or fear of pain is another common problem: For Smyres, orgasms can sometimes trigger migraines, which "doesn't give me a whole lot of incentive," she says.
Communication is the key to rekindling
People with chronic pain—and those who love them—don't need to resign themselves to a lifetime of celibacy. The subject can be broached from several angles, but the main lesson from doctors and couples is this: Communicate.
First, don't be embarrassed to talk to your doctor. "If the physician doesn't bring it up, the patient should," says Dr. Sitzman. "They should get validation that this is a common consequence of chronic pain and its therapy—and they should expect treatment."
Dr. Gevirtz recommends emailing questions beforehand so they can be discussed during the session. He also suggests keeping a pain diary at home so you can remember the details: For example, at what point during intimacy pain occurred or what the circumstances were surrounding an instance where your pain subsided.
Help is a doctor's visit away
Once your doctor has a clear picture, he or she can help. "The main thing is to validate that this is an anticipated side effect that can be treated, and that sexual activity is a normal part of intimacy that chronic pain patients shouldn't be denied," says Dr. Sitzman. Then, patient and doctor can work together to devise a pain management protocol for alleviating pain during sexual activity.
Addressing the emotional component
Couples can also seek out a sex therapist or couples counselor to relearn the building blocks of intimacy. "A lot of times couples are avoiding even basic levels of contact, not holding hands, not kissing, not even talking," says Datz. Part of her therapy with couples includes helping them reestablish physical contact and teaching them relaxation techniques: "Because there is often a lot of anxiety about sexual activity when you have pain," she explains, "it's helpful to learn to relax mentally and physically."
When a loss of self-esteem is keeping a patient from being comfortable with their partner, "we have specific ways of treating that in therapy," says Datz, including "normalizing" a person's symptoms so they don't feel quite so alone and alienated.
The payoff in pain reduction and relaxation
Reigniting intimacy can actually help pain, at least temporarily: "As doctors, we prescribe external opiates, but the best opiates around are the natural ones that the brain produces," says Dr. Gevirtz. "If you can give someone an orgasm, they will have a flood of endorphins and their overall pain numbers will go down."
People with chronic pain—and those who love them—don't need to resign themselves to a lifetime of celibacy. The subject can be broached from several angles, but the main lesson from doctors and couples is this: Communicate.
First, don't be embarrassed to talk to your doctor. "If the physician doesn't bring it up, the patient should," says Dr. Sitzman. "They should get validation that this is a common consequence of chronic pain and its therapy—and they should expect treatment."
Dr. Gevirtz recommends emailing questions beforehand so they can be discussed during the session. He also suggests keeping a pain diary at home so you can remember the details: For example, at what point during intimacy pain occurred or what the circumstances were surrounding an instance where your pain subsided.
Help is a doctor's visit away
Once your doctor has a clear picture, he or she can help. "The main thing is to validate that this is an anticipated side effect that can be treated, and that sexual activity is a normal part of intimacy that chronic pain patients shouldn't be denied," says Dr. Sitzman. Then, patient and doctor can work together to devise a pain management protocol for alleviating pain during sexual activity.
Addressing the emotional component
Couples can also seek out a sex therapist or couples counselor to relearn the building blocks of intimacy. "A lot of times couples are avoiding even basic levels of contact, not holding hands, not kissing, not even talking," says Datz. Part of her therapy with couples includes helping them reestablish physical contact and teaching them relaxation techniques: "Because there is often a lot of anxiety about sexual activity when you have pain," she explains, "it's helpful to learn to relax mentally and physically."
When a loss of self-esteem is keeping a patient from being comfortable with their partner, "we have specific ways of treating that in therapy," says Datz, including "normalizing" a person's symptoms so they don't feel quite so alone and alienated.
The payoff in pain reduction and relaxation
Reigniting intimacy can actually help pain, at least temporarily: "As doctors, we prescribe external opiates, but the best opiates around are the natural ones that the brain produces," says Dr. Gevirtz. "If you can give someone an orgasm, they will have a flood of endorphins and their overall pain numbers will go down."
Helping yourself at home
Express your limitations and desires to your partner, says Sueann Mark, PhD, a clinical sexologist with a private practice in San Francisco. "The person in pain needs to take an inventory about what touch is pleasurable and what's not," she says.
While communication is important, it has to be done at the right time: "Talking about these issues is best done when not in bed," she says. Instead, set aside a separate time of day. And remember to think beyond intercourse: "You can find ways to maintain some sexual relationship," she says, including massage, bubble bath, cuddling, and masturbation.
Couples find what works
Through trial and error, couples have found creative ways to maintain intimacy. Jennifer, who lives with chronic migraines, says that she takes advantage of her pain-free days: "We make the best of the times that I feel better than usual," she says. "Even if we have plans, we decide that the most important thing is going to bed together."
Smyres says that she tries to initiate sex once a week and at times other than the evening, when her head often hurts. She's found that talking about sex more with her husband also helps.
Smyres is proof that by communicating and staying in touch with your partner, you can have a rich and loving relationship in spite of chronic pain: "In general, I'm very happy," says Smyres. "My husband is great and my life is wonderful, I'm in the healthiest emotional place that I've ever been."
If over-the-counter drugs don't deliver enough pain relief, your doctor may prescribe an opioid—a narcotic. Opioids are either refined from the opium poppy plant, or have been artificially created to work in the same way. The most well known is the very powerful drug morphine.
Opioids can drastically lower pain messages being sent by the body to the brain, and then calm the brain's reaction to them—which in turn helps a patient deal better with the pain emotionally. Our bodies produce opioids naturally; we call them endorphins, and they are often associated with pleasurable things like a runner's high or sexual bliss.
Unlike NSAIDs, there is no ceiling dose at which opioids stop working. Users can become tolerant and require more for the same effect. (Among addicts, this can lead to phenomenal intake as tolerance builds and the high becomes more elusive.)
Opioids do have side effects
Even when not abused, opioids do have side effects including:
Express your limitations and desires to your partner, says Sueann Mark, PhD, a clinical sexologist with a private practice in San Francisco. "The person in pain needs to take an inventory about what touch is pleasurable and what's not," she says.
While communication is important, it has to be done at the right time: "Talking about these issues is best done when not in bed," she says. Instead, set aside a separate time of day. And remember to think beyond intercourse: "You can find ways to maintain some sexual relationship," she says, including massage, bubble bath, cuddling, and masturbation.
Couples find what works
Through trial and error, couples have found creative ways to maintain intimacy. Jennifer, who lives with chronic migraines, says that she takes advantage of her pain-free days: "We make the best of the times that I feel better than usual," she says. "Even if we have plans, we decide that the most important thing is going to bed together."
Smyres says that she tries to initiate sex once a week and at times other than the evening, when her head often hurts. She's found that talking about sex more with her husband also helps.
Smyres is proof that by communicating and staying in touch with your partner, you can have a rich and loving relationship in spite of chronic pain: "In general, I'm very happy," says Smyres. "My husband is great and my life is wonderful, I'm in the healthiest emotional place that I've ever been."
Tips for Managing the Side Effects of Narcotic Painkillers
If over-the-counter drugs don't deliver enough pain relief, your doctor may prescribe an opioid—a narcotic. Opioids are either refined from the opium poppy plant, or have been artificially created to work in the same way. The most well known is the very powerful drug morphine. Opioids can drastically lower pain messages being sent by the body to the brain, and then calm the brain's reaction to them—which in turn helps a patient deal better with the pain emotionally. Our bodies produce opioids naturally; we call them endorphins, and they are often associated with pleasurable things like a runner's high or sexual bliss.
Addicts seek narcotics for a variety of benefits, including a high, although many patients do not experience this effect. Chronic pain patients are generally looking for another kind of relief.
Opioids only help with pain, not its cause
But it's important to remember that opioids only suppress pain. "Opioids don't work on the source of the pain like NSAIDs—which can reduce inflammation—do," says Jeffrey Goldstein, MD, director of the Spine Service at New York University's Hospital for Joint Diseases. "Instead they just mask the pain and help you deal with it."Opioids only help with pain, not its cause
Unlike NSAIDs, there is no ceiling dose at which opioids stop working. Users can become tolerant and require more for the same effect. (Among addicts, this can lead to phenomenal intake as tolerance builds and the high becomes more elusive.)
Opioids do have side effects
Even when not abused, opioids do have side effects including:
- Constipation
- Respiratory depression (slowed rate of breathing, one of the more serious concerns)
- Nausea
- Vomiting
- Drowsiness
- Dizziness
- Weakness
- Dry mouth
- Confusion
- Difficulty urinating
- Itching
medications.
A "tightwire balancing act" on narcotics
When contractor Nicholas Severais, 58, of San Mateo, Calif., fell off a roof several years ago and broke one of his vertebrae, he was put on a whole slew of opioids during the course of his treatment. They alleviated the pain but brought other challenges."I got nightmares and hallucinations from the morphine. And with that, and the codeine, I also got long-term constipation," he remembers.
Severais ate fruit and took mild laxatives but found he was constantly worried about how many painkillers he'd taken and how many laxatives he needed to counteract them.
"Your whole life becomes this kind of tightwire balancing act between 'How many painkillers did I take today?' and 'Should I or shouldn't I take one of these?' You get into these patterns where you're taking all these pills to counteract the pills that you are already taking."
Roger Chou, MD, an associate professor of medicine at Oregon Health and Science University, says that although constipation will be a problem as long as you're on the medication (the drug slows down your gut), other side effects do seem to diminish with time.
"The sedation, or sleepiness, usually gets better as people are on the medication longer, as does the nausea. But some people just can't stay on it, because they can't take being sedated or nauseated for two or three weeks."
Aside from oral dosages, opioids can be taken many ways, including by rectal suppository, intravenous injection, under-skin implantation, skin patch, or even injection into a region around the spinal cord. Some opioids give relief for just a few hours, though controlled-release formulations, such as that found in OxyContin, can provide pain relief for much longer. (A fentanyl patch can give pain relief for up to 72 hours.)
Though these drugs can bring great relief to chronic pain patients, scandals surrounding them have led to the prosecution of doctors who prescribe them inappropriately. And that can make it more difficult for legitimate pain patients who need the relief of opioids to get access to them.
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