Pathways through persistent pain: Tips for managing chronic pain

Living with chronic, persistent pain is a fact of life for 3 out of 10 people in the U.S. Chronic pain can develop in various ways, including from injury or illnesses. When pain lasts beyond three to six months, treatment focuses on the central nervous system, which includes the brain and spinal cord.

Pain pathways

Chronic pain can be difficult to pinpoint due to a process called central sensitization.

Think of a city with just one highway leading into it. Now imagine that as the city grows, multiple highways are built leading in and out of the city. Similarly with pain, as symptoms develop and expand, it's hard to pinpoint the location of the problem due to the multiple pathways involved.

How you act and think in response to pain interacts with the central sensitization process.

Certain factors can magnify the experience of pain, including:

• Stressful life experiences
• Mental health issues, including depression, anxiety and social isolation
• Decreased ability to do the things you enjoy doing
• Overexertion or underexertion

No diagnostic test can show your pain level. It's a subjective, individual experience. Your health care team may ask you to rate your pain level on a scale of 0–10 to help evaluate and document your symptoms.

Coping strategies

There is no single cure for chronic pain. It takes a team approach and involves medical management, movement therapy and learning specific coping strategies.

Let's review some of those strategies:

• Practice breathing exercises.
  Inhale slowly through the nose, allow your lungs and belly to expand, then exhale slowly through your mouth and nose.
• Get moving.
  Work with a physical or occupational therapist on appropriate exercises to gradually retrain your body. Incorporate a gentle stretching program into your routine, such as yoga or tai chi.
• Participate in meaningful activities.
  The body's natural, feel-good chemicals, called endorphins, are activated by exercise, relaxation techniques and enjoyable experiences. Set aside time each day for a simple activity that is calming or brings you joy.
• Engage in mindfulness.
  Meditation does not have to be fancy or complicated. Allow yourself to focus on the present moment, letting go of any interpretation or judgment. To start, try paying attention to one sensory input at a time, such as hearing or vision.
• Use moderation and pacing.
  Set realistic goals and start by doing one-third of what you think you can do. For more difficult tasks, try setting a timer to remind yourself to take a break.
• Practice good sleep habits.
  Establish regular bed and wake times. Use your bed for sleep and sex only. Do not spend your day there.
• Eliminate unhelpful substances.
  Smoking restricts blood flow, which prevents healing. Alcohol creates nerve damage over time.
• Treat related conditions.
  Cognitive behavioral therapy with a licensed mental health professional helps decrease symptoms of depression, anxiety, and other mental and physical health concerns.
• Stay connected to your support system
  While it's important to take time for yourself, having family and friends that care about you is important. Although you may want to be left alone during bouts of chronic pain, lean in to support from others.

These self-management tools, along with the appropriate use of over-the-counter and prescription medications, can help reduce the effects of persistent pain.

If you have difficulty with pain, speak with your health care team regarding a comprehensive pain treatment plan to help put you back in control of your life.

Read more about managing back pain and stress, and staying active.

Monica Foster, Ph.D., is a psychologist in Psychiatry & Psychology in La Crosse, Wisconsin.