What is pain management?

Wow - sudden pain is your body's "red alert" warning system & should be heeded. Have you figured out the source?

I sympathize with the loss of gardening as a distraction. Maybe you need to do what I have done after 5 hip replacements, and now wearing-out knees - contract the heavy duty work like turning the garden to someone young. My grand nephews treat it like a workout, and they like the extra cash!
Also, I plant many of my veggies in straw bales, which involve no bending or kneeling, no digging (and little weeding). Then after 2 years, the bales collapse, and you plant right in the resulting compost, again with no digging. And all the herbs go in pots - big ones, that are part of the decor on my patio.

Sue

With chronic pain, the body part that hurts is often just the tip of the iceberg. Underneath lay various impacts that often accompany, and may worsen chronic pain, including:

- Emotional distress
- Physical deconditioning
- Fatigue
- Sleep disturbance
- Thinking and memory problems
- Poor nutrition

Lifestyle changes do make a positive impact. Retraining the brain (neuroplasticity) does make a positive impact. No, they do not remove all the pain, but they create healthier ways to approach pain, and recreate pathways in the brain.

An example I learned at pain rehab was to think of a little boy (we'll call him Timmy) who goes to the grocery store with his mom and wants a free cookie at the deli. TImmy throws a HUGE tantrum in the middle of the store, begging for a cookie. His mom has two choices:

1. give in to Timmy and let him have a cookie
2. stand her ground and say no because he has not had lunch

Pain is like a tantrum. If we continue to give in to it and let it have its way, we will lose control and create bad habits. We will not allow ourselves to live our best life possible.

No matter how long you've lived with chronic pain, you can take steps to manage it more effectively and improve your quality and enjoyment of life. Your attitude and lifestyle play key roles in how well you cope with pain.

If you have a negative attitude and view yourself as a victim of pain, pain will continue to control you and consume your energy. If you approach your condition with a positive outlook and openness to change, you're more likely to manage pain successfully.

Some key lifestyle choices to help you live well with chronic pain may include:

- Becoming more physically active
- Practicing techniques that relieve stress
- Focusing on your abilities, not just your limitations
- Improving communication with family members and friends
- Learning to shift your focus away from pain
- Reducing or stopping reliance on pain medication and medical solutions to pain
- Eating a nutritious diet, and getting the sleep you need
- Speaking to a psychologist
- Scheduling your days, for accountability
- Setting goals

No one says this is easy, it takes diligence. I certainly have my difficult days where I must go back to the drawing board and pull from these tools I've outlined. Regardless of individual underlying causes, chronic pain presents the same for us all, chronic, its never going away, but can be managed.

@rwinney That was wonderful analogy of pain and how to help ourselves .This is just what I've gone through I fell hard on my bottom resulting in alot of lower back pain Dr diagnosis is paraphrase I let my back heal now am waiting for my scooter to be built since I can't walk far only in my 1 bedroom apt. But I'm blessed I'm not paralyzed this has happen 2 times now in my life I've escaped being paralyzed Distraction is so important from pain

I am sorry @martoof, to hear of this awful experience. That is not Pain Management. I would love to have people refer to the process (subspecialty) as "Active Pain Management" because it is not a passive process of adding another pill...

Pain management as practiced by my Pain Management specialist consists of the following:
- Review patient medical records for history and present and past symptoms and treatments
- Interview patient (in my case remote, due to Covid) to determine current state, hopes, expectations and willingness to fully participate
- Coordinate with primary care practitioner
- Explain the concepts of actual physical pain response, Central Sensitization Syndrome (CSS), Chronic Regional Pain Syndrome (CRPS), Neuropathy and philosophy of using a multi-pronged strategy to deal with whichever is causing the most problem. In my case, I have CSS and physical pain from arthritis.
- Explain that opioids do not really cure pain, and that the goal, if currently used, is to end or minimize their use. My body had never become dependent on narcotics for pain management, so I didn't have to break that cycle.
- Explain that the goal is to minimize and manage pain, as the underlying causes usually don't "go away"
- Develop a comprehensive pain management strategy. In my case it was a combination of physical therapy (PT) and myofascial release (MFR) by a specially trained therapist, a home routine of stretching, strengthening and walking, medication (non-narcotic), visualization exercises, and becoming attuned to what my body is saying to me.
- Review progress and adjust to find balance.

Since I started active pain management almost a year and a half ago, I have gotten my life back. It is not perfect - there are bad days and good days, I have learned to take them as they come, and which tactic to use for specific issues. I have learned that all of the strategies must stay in place for life - if you stop, the pain can come roaring back. I have hard surgery 3 times since I began active pain management, and managed recovery from each one with minimal opioids (2 days max) by using Tylenol, ice and my PM strategies. I use topical NSAIDS only for arthritis pain because I cannot use the meds internally, combined with ice or heat as needed.

Sorry, I cannot refer you to my pain management specialist, she operates on referral only, and from within the clinical practice where my primary is located. Mayo offers an inpatient Pain Rehab Clinic (https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691) There are other qualified Pain Management specialists and practices all over the country. Based on your experience, I would call and pre-interview any place to which I was referred to learn their philosophy.

I encourage anyone with a Pain Management experience to tell us about it.
Sue

Wow, thank you Sue! I have just been referred to pain management by a nurse practitioner who I thought would be a neurologist to explain what my MRI’s showed. I won’t go into that now. All she offered was PM, I will definitely research the clinic which I was referred to. I will not take narcotics for any pain, there are too many horror stories out there I will Search for a natural remedy to manage my pain. Thank you again Sue.

Sue, what I’ve “think” I’ve discovered, is that pain management doctors still want to cut some part of your body where the pain is. The one that dismissed me, wanted to do a spinal stimulator. I’ve already had three major back surgeries, and am not going to have anything else implanted in my back. I had all the hardware taken out of my back on my third surgery, because it just made it so much worse. My knee pain from an arthroscopic meniscus tear surgery, has never gotten better. I stopped going to therapy because the laser they put on my knee felt like my leg was being electrocuted! As far as opiates go, there’s such a STIGMA attached, and it really makes me angry. I take everything as prescribed; if it takes the edge off so you can at least function, what is the harm? I’m 70. Not someone young who might be running around the streets looking for drugs. I’d rather have the remaining years of my life as pain-free as possible. Opioids have never affected me in the way most people react to them. I don’t get a “high feeling” at all. Of course, that’s the first thing you’re accused of… drug searching. If I’m accused of that, all I can say is “Yes. I’m doing this the legal way. I’m in constant pain, and you’re the only one who has the power to write a prescription.
I’ve had too many surgeries, cut from front to back, hip replacement, and reconstruction of my right foot. I don’t want any more doctors cutting into me.

I am sorry that has been your experience. Have you consulted a comprehensive pain management clinic, such as Mayo and some other places offer? you can read about that here: https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691

My sister told me the same about a "pain specialist"- all he offered was injections - in our large clinical network. But when she asked for more services, was referred for comprehensive evaluation, physical therapy, focused meditation and medication management...similar to my experience.

One thing most pain management programs do stress is that opioids are not effective for long term management of chronic pain, so if you are adamantly opposed to cutting down or giving them up, you will be unhappy with the process.

However, the approach includes training in many tools to deal with the pain and its management - you are not just cut off and left hanging.
Sue

Sue, I find it very hard to “deal” with pain.