Mar 9, 2011 7:33 PM
When you have chronic pain, it's hard to sort out the myths from the facts. To feel better, are you supposed to rest in bed or go jogging? Should you talk to your doctor about trying potent opioid painkillers or should you steer clear? Is it worth trying that "miracle cure" that your co-worker absolutely swears cured her sciatica?
Chronic pain is a serious and debilitating condition. Many people suffering with chronic pain are so desperate for help that they're willing to believe anything -- and as a result buy into some chronic pain myths that could be unwise and even dangerous.
To help you separate the chronic pain myths from the facts, WebMD turned to noted pain management specialists. Here's what they had to say.
Treating chronic pain is just not that simple.Yes, sometimes treating the cause does resolve the pain: if you have a tack in your foot, you remove the tack. Anyone with chronic pain must get a complete work-up by a doctor to see if there's a treatable problem or disease, says Anne Louise Oaklander, MD, PhD, an associate professor of neurology at Harvard Medical School.
But in many cases, the intersection of an underlying cause and pain is more complicated. Painful diseases might be chronic and hard to control. Sometimes pain lingers even after the original cause seems to have been resolved. Other times, the cause of pain is just plain mysterious.
"With some people, we run all the tests but we just can't figure out what's causing the pain," says Steven P. Cohen, MD, director of pain research at Walter Reed Army Medical Center in Washington, D.C. "We can't come up with a diagnosis."
People with chronic pain often need a two-pronged approach: get treatment for the underlying cause (if there is one) and separately get treatment for the pain itself. That often means seeing a pain expert as well as other doctors.
Pain experts say that too many people still struggle through life with chronic pain for no reason. People think that if their pain is bearable, it's not worth asking a doctor about it.
However, you need to get pain evaluated, even if it's mild. First, it could be the sign of underlying disease or health problem that needs treatment. Second, treating pain promptly can sometimes prevent it from turning into hard-to-treat chronic pain.
Beyond that, it's always important to take pain seriously in its own right. Chronic pain is insidious. It sneaks up on people, worsening slowly and imperceptibly.
Without realizing it, you might develop unhealthy ways of coping with it. That might include using over-the-counter painkillers for a long time or at high doses, which can have serious risks. People with chronic pain are also at higher risk of relying on alcohol or other substances to numb their pain.
Over time, chronic pain can also lead to sleep deprivation, social isolation, depression, and other problems that can affect your relationships at home and at work.
The old medical advice for people with some types of chronic pain - such as back pain -- was to rest in bed. But that's not the case anymore.
"Now we know that for almost all types of chronic pain conditions, not just spinal pain, [prolonged] bed rest is almost never helpful," says Cohen. "In some cases it will actually worsen the prognosis."
It turns out that for most causes of pain, keeping up your normal schedule -- including your physical activity -- will help you get better faster.
Of course, there are some situations where rest is important -- especially for a day or two after an acute injury. So always follow your doctor's advice.
Pain experts say there is one particularly damaging myth about chronic pain. Too many people think that pain is just a sign of aging and that there's not much to be done about it.
"I think unfortunately too many doctors believe this," says Cohen. "They see an older patient with pain and don't think anything of it."
It's unquestionably true that our odds of developing a painful condition, such as arthritis, are higher as we age. But those conditions can be treated and the pain can be well-controlled. So no matter what your age, never settle for chronic pain.
For many people, chronic pain is intertwined with depression -- as well as anxiety and other psychological conditions.
"There's a very complex relationship between pain and depression," says Cohen. "Pain can be a symptom of depression, and depression can certainly worsen the diagnosis of pain." It's a cruel combination. Often, it's impossible to tell where one cause ends and the other starts.
Of course, some people with chronic pain don't like this idea. They feel that accepting a psychological connection to pain implies that they're making it up, that their pain is "all in their heads." But that's not the case at all.
Depression and anxiety disorders are real medical conditions. Studies have also shown a clear connection between emotional trauma and pain disorders. Brain imaging studies have actually found that physical and psychological pain activates some identical areas in the brain, says Seddon R. Savage, MD, incoming president of the American Pain Society. Acknowledging that chronic pain and depression are connected in no way diminishes what you're feeling.
Also, some antidepressants have been shown to help manage certain types of chronic pain. Your doctor might suggest an antidepressant for your chronic pain, even if you are not depressed.
We've all read sensational stories of celebrity addiction. So it's no surprise that many people with chronic pain fear that taking opioids will result in drug addiction. As a result, some people with terrible chronic pain refuse medication that could really help them.
"When they're taken in the short-term and used as directed, the risk of becoming addicted to an opioid medication is very, very low," says Cohen.
There are instances where doctors need to be especially careful with opioids, says Oaklander. For instance, people who have a strong personal or family history of addiction are at higher risk. "But even they can use these drugs safely in some cases," she says, "although preferably with the guidance of a pain specialist."
Although opioids are effective at treating pain, they are not the Holy Grail of pain relief. Some people think that if they could only get their doctor to give them a prescription, their troubles would be over.
"There's a big downside to treatment with opioids," says Cohen. They're not effective with all types of pain. They can cause unpleasant side effects. A physical dependency can develop if pain management and treatment is not monitored. That's not an addiction -- instead, their bodies acclimate to the medication. Over time they need higher doses to get the same level of relief.
Opioids seem to increase the risk that other treatment approaches will fail. There's even evidence that opioids can result in chronic pain, Cohen says. A person with mild, occasional headaches might develop chronic, debilitating ones after using high doses of opioids.
So depending on the cause of your chronic pain, opioid painkillers might help. But they're not the universal "best" treatment for chronic pain. They're just one tool among many others, from anti-inflammatory medicines to alternative therapies such as acupuncture.
"People with chronic pain often have this misconception," says Savage. "They think that they'll be able to find this one perfect treatment that will cure their pain."
Maybe it's a new drug or a new surgical technique that they read about in the paper. Or maybe it's a device or a supplement they see advertised on a 3 a.m. infomercial. But they're hoping that there's one answer for them that will take their pain away completely.
Coping with chronic pain is rarely that simple. Savage says that tackling chronic pain often requires a team of experts using a combination of approaches -- different medications, physical therapy, psychological counseling, relaxation techniques, and more -- to get it the pain control.
Adopt realistic expectations. You will get better, but it will take some hard work, different treatments, and time.
It's unfortunate but true. "Someone who has had ongoing back pain for 18 years shouldn't expect that after few visits to a pain doctor they'll be cured," says Cohen. "Managing chronic pain is usually a long process."
But don't get discouraged. Even if experts can't make your chronic pain disappear completely, treatment can still make a big difference. Pain isn't everything, after all -- it's how your pain affects your quality of life that matters most.
Maybe you'll still have some pain after treatment. But if treatment restores your ability to do things that your chronic pain prevented -- whether it's going for long walks, or crocheting a blanket, or returning to work - it's worthwhile.