En español l We are a nation in pain. Sharp, burning, nagging, achy, throbbing, can't-sleep-at-night pain. Some of it is temporary — what docs call "acute" pain — from a hammered thumb, say. Chronic pain, though, not only lasts long after the initial trauma but also transforms our brains and nervous systems into hurt machines, pumping out pain, day after dismal day. The more we learn about pain, however, the more we learn of ways to put an end to it. Here are six ways to take back control.
Strategy No. 1: Don't let it start
As if you needed one more reason to get moving: Research shows that people who exercise as well as those who meditate are less likely to suffer from chronic pain, perhaps because those two activities alter the brain in some protective way.
In fact, researchers at Northwestern University recently found that "the structure of a person's brain may make one more susceptible to chronic pain," says study author A. Vania Apkarian. He envisions that one day, diagnostic brain scans for people in pain will become routine to identify those most at risk. "Early treatment does seem to keep the brain from reorganizing itself into the patterns associated with chronic pain," Apkarian explains. His team is now using brain scans to see which treatments work best for people with particular types of pain. "It's coming," he says. "That's where we're going."
Strategy No. 2: Figure out exactly what type of pain you have
Doctors used to identify pain by its cause — an injury, an illness or an infection — so people would talk about arthritis pain, cancer pain or back pain. Increasingly, though, docs identify pain by the way it affects the nervous system. This is good info to have if you're trying to stop such pain.
Inflammatory pain occurs as the result of a specific trauma, which causes your body to release pro-inflammatory cytokines that stimulate your nervous system and promote healing. This is good, but for some, the inflammatory response never turns off, causing chronic pain.
Dysfunctional pain can be triggered within the brain in the absence of obvious trauma, inflammation or damage to the nervous system. Fibromyalgia and irritable bowel syndrome are common examples of dysfunctional pain.
Neuropathic pain is caused by damage to the nerves themselves, and can be triggered if nerves are cut during surgery; pinched, as with a bulging spinal disk; or targeted by viruses, such as the chicken pox virus, which causes shingles.
Strategy No. 3: Know that it's real
One of the greatest challenges faced by people with chronic pain is that some people don't believe them — occasionally not even their own doctors. A team of Stanford University researchers, however, has recently found a way to diagnose pain using functional magnetic resonance imaging (fMRI). That means they can look at your brain and prove you are hurting. In addition, University of Colorado neuroscientist Tor Wager has used this technique in research to confirm that someone is in pain. "And, if medication or other treatments have helped, we can see which parts of the brain have changed," he says.
Strategy No. 4: Treat it right away
Why? Well, it hurts, for one thing. Also, chronic pain can lead to depression, possibly because your body responds to pain by releasing serotonin and norepinephrine, two brain chemicals that affect mood, too. But the real reason you need to get your chronic pain under control — and fast? Chronic pain may reduce the volume of brain tissue by as much as 11 percent, which can age you 10 to 20 years. This finding, in people with chronic low-back pain, has since been confirmed in people with fibromyalgia, irritable bowel syndrome and headaches.
Strategy No. 5: Try non-drug treatments first
Many people who suffer from chronic pain understandably reach for medication as soon as they feel the pain coming on. But a large body of research shows that some nondrug treatments can work just as well, if not better. These are a few.
- Acupuncture works by triggering the body's natural opioids — endorphins. It's best for those with back pain.
- Cognitive behavioral therapy helps sufferers learn to correct negative thoughts and behaviors. It's helpful in reducing the tendency to catastrophize.
- Meditation reduces pain by altering activity in four pain-processing areas of the brain. Longtime meditators seem to get less chronic pain in the first place.
- Spinal cord stimulation, in which an electrode is implanted in the space around the spinal cord, can often help failed-back-surgery syndrome, when back surgery has left a person in worse pain than before.
- Deep brain stimulation, another invasive procedure, involves putting electrodes in certain brain regions; it has been used for more than 50 years, though researchers are still not clear on exactly how it works.
Real-time functional magnetic resonance imaging (rtfMRI) is a new approach with exciting potential. Sean Mackey, chief of the Division of Pain Medicine at Stanford University, used the technique to see if people could control isolated regions of their brain — "and if they could," he asked, "would that lead to increased control over pain?" The answer to both questions was yes. Study participants used cognitive strategies — such as telling themselves the pain was not so bad — to dampen the pain response, all while sitting in an rtfMRI scanner and watching and controlling their brains in real time.
Strategy No. 6: Take the right drugs for your pain
Certain drugs work better for certain conditions, research shows. Here's what to take if you have:
Tension headaches, low-back pain: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve)
Migraines and cluster headaches: Triptans such as sumatriptan (Imitrex) and rizatriptan (Maxalt)
Rheumatoid arthritis: Methotrexate, Plaquenil and biologic therapies
Fibromyalgia: Pregabalin (Lyrica) and antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella)
Irritable bowel syndrome: Antidepressants such as amitriptyline (Elavil) and antispasmodics such as dicyclomine (Bentyl) or hyoscyamine (Anaspaz, Cystospaz and Levsin), pinaverium (Dicetel) and cimetropium bromide (Alginor)
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