Meds, mind, and movement team for better pain control
Chronic pain problems best resolved with variety
People with chronic pain frequently undergo a desperate search for a pill or therapy to cure what ails them. But unfortunately, there is no magic-bullet therapy for chronic pain. The key to successfully managing chronic pain is a combination of pharmacological interventions, physical therapy, and behavioral medicine modalities, says David Pacheco, RPH, PAC, pain management clinical specialist at the New Mexico VA (Veterans Affairs) Health Care System in Albuquerque.
That’s why the pain management clinic in this VA system uses a combination of all three interventions to treat chronic pain. "If people only use pharmacy the probability of successful chronic pain management is going to be slim," he says.
Successful pain management requires a change in mindset and behavior as well as proper medication. Chronic pain sufferers often become socially isolated and suffer from depression because these active members of the community suddenly have trouble getting out of bed. "Changes in their life-style augment their stressors, and therefore the pain is increased," says Pacheco.
The goal of treatment for chronic pain patients is to help them retrieve as much of their former lifestyle as they can. Part of the teaching process, however, is to help patients accept their new role in society because, for many, their lives never will be the same.
In consultations with patients, Pacheco tells them that the treatment of their chronic pain is no different than hypertension or diabetes. A single treatment for these diseases may mask some difficulty, but until they start changing their lifestyle, they aren’t really going to get better. Patients must actively be involved in physical activity, mental coping skills, and compliance with their medication. It’s a whole-body approach that includes proper diet as well, says Pacheco.
Patients referred to the pain clinic at the New Mexico VA by their physicians frequently are in pain because of failed back procedures, motor vehicle- or work-related accidents, muscular-type pain such as fibromyalgia, headaches, and pain from arthritis. Following referral, these pain sufferers undergo a series of consultations meeting individually with professionals from pharmacy, physical therapy, and behavioral medicine.
The assessment includes a patient’s history and past treatments for pain, what has worked and what hasn’t. Also, the patient’s goals are assessed, including what they expect to get out of pain management therapy. Patients often think that the modalities available can cure pain, but more than likely that is not the case. "What we try to do is incorporate methods that will help the patient manage pain better," says Pacheco. Patients are advised to sample a variety of therapies to determine what might work.
While trying techniques such as guided imagery or biofeedback is appropriate, it is important that the regimen for pain control includes medication, physical activity, and mind-oriented therapies, says Pacheco.
Patients frequently are not getting adequate relief from pain medications. There are two reasons for patients with chronic pain to take opioids, which are the painkillers, says Pacheco. They produce adequate analgesia, meaning that they make the person comfortable enough to say the pain is tolerable, and they make it possible for the patient to increase physical activity.
"We let it be known early on that we need to know if the pain medication is not adequate so that we can do adjustments or switch medications to find something that will work," says Pacheco. Sustained, or long-acting, medication works best for chronic pain because it provides baseline pain control. Immediate-release pain medications are quickly gone from the system, so they must be taken at frequent intervals to sustain adequate pain control, he says.
In addition to adjusting medications, appropriate physical activity is initiated at the pain clinic. Chronic pain patients who remain active do not deteriorate as much as those who are sedate. Conditioning with physical therapy helped one patient who had been bedridden for many years walk up a flight of stairs, says Pacheco. However, without adequate pain medications, patients will have difficulty moving around so the two go hand-in-hand.
The appropriate physical activity must be determined as well. For some, a series of exercises work well, while others find pool therapy helpful. Exercise in the water allows for less weight bearing on the joints so that people with chronic pain, especially those who are overweight, are better able to be physically active, explains Pacheco. Other forms of exercise that help chronic pain patients include tai chi and yoga, he says.
A good chronic pain management regimen is rounded out with techniques that divert patients’ minds from pain, which tends to be their primary focus. "These are therapies that focus on distraction or helping patients cope with the pain," says Pacheco. This therapy might include teaching the patient relaxation techniques or using music therapy. It also might include helping the patient take up a hobby.
To keep pain under control long after leav-ing the pain management clinic, patients must develop good rapport with their health care provider and work with him or her to determine which medications are appropriate and how to incorporate physical activity and complementary therapies into the pain management regimen. When patients are interested in trying an herbal remedy or a treatment such as acupuncture, they first should do their homework and then speak to their physician, says Pacheco.
Pacheco tells people with chronic pain that they need to have support with their therapy from their provider. If they don’t have strong support from their provider, then they need to find someone who will work with them.
For more information about managing chronic pain, contact:
- David Pacheco, RPH, PAC, Pain Management Clinical Specialist, Pain Management Clinic, New Mexico VA Health Care System, 1501 San Pedro Drive S.E., Box 3D104, Albuquerque, NM 87108. Telephone: (505) 265-1711, ext. 2089. E-mail: [email protected].
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