Expert Tips on Managing Chronic Pain and Enhancing Well-Being

By Jamie Bussin and Andy Donald

Everyone has experienced pain at some point in their life. Babies teethe. Kids scrape their knees. As we get older maybe we break a bone. And as we age we become more susceptible to pain and experience chronic pain more intensely. On Episode #308 of the Tonic Talk Show/Podcast I spoke to Clinical Pharmacist Andy Donald about the nature of pain, and its treatment. This is a digest of that conversation.

There are different kinds of pain – which require definition and explanation:

Acute pain is transient. It might be the result of an injury like a cut or a broken bone.  And it usually resolves shortly (ie. within 3 months).

Chronic pain takes longer to heal, even after the causative injury. Examples are lower back pain, nerve pain or arthritis.

Nociceptive pain is muscle pain.

Neuropathic pain which feels like a shooting or stabbing pain is when our nerves are damaged, perhaps because of micro tears. This type of pain occurs when we have conditions like shingles, diabetic neuropathy or fibromyalgia. 

Pain gets worse as we age. The phenomenon of “war wounds” or old pains that persist can come back to haunt us. But according to Andy, there are two more serious aspects of pain that become worse as we age. 

First, our pain threshold increases as we age and we become less sensitive to low level pain. On the face of it, that might seem like a good thing. However, pain has a purpose. It tells us that something is wrong; for example, that we’re putting too much stress on our joints. Pain tells us to stop what we’re doing and allow our body to heal. So if we can’t feel low levels of pain, that pain may develop and become much worse.

Second, we have less pain inhibition as we age. So once we do notice pain, we are less able to block the sensation of pain. We have fewer endorphins and endogenous opioids (those we produce within our body) which would dampen pain. Repetitive pain sensitizes neurons in our body and our spinal cord, which then means a smaller stimulus of pain can cause a bigger amount of pain

Pain, Sleep and Mood: Approximately 50 to 80% of patients who have chronic pain have a significant sleep disturbance. If you can’t sleep and you’re in pain, it’s a cardinal symptom that can cause depression. This creates a perpetual cycle: if you can’t sleep, your body can’t heal and make endogenous opioids, and the pain continues or perhaps increases.

Lifestyle choices: Maintaining regular exercise, particularly movement, is crucial to managing chronic pain. If we don’t build or maintain our muscles, they weaken around our joints and bones which puts extra strain on our frame and will lead to further damage and resultant pain.

Of course it’s hard to exercise if you’re in pain. But even low impact activities like walking or swimming can maintain muscle mass while putting less stress on your joints. Another way to reduce stress on your frame is to maintain a healthy weight. And as mentioned above, sleep is crucial to allow your body to repair.

Residual chronic  pain from injury can sometimes be treated by the application of heat or cold. Ice packs or gels for cold, hot compresses, capsaicin or tiger balm for heat.  The science behind such treatment is a bit counterintuitive. Dull heat or cold overwhelms the pain receptors so that it ignores the chronic pain.

TENS therapy uses overstimulation of electronic signals to drown out chronic pain. But one has to be careful utilizing TENS therapy as it mutes our body’s response to pain – and therefore should not be used for acute pain.

Over the counter drugs: There are many commonly used over the counter drugs for pain relief. Andy recommends Tylenol for chronic pain, but anti-inflammatories for acute pain. Anti-inflammatories are appropriate for short term use, but shouldn’t be used in long term applications as they can impact stomach ulcers, your kidneys or even contribute to heart disease. 

Prescription drugs are designed to deal with more specific types of pain. And they are better at dealing with more severe pain. If you’re suffering from nerve pain, you want a drug specifically designed to deal with neuralgic pain. Similarly, you wouldn’t want to treat a lesser pain with an opioid.

Andy says there are approximately 40-50 prescription drugs which can help with nerve pain, but focuses on a few: “ Cymbalta (duloxetine) which is actually a mood medication that helps with depression and serotonin. Or epinephrine (adrenaline), which naturally does decline with age. There are a couple of anticonvulsants – gabapentin or pregabalin, which is Lyrica. Some of these drugs will have different side effects. Gabapentin can make you more drowsy and you can gain more weight. So you’ve got to kind of weigh out the pros and cons for these drugs.” 

Whether you’re taking prescription drugs or utilizing any of the above referenced treatments, make sure that you talk to your doctor, or your pharmacist, to see which is right for you.