Related topics: •  Fitness Finder •  Guided Imagery •  Ice and Heat Packs •  Pain Management 101, Part 1: Harness Your Mind •  Pain Management 101, Part 3: Alternative Therapies •  Quiz: Do You Know Your Pain Relievers?

No one can be more of an expert on your pain than you -- you're the one who feels and experiences it. Pain is personal, and when it comes to relieving pain, what works for one person may not work for another. Also, pain relief isn't an exact science -- you may need to try several things before you find what works for you. But with a little persistence and an open mind, you should be able to find ways to live more comfortably with less pain.

In the previous class, we covered ways to take charge of your situation and use your mind to overcome some of the pain you experience. In this class, we'll cover various self-care options -- over-the-counter drugs, heat and cold, exercise, and two relaxation techniques -- to help you manage your pain and improve your quality of life.

Many times the first line of defense against pain is an over-the-counter pain reliever. These can be effective, but watch your dosage -- it's easy to take too much. Some of the same ingredients in pain relievers are also found in cough and cold medicines, so read the labels carefully and follow the dosage instructions. Keep in mind that many products, such as Excedrin, have combinations of different drugs to increase their effectiveness. It's a good idea to talk to your doctor if you're planning to take OTC pain relievers regularly. Long-term use can lead to side effects such as stomach bleeding and kidney or liver problems.

There are two types of over-the-counter pain relievers: Those that relieve pain and reduce inflammation (called nonsteroidal anti-inflammatory drugs, or NSAIDs), and acetaminophen ( Tylenol), which only reduces pain.

•NSAIDs include medications with aspirin, ibuprofen (Advil, Motrin), ketoprofen (Orudis), or naproxen sodium (Aleve). If inflammation is causing your pain, then a NSAID may be a better choice than acetaminophen, but these drugs do have a downside. In 2005 the U.S. Food and Drug Administration requested that the manufacturers of NSAIDs add warning labels to alert consumers about the risk of heart problems and gastrointestinal bleeding associated with heavy or long-term use of their products. Take the lowest dose you need to control your pain to reduce the risk of side effects.

•Acetaminophen's best-known brand name is Tylenol. While acetaminophen is gentle on the stomach, it isn't completely worry-free. Very large doses of acetaminophen can overwhelm and destroy the liver, like many other drugs. Even at regular dosages, acetaminophen combined with alcohol or other toxins can damage the liver. Since 1998, the FDA has required all pain relievers and fever reducers -- including acetaminophen products -- to carry a warning label advising people who drink three or more alcoholic drinks a day to check with their doctors before taking the drug.

Topical NSAIDs penetrate deep into the skin and may deliver local pain relief without the gastrointestinal side effects. A 2004 review of studies of topical NSAIDs found that topical ointments and patches are as almost as effective as oral versions for the first two weeks of use. After two weeks, the review found that they lose their effectiveness, so the reviewers suggest that they are not a useful long-term treatment for osteoarthritis pain or stiffness.

Many ointments use a variety of drugs and chemicals called counter irritants because they counter pain by irritating the skin instead of penetrating deep inside like topical NSAIDs. Salicylates, a class of drugs related to aspirin, sometimes act like NSAIDs and sometimes as irritants. Studies of the active ingredient trolamine salicylate (found in Aspercreme and Sportscreme) have found it isn't significantly effective against osteoarthritis pain. However, it can be effective at delaying and reducing muscle soreness from exercising.

Other creams use camphor, menthol, and other drugs to create cool, warm, or numbing sensations. These include Bengay, Icy Hot (both contain methyl salicylate and menthol) and Tiger Balm (which uses camphor, menthol, and other herbal oils). They may temporarily relieve mild muscle aches, but aren't much use against chronic pain. Creams, gels, and sprays containing an herb called arnica are popular for preventing and relieving muscle soreness and joint pain, but there is no good evidence that arnica really works.

Capsaicin -- the ingredient that makes chili peppers hot -- is another irritant used to temporarily relieve pain. Capsaicin initially causes a burning sensation, but eventually desensitizes your nerve endings so that they can't transmit pain signals. It normally takes a few weeks of use to notice much relief. Ointments with capsaicin include Capsagel and Zostrix and are most effective in relieving arthritis pain in joints that are close to your skin's surface, like finger joints. In some cases, capsaicin may help relieve the pain of nerve damage from shingles and diabetes.

Heat packs and warm showers or baths can ease pain by relaxing tense muscles and stimulating blood circulation. Your neighborhood drugstore probably has electric heating pads in stock, as well as gel-filled ones you can heat in the microwave and the new temporary pads you apply like bandages.

Cold packs numb the nerves and help reduce swelling and inflammation. You can store gel-filled ones in the fridge or freezer so they're ready to use. In a pinch, bags of frozen vegetables make a handy cold pack, or you could use a freezer bag filled with ice cubes.

Whether you use heat or cold, be sure to place a towel over your skin first to protect it, and only apply the heat or cold for 15 to 20 minutes at a time. Your skin will probably look pink after the application, but if it looks blotchy or blistery, you’ve used too much heat or cold. Always let your skin temperature return to normal before applying another hot or cold pack.

When you hurt, exercise is probably the last thing on your mind. Avoiding exercise, however, can cause you to lose muscle tone and strength, reduce your cardiovascular conditioning, and actually increase your pain. It's a good idea to talk with your doctor about which kind of exercise is best for you. He or she can help you come up with appropriate activities and exercises.

Exercise helps on a number of levels: It increases your strength and flexibility, making it easier for you to get around and avoid injury. (Strengthening your muscles is especially important if you have arthritis because it makes it easier for them to support your joints, which then reduces pain and inflammation.) It also releases endorphins -- your body’s natural painkillers -- which relieve tension and make it easier to sleep.

Some good choices:

•Swimming and water aerobics are excellent low-impact exercises for people in pain. The water absorbs about 70 percent of the effects of gravity, making it easier to move around without putting too much strain on the body. But a word of caution: It feels easier to move in water, so you might be tempted to overdo it your first few times. Start with less activity than you think you can do and work up from there.

•Walking -- on a treadmill or even around the block -- is a good exercise to start with when you haven't been exercising for a while. Start by walking for five minutes, and build up from there.

•Yoga or Tai Chi are both good exercises for people in pain because they can be modified to suit your mobility. They also help reduce stress, which can increase pain. You will need a class or instructor to get started, but later you can practice on your own or with a video.

Sometimes relaxation is more than just taking it easy -- it can actually be therapeutic. In the mid-1970s, cardiologist Herbert Benson and his colleagues at Harvard Medical School identified something they called the "relaxation response" that benefits the body in several important ways. Different than simply relaxing with a book or by listening to music, the relaxation response refers to a specific state in which the body's metabolism, heart rate, and breathing rate slow down, blood pressure lowers, and brain waves are altered. When practiced regularly, the relaxation response can reduce pain and stress and help you sleep more comfortably, too.

There are a number of ways you can achieve the relaxation response, including through meditation, hypnosis, and biofeedback. In this class, we'll focus on progressive muscle relaxation and visual imagery -- two methods you can easily practice at home without specialized training.

This technique is just what it sounds like -- systematically tensing and relaxing each group of muscles in turn, starting with the feet and working your way up the body. It's important to breathe deeply and easily throughout the exercise. If it is too painful to tense a particular muscle group, skip it and move on to the next. Do each step of the exercise deliberately, consciously focusing on tensing your muscles and then feeling the tension leave your body during the relaxation phase.

To begin, sit in a comfortable chair and rest your hands in your lap.

Take several deep, calming breaths. Concentrate on breathing through your diaphragm. In diaphragmatic breathing, your stomach expands as you inhale and flattens as you exhale.

1. Feet and calves

•Flex your toes up, tensing the muscles in your feet and calves.

•Hold the tension for a couple of seconds.

•Take a deep breath.

•Relax your muscles as you exhale. Say the word "relax" out loud or in your mind as you feel the tension leave.

2. Knees and thighs

•Squeeze your knees and thighs together, feeling the tension.

•Hold for a couple of seconds.

• Relax your muscles as you exhale. Say the word "relax" out loud or in your mind as you feel the tension leave.

3. Hips and buttocks

•Tense the buttocks by squeezing the muscles together.

•Hold the tension for a couple of seconds.

•Take a deep breath.

•Exhale and relax your muscles, repeating the word "relax" as you do so.

4. Abdomen

•Press your belly button toward your spine, tensing your stomach muscles.

•Focus on the tension and hold for a few seconds.

•Take a deep breath.

•As you exhale, let the tension go and say the word "relax."

5. Back

•Draw your shoulder blades together around the spine, contracting the muscles of your back.

•Feel and hold the tension for a couple of seconds.

•Take a deep breath.

•Release the tension as you exhale, saying the word "relax."

6. Arms and hands

•Turn your hands so the palms are facing down, and make a fist with each hand. Raise and stretch both of your arms out while clenching your fists.

•Feel and hold the tension for a couple of seconds.

•Take a deep breath.

•Exhale and release the tension as you say the word "relax."

7. Chin, neck, and shoulders

•Drop your chin to your chest and shrug your shoulders up toward your ears.

•Focus on the tension and hold it for a couple of seconds.

•Take a deep breath.

•Exhale while you release the tension and say the word, "relax."

8. Jaw and face

•Clench your teeth and tense the muscles of your jaw. Turn the corners of your mouth up, wrinkle your nose, and squeeze your eyes tight.

•Feel the tension in the center of your face and hold it for a couple of seconds.

•Take a deep breath.

•Relax all your facial muscles, exhaling and saying "relax" as you do so.

9. Forehead

•Raise your eyebrows and tense your forehead and scalp muscles.

•Feel and hold the tension for a few seconds.

•Take a deep breath.

•Relax your muscles as you exhale and say the word "relax."

10. Relax throughout your body

•Feel relaxation flowing like a waterfall from the top of your head,

•Over your shoulders,

•Down the back of your neck and shoulders,

•Over your chest and stomach,

•Through your hips and buttocks,

•Into your thighs, then your knees and calves,

•And finally into your ankles and feet.

•Continue to breathe deeply and feel relaxed for a few minutes.

11. Finish the exercise by counting back from 3:

•3 -- Let awareness of your surroundings come into your consciousness.

•2 -- Move your limbs and rotate your head.

•1 -- Open your eyes and feel refreshed and relaxed.

Where the tense and relax exercise focuses on your body, the visual imagery exercise flexes only your brain. This exercise has four parts. First you'll go to the place in your imagination. Next, you'll travel deeper into this place. You'll spend some time there experiencing the calming effect of your imaginary location, and then finally you'll return.

•To begin, sit or lie in a comfortable position.

•Take several deep, calming diaphragmatic breaths. Close your eyes.

•Think about a beautiful, relaxing place. It can be a real place you've visited in the past, a place you've seen in a movie or on TV, or it can be completely imaginary. You decide.

1. Enter your image. Use all of your senses to explore the image. What can you see? Can you smell the ocean? The forest floor? What sounds do you hear? What do you feel? Is there a breeze? Is it warm or cool? Can you taste the salt in the sea air, or the sweetness as you bite into a crisp apple in an orchard? Spend some time concentrating on each sense and what it tells you about the place you've chosen.

2. Take several deep, calming breaths. Travel deeper and deeper into your chosen place. Hear the noise your feet make as they make each step. Do you hear new sounds, or is it getting quieter the deeper you go? Open all of your senses to this experience. This is your own special journey. Continue until you feel you are in a very private place where you feel comfortable.

3. Take several more deep, calming breaths. Now you are in your special, private place. Feel how soothing and calming it is. Listen to the sounds and feel the textures of this place. Stay in this place for several minutes and allow your imagination to roam freely, enjoying everything this place has to offer.

4. Before you return your awareness to your body, notice how your body feels. You will want to remember this feeling in the future. Think of what you like best about this place so you can recall it later. When you are ready to leave your private place, count backwards from 3:

•3 -- Become aware of your surroundings.

•2 -- Move your feet, legs, and hands, and rotate your head.

•1 -- Open your eyes and feel refreshed and relaxed.

Pick a few times a week to practice both of these techniques. It may help to record the instructions on a tape recorder, so you won't have to open your eyes to read them. If you do this, allow enough time between instructions so you aren't rushed between steps. You can also buy relaxation tapes that will help guide you. The more you practice these techniques the easier they will be -- and the more benefit you'll receive.

What to do next

Use our Relaxation Practice Sheet to help you keep track of when you do these relaxation response exercises and note how they affect your pain levels. Don't give up if you don't see results the first few times. Keep at it and you may be surprised by how much they change your awareness of your pain and increase your sense of well-being.

In the next class, we will cover alternative therapies -- including acupuncture, hypnosis, biofeedback, and massage -- that you can explore with the aid of a health professional.

Further Resources

American Chronic Pain Association
PO Box 850, Rocklin, CA 95677
Phone: 1-800-533-3231
http://www.theacpa.org/

American Pain Foundation

201 North Charles Street, Suite 710

Baltimore, Maryland 21201-4111

1-800-615-PAIN (7246)
http://www.painfoundation.org

References

First published June 14, 2006
Last updated May 14, 2008
Copyright © 2006 Consumer Health Interactive

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