Chronic Pain Syndrome: Treatment and Management for CPS

You know it when you feel it. It may be sharp or stinging, hot or aching, dull or prickly. Either way, we call it by the same name: "pain." When it lasts and lasts, it becomes a disorder known as chronic pain syndrome. The condition occurs in a wide range of diseases and conditions, including

• arthritis,
• migraines,
• fibromyalgia,
• back spasms,
• inflammatory bowel disease,
• endometriosis,
• temporomandibular joint dysfunction (TMJ), and
• chronic fatigue syndrome.

In the following slides, our medical experts will describe the sources and causes of pain, signs you may need to monitor it, and many ways to manage it.

Our ancestors thought that pain came from evil spirits or even avenging gods like Poine, the Greek goddess of revenge, from whose name we get the word "pain."

With the help of modern medicine, we now know that pain is a complicated process involving the various chemicals of the brain and spinal column. To start, electrical impulses send messages of pain from specific pain sensory nerves to the brain.

A big role in the chronic pain process is played by neurotransmitter receptors. These receptors are the things our bodies’ chemicals are stimulating when they transmit pain, whether it’s chronic or not.

When the brain reacts to pain, the signal is usually directed to the thalamus. The thalamus is a bulb-shaped object with two roughly walnut-sized halves split at the center of the brain at the top of the brain stem. It relays messages between the brain and various body parts.

There are no medical instruments to measure pain. It affects people differently, and doctors typically rely on a patient's own description of their CPS before recommending pain management treatments.

There are no medical instruments to measure pain. It affects people differently, and doctors typically rely on a patient's own description of their CPS before recommending pain management treatments.

Remember: chronic pain can creep up on you. Even if it starts out as occasional and bothersome, frequent suffering can become serious and debilitating over time.

If you’re serious about ending CPS, walk more. It's one of the best prescriptions we have to ease the suffering of chronic pain.

When you suffer from daily agony, you’re likely to be less active. That often makes chronic pain syndrome worse. Exercise also releases endorphins -- the body's natural painkillers.

Try to find time for walking or other exercise five times a week for 30 minutes. To start off, work up to it slowly, each week adding a few minutes.

Acupuncture has been practiced for more than 2,500 years. This practice of poking needles into different areas of the body was once viewed by many in the U.S. as outlandish. Now acupuncture is a common treatment for some chronic pain, though it remains controversial.

Why does poking needles in the skin seem to help relieve suffering? No one's really sure. It may help release natural painkillers in the body or block pain signals from the nerves. But studies have linked the practice to two potential benefits for those suffering from chronic pain:

• Increased pain threshold
• Long-term chronic pain relief

Acupuncture Styles

There are several different styles of acupuncture, each with a slightly different approach. Some of the most common styles of acupuncture practiced in the United States are:

• Traditional Chinese Medicine (TCM)-based acupuncture
• French energetic acupuncture
• Auricular acupuncture
• Korean hand acupuncture
• Myofacially-based acupuncture
• Japanese acupuncture (also known as meridian therapy)

Check with your doctor before getting acupuncture; be sure to choose a reputable acupuncturist.

Together, chronic pain syndrome and sleeplessness make for a vicious cycle. Not only can it keep you from getting a good night’s sleep, but not getting enough sleep can make the pain hurt more the next day.

Is chronic pain making it hard for you to sleep? Talk to your doctor. It’s also helpful to get into good bedtime habits: keep a regular bedtime and wake time schedule for better overall sleep.

We sometimes think of distraction as a bad thing. Doesn’t distraction keep us from getting our work done? But in the case of chronic pain, distraction can be a type of treatment.

When you're distracted by a conversation, a crossword puzzle, a book, or something else, the areas in your brain that process pain are less active, according to studies. Even on a neurological level, getting your mind off your aches and discomfort really does help.

Is food causing your agony? It's possible. People with migraines often find that specific foods -- like red wine and cheeses -- trigger attacks.

Keep a food diary for a few weeks to see whether any foods seem to make your suffering increase. Then cut them out and see if your symptoms improve.

Pain can be hard to put into words. But you’ll need to describe your suffering to your doctor in order to get the best possible treatment. Make it more concrete by keeping a chronic pain syndrome journal. Using a scale, note how much you hurt each day.

One popular pain scale asks you to rate your painful experiences from 0 to 10, from no pain to excruciating. Other scales use smiling and frowning faces, along with room to add details about what you did that day. After a few weeks, you'll have a valuable record to share with your doctor, making effective treatment more likely.

Stop what you’re doing. Pause, relax, and take just a minute to breathe deeply and slowly. With your hand on your belly, feel it rise and fall.

After a few minutes of using this simple deep breathing technique, you may feel some the discomfort and tension melt away. Want to know what’s great about using deep breathing as a treatment? You can do it anywhere you like, whenever you like -- when you're stuck in a traffic jam, at your desk, or in bed trying to fall asleep.

Tense, weak muscles tend to be linked with chronic pain. Building muscle strength with weights or resistance exercises may help reduce suffering just as effectively as drugs do for arthritis and back pain. Building strength also improves your balance and flexibility. Aim to strengthen muscles twice a week.

There’s another benefit to exercise, too. Stress contributes to pain, and exercise is one of the activities that can help relieve stress, along with sleep and rest.

Biofeedback can teach you how to control unconscious body processes – the ones that normally happen without thinking like heart rate and blood pressure. After attaching to your body sensors connected to a computer, you learn how to

• relax your muscles,
• ease tension, and
• reduce pain.

Biofeedback is most notably used in fighting headaches and painful back conditions.

Want to take supplements for daily soreness? Ask your doctor. Studies show that some supplements seem to help with chronic pain. Stiff, painful, arthritic joints may be relieved from the following:

• Fish oil
• Glucosamine
• Chondroitin sulfate
• SAMe

Yoga is about gentle stretching and mind-body techniques that can help with daily discomforts like sore backs, fibromyalgia, and arthritis. Through studies, regular yoga has been shown to

• ease pain,
• increase function,
• improve mood, and
• reduce the need for medication.

In the old days, people treated their suffering with rest. While a little rest is reasonable with a new injury, such as an ankle sprain, Now, doctors say that while a little rest is OK after a new injury -- like an ankle sprain -- it won't help with chronic pain.

You hurt more, not less, when lying on the couch for too long. Too much rest can also weaken muscles. Try to stay active instead.

Both physical and occupational therapy can help ease chronic pain.

Physical therapy dates back to ancient times, when exercise, massage, heat, and cold would be applied to treat a variety of conditions. Today, physical therapy aims to teach you exercises and offer treatments that help build strength and increase mobility.

From buttoning buttons to cooking dinner, occupational therapy aims to help you work around chronic pain syndrome by teaching you new ways to do things.

Some people are embarrassed to get help from a counselor or therapist for chronic pain. They feel it's an admission that the suffering is not real and that the suffering is "all in their heads." That's simply not true. Therapists can help you cope with the physical suffering and discomfort in your life – and work through practical solutions to the problems you face daily.

If you find yourself relying very often on over-the-counter painkillers to ease your chronic pain, you may be doing yourself more harm than good. OTC (over the counter) painkillers such as

• acetaminophen,
• aspirin, and
• ibuprofen

are good for occasional aches and soreness, but they may be risky if you take them in high doses or for a long period of time without the advice of a healthcare professional. Remember to always follow medication instructions and don't use OTC painkillers for more than 10 days in a row unless instructed and supervised by a doctor.

If you're in chronic pain, you may benefit by seeing an expert. Pain specialists focus on one thing: getting rid of their patients’ discomfort. Many of these experts work at specialty pain centers. Patients can get all sorts of treatment from medication to massage. If you want to find a center for chronic pain syndrome, ask your doctor for a referral or call local medical centers.

Before your doctor's visit, it's a good idea to prepare by thinking about how your suffering feels and how it affects you. By answering these questions, you can help your doctor pinpoint the root cause of a patient's pain, as well as recommend effective treatments.

• Where is it located? Is it in one spot, or spread out?
• How severe is it? If you put it on a scale from 0-10, how would you rank it?
• How long have you been feeling these symptoms?
• Is it constant? Or does it come and go? If it comes and goes, how often does it occur, and how long does it last?
• What are you doing when the symptoms feel worse, and when they feel better?
• What do your symptoms prevent you from doing?
• What triggers your symptoms?

Words to Describe Chronic Pain Syndrome

Chronic pain comes in many forms, and distinguishing one kind of hurting from another can be challenging. Here are some descriptive words that may be useful when describing your condition to your doctor:

• Aching
• Burning
• Cramping
• Exhausting
• Gnawing
• Heavy
• Hot
• Nagging

Painkillers are probably the first medicines you think of for relief. But other drugs can be just as effective in fighting chronic pain. Under the right circumstances, some depression and epilepsy drugs can help, too.

• Antidepressants alter brain chemical levels that affect how much you are hurting, as well as your mood. Epilepsy drugs seem to block pain signals going to the brain.
• Anti-anxiety drugs (benzodiazepines) also help relax muscles, and are sometimes used to fight chronic pain syndrome.

Typically, other medicines are tried before using antidepressants and anti-anxiety drugs. If these drugs are used, they become addictive - use only under a doctor's close care.

Surgery isn’t always an option for chronic pain. But when a patient’s suffering comes from the back or serious musculoskeletal injuries, surgery may be the right option.

Patients have access to a range of surgical options, including operations to correct the underlying cause (slipped disc for back disorders) to implanted pain control devices.

Some surgical options include

• nerve blocks,
• discectomy and microdiscectomy,
• laminectomy, and
• spinal fusion.

Although surgery can bring relief for many patients, it does have its risks and works only in specific circumstances. Talk to your doctor about the possible options, including noninvasive brain stimulation and transcutaneous electrical nerve stimulation (TENS).

It can be tempting during bouts of severe chronic pain to turn to drugs and alcohol. Don't rely on alcohol or illicit drugs. Self-medicating may ease the pain temporarily, but over time substance abuse can make your disorder worse.

Along with other dangers, alcohol and illicit substances can have dangerous interactions with other medications you may be taking. If you're leaning on alcohol or other substances to get through chronic pain, seek help.

Most people with chronic pain find that there is no single, miracle cure for what ails them. Instead, a combination of approaches that is customized for each individual is usually used. That might include things like

• improved habits,
• a new exercise routine,
• medication, and
• therapy.

By taking the time to discover what works, you’ll most likely find a combination that eases your chronic pain.