Chronic pain: Expert pain management advice

For many people, chronic pain can negatively impact not just their mobility but also their mood. In fact, living with persistent pain can be both physically and mentally exhausting. So, we spoke to YourGP’s Dr Phimister about the most common areas of pain and the best ways to deal with it. Here he talks openly about the shortfalls of some prescribed painkillers, and provides some eye-opening advice about ‘reprogramming’ your perception of pain…

A common problem
The most common areas affected by pain are usually the neck, back, hip joints and knees. The cause is often myofascial pain syndrome, which is pain in the knotted muscles and tightened fascia, or osteoarthritis. Generally, patients come to see me after 1-2 weeks of experiencing the pain and it not subsiding.

Is medication the answer to the problem?
The most common treatment for chronic pain is prescribed medication by GPs. This includes co-codamol 8/500 or 30/500, with 8mg or 30mg codeine, along with 500mg paracetamol.

Other options include topical non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the risk of adverse effects of these oral medications. Or oral NSAIDs with a gastric protective drug like omeprazole to prevent peptic ulcers. Or finally, neuropathic medications like gabapentin, pregabalin and amitriptyline.

Physiotherapy is commonly prescribed too. But what these modalities all fall short of is optimally treating chronic pain.

Essential lifestyle changes
There are several lifestyle changes that can make a major difference to an individual living with pain:

• Exercise: Keep moving! Start with small steps and increase to 150 minutes of walking per week. Choose whatever exercise you love, do it and enjoy it! Consider weights and resistance training in the gym or at home as building muscle is key to optimal metabolic health.
• Eat a healthy diet: First, cut out as much processed foods as you can. Instead, aim to eat a clean, nutrient-dense diet with lots of vegetables and low sugar fruits. Opt for grass-fed beef/meat, organic chicken and wild fish, or meat alternatives if vegetarian or vegan. Choose gluten-free grains, non-cow dairy milk and cheese, and plain nuts. Cook with coconut oil and pour extra virgin olive oil liberally on your salad and vegetables to optimise absorption of natural vitamins and reduce inflammation in the body. Foods that support your natural microbiome, such as fermented kefir, kimchi, and yogurt with live active cultures, will help to reduce inflammation in the gut, brain and nervous system, and help to reduce pain.When it comes to drink, aim for 1.5-2.0 litres of water daily. For teas and coffee, limit to 2-3 daily and don’t add sugar or sweeteners. Avoid diluting, fizzy and fruit juices, as well as energy drinks which are too high in sugar and caffeine for health.
• Get enough sleep: Try to get around 7-9 hours of quality sleep every night to enable your body to rest and recuperate. And when possible, keep to a routine – go to bed and get up at the same time everyday.

There is another way
From my experience, I have found that releasing the tightened myofascial tissues is an important step towards reversing or reducing the physical component of treatment.

CBT (Cognitive Based Therapy), PRT (Pain Reprocessing Therapy), ACT (Acceptance Commitment Therapy) with Mindfulness Based Stress Reduction Therapy are all essential tools for a person in chronic pain.

With regards to CBT, it is important to realise that all chronic pain has the brain program of “fear” attached to it. So move your body with the idea that you are safe to make small movements. Say to yourself repeatedly “I am safe, I am safe” while you reprogram the brain to heal the pain. Increase exercise slowly when you start to feel safe.

When pain is less than 5/10 on a scale of 0-10, hang out with it, feel it without judgement – remember, it’s a sensation you are experiencing. Don’t judge it as bad. Be aware the pain will get worse some days – that’s normal and not a sign of damage or threat.

Be focused on other sensations in the body, for example the beauty of nature through sight, the sound of the wind blowing, the taste of your coffee, the smell of a flower and touch of your skin as you hold an object. Focusing on other sensations stimulates more areas of the brain to effectively rewire the program, reduce or even eliminate pain in some cases.

Speak to someone who understands
Dr Phimister has years of valuable experience helping people manage their pain. If you would like to discuss all the available options with him, just email reception@your.gp or call us on 0131 225 5656 and we’ll be happy to arrange an appointment.