What can I do about persistent pain?
Although no cure exists for persistent pain, this does not mean that nothing can be done to improve your symptoms. There are many things that contribute to pain and learning how to work on each of these is usually the best way to improve your symptoms. Regularly exercising, gradually exposing your body to normal movements, improving your sleep and focussing on your mental health and emotional wellbeing can all improve pain and function. Learning how to make changes in how you do your day-to-day activities can also be helpful in managing your symptoms.
Persistent pain is often caused by our nerves becoming too sensitive. Gradually getting things moving helps to de-sensitive the nerves and get them used to doing that activity again. If a movement is painful, do a slightly easier version of it on a regular basis. It will gradually get easier and you can then increase the difficulty of the activity. Try to avoid doing so much of an activity that you can’t do it again for several days. The body responds best to doing activities little and often at first.
Exercise can help pain in a number of ways. Firstly, moving the body helps to de-sensitize the nerves which play a part in persistent pain. Exercising also stimulates your body to release chemicals which can help to reduce pain and de-sensitize nerves. Finally, regularly exercising helps to build strength and fitness which will make doing activities easier.
Improve your sleep
We know that a lack of refreshing sleep will make your pain worse and in some cases can actually be the main cause of pain. Likewise, getting too much sleep or sleeping during the day can also make problems worse. Try to establish a routine, avoid daytime naps and cut down on the amount of caffeinated drinks, alcohol and cigarettes you consume, particularly before bedtime. Click here to learn more about strategies to help improve your sleep
Pace your activities
Many people with persistent pain experience good and bad days. People often cram as much activity as possible into days when they have less pain, but find that their pain is much worse the next day. Aim to do similar amounts of activity on all days, even when you may be feeling worse than usual. Making a plan, rather than seeing how you feel at the time, can be helpful in setting sensible activity levels. More information can be found on pacing here
Many people find that their pain limits how much activity that they can do. Although it is not always possible to get straight back to the things you used to do, setting goals can be a helpful way to gradually get back to doing your usual activities. Think about which activities are most important for you to get back to doing. Choose one or two activities to start with and set your goals around this.
Try and set realistic targets and try to stick to these. Think about how long it is since you last did the activity. If it has been a long time you will probably need to do a smaller amount at first than you used to do. Also think about what happened last time you tried the activity. If it made you feel lots worse afterwards, make the goal easier to start with. If you were just a little worse, remind yourself that this is normal until your body gets used to doing it again. Often, good goals to start with are activities that you miss doing or things that make you feel down because you can’t do them (e.g. hobbies or socialising). Once you have done the activity think how this has affected your mood. Does it feel good to be doing it again? Has it given you a sense of achievement? Once you achieve one goal, make a new, slightly more difficult one. By doing this you should find that you can gradually build up your activity levels over time.
Take care of your mental health
Your mood can have a big effect on your physical health, and vice versa. Scientists who study the brain have shown us that if you’re stressed or feeling low you experience much more pain than when you’re feeling happy. Many people with symptoms of pain become very frustrated that they cannot do things as they would like. This can lead to anger, anxiety, low mood and loss of confidence. For some people simple steps, such as making sure you do an enjoyable activity each day, can be enough to improve their mood. For others, talking therapies can be extremely helpful in managing stress, anxiety or low mood. Occasionally peoples’ mood can be so low that they need medication to help to return the chemical imbalance in the brain to normal and allow them to engage with other treatments. Getting some support with from a psychological therapist who understands pain can be really useful in beginning to reduce the pain you feel. If your pain clinician has not already done so, you can refer yourself for talking therapies here.
Reflect and accept
Recognise that symptoms will be worse at some times than others. Sometimes there will be a physical reason for this (such as over-doing an activity), however, there may not always be. Reflect on what you have and haven’t been doing recently. Have you been exercising? Are you under more stress or feeling low? Have you been using the strategies that have helped you in the past? It is often what you haven’t done, rather than what you have done that causes symptoms to worsen.
Have a flare up plan
Unfortunately, people with persistent pain can experience times when their pain is much worse than at others. This is known as a flare up. This does not usually mean that you have done anything wrong and flare ups can happen even if you manage your symptoms as well as you can. However, if you do experience a flare up, there are certain steps that you can take to make sure that your symptoms settle and you get back to your normal activities as quickly as possible. Although short periods of rest can be helpful, prolonged bed-rest is likely to mean that your flare up lasts longer. It will also mean that getting back into activities will be harder. Try to do some simple exercises to get the painful body part moving and gradually build your activities up over time. Further information about managing a flare up can be found here
Very occasionally an increase in symptoms can be due to a different problem. If an increase in symptoms is associated with weight loss, feeling generally unwell or other new symptoms speak to your GP. If you have problems with back pain and you develop any of the following problems you should attend A&E immediately:
- Numbness or loss of feeling around the genitals or back passage
- Losing control of your bladder or bowels
- Not being able to pass urine
- Not knowing when you need to pass urine
- Loss of the ability to achieve an erection
- Loss of feeling during sexual intercourse