WHEN THE DRUGS DON'T WORK...
FOUR IN 10 OF US LIVE IN CHRONIC PAIN, YET RESEARCH SUGGESTS PAINKILLERS MAY NOT RELIEVE IT. MICHELE O’CONNOR LOOKS AT ALTERNATIVES
MOST of us reach for pills when we’re in pain. But new guidelines from NICE, the National Institute for Care and Health Excellence, say there is “little or no evidence that commonly used painkillers are effective” for chronic pain. That is defined as pain that persists or recurs for more than three months, no matter the cause.
It appears that, on average, a third of people do not get significant pain relief with paracetamol, a third do not respond to codeine and only 60% of people will benefit from non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
“This is because the genes we inherit influence how we respond – and the speed at which the drug is broken down and cleared from the body,” explains Dr Sarah Brewer, GP and medical director for Healthspan.
So what are the alternative ways to help manage long-term pain?
GET MORE EXERCISE
ALTHOUGH patients with chronic pain tend not to be active because of the pain, fatigue and a fear of making their pain worse, the benefits of exercise far outweigh the risks.
For instance, walking helps the joints and muscles with flexibility, while cycling, swimming or water aerobics are perfect for those requiring a low-impact activity.
Pilates, yoga and Tai Chi are also extremely beneficial because they increase the blood supply and nutrients to the joints, reduce stress to the muscles and improve coordination and balance.
Exercise can also have a direct impact on how pain is actually felt. The body releases natural painkillers, called endorphins, during physical activity, which work to block pain signals from reaching the brain.
Physical activity also helps with weight maintenance – which can help reduce stress on joints – and increases energy levels, reduces anxiety and improves sleep – all of which can make people feel more positive.
And it’s never too late to start. Research shows people who have led sedentary lives and have weak muscles can get strong quickly after they begin exercising regularly. It’s important to identify how much the patient can do and build up slowly.
Don’t push yourself, consult your GP and tell your exercise instructor about your issues.
RETHINK YOUR NUTRITION
RESEARCH has shown an antiinflammatory diet can be beneficial for people struggling with pain, explains Dr Helena Miranda, author of Rethinking Pain (Hammersmith Books, £14.99).
Inflammation is a normal and healthy process of our immune system to fight off illness. However, when the body becomes chronically inflamed, this can contribute to various diseases and conditions. The Mediterranean Diet is recognised by the World Health
Organisation as a healthy and sustainable diet, which means it’s easy to stick to. Aim for:
■ At least seven different colourful, vegetables and two to three fruits a day.
■ Healthy fats, including omega-3 fatty acids (salmon, mackerel, anchovies, sardines, tuna steak, walnuts, ground flaxseed), avocado, olive oil, olives, nuts and seeds.
■ Quality protein, including fish, poultry, beans, eggs, tofu, lentils, nuts and seeds. Our nervous system, which moderates pain, needs amino acids (the building blocks of protein) to function.
■ 30G of fibre a day – in the form of vegetables, fruit, nuts, s seeds, wholegrain bread a and pasta. Fibre has been shown to lower inflammatory markers in the blood.
PHYSICAL THERAPY
CHRONIC pain often presents as joint and muscle (musculoskeletal) pain, says Tim Allardyce, from Surrey Physio, who runs chronic pain services.
“Osteopathy and physiotherapy are two very useful therapies for not only managing chronic pain but reducing it,” he says. “By identifying the underlying cause of the pain, the actual problem can be treated as well as the symptoms.
“A session starts with a thorough case history, and identification of any red flags (serious medical problems), followed by an examination and then a treatment programme consisting of manual therapy or exercise rehabilitation.
“Good practitioners will discuss nutrition, weight loss, posture, workplace set-up, medication, stress and sleep patterns with clients.”
CONSIDER ACUPUNCTURE
ACUPUNCTURE is now widely used in pain management, including in NHS pain clinics. Studies show it can effectively treat cases which fail to respond to conventional treatments.
Very fine needles are inserted into specific acupuncture points, stimulating specific nerves. This causes the body to release endorphins, which can naturally dull pain.
Recent scientific reviews have shown that acupuncture can be helpful in providing pain relief in many conditions, such as headache and neck pain, musculoskeletal pain related to cancer, peripheral neuropathies (a type of nerve damage), myofascial pain syndrome (pain and inflammation in the body’s soft tissues) and pain related to medical procedures.
The best effect is achieved with at least five treatment sessions.
PSYCHOLOGICAL THERAPY
“THERE are two types of psychological therapies – rehabilitative (seeing a clinical health psychologist) and the use of antidepressants,” explains Dr Ivan Ramos-Galvez, of the London Pain Clinic.
“Techniques can include Cognitive Behavioural Therapy (CBT), mindfulness and EMDR (Eye Movement Desensitisation and Reprocessing).”
These techniques can be extremely effective in reducing frustration and anger as well as distracting from pain.
“It’s not about lowering pain, but minimising the psychological effects,” he says of the therapy, which provides strategies to help people live alongside pain rather than be dominated by it.
Certain antidepressants can be used to treat chronic nerve pain.
“Antidepressants are not the answer for the majority of patients with chronic pain, but may be used to help with mood swings and as a muscle relaxant (in neck or back pain, for instance) while a patient is having psychological therapy,” says Dr Ramos-Galvez.
GIVE YOGA A GO
THERE is substantial scientific evidence that yoga may be beneficial for chronic low back pain, osteoarthritis and cancerrelated pain in breast cancer patients, and neuropathic pain, says Dr Miranda.
She says: “Yoga is a mind-body therapy so it naturally produces physiological changes in brain and body and increases flexibility and muscle strength.
“Brain-imaging studies demonstrate objectively yoga alters functioning of pain pathways in the cerebral cortex.”
It’s not about lowering pain, but minimising the psychological effects... Dr Ramos-Galvez, of the London Pain Clinic on psychological therapies