Treating chronic pain can be tricky, especially when it comes to chronic primary pain. This means there’s no clear cause, as opposed to chronic secondary pain where there’s an identified underlying cause – such as arthritis, endometriosis or injury.
Health officials have now raised concerns over prescribing painkillers for chronic pain where there’s no clear cause, saying there’s “little or no evidence” it’s an effective solution.
The National Institute for Health and Care Excellence (Nice) suggests a range of other therapies should be offered instead – including exercise programmes, psychological therapies, acupuncture and antidepressants. This would mean avoiding unnecessary side-effects associated with certain painkillers, as well as providing options that do actually help.
Drugs are just part of the picture
Whatever the cause, living with chronic pain can be extremely tough, impacting everything from mental health to work, family and relationships too. When it comes to managing it though, painkillers are only part of the picture.
“Even when you’ve got a [diagnosed] cause, whether it’s mechanical or otherwise, once it becomes chronic, you need more than just painkillers to manage it,” says Des Quinn, chair of Fibromyalgia Action UK (fmauk.org).
Pain is a big part of fibromyalgia and Quinn says learning to manage this often involves a number of adjustments – including addressing things that may exacerbate flare-ups, like stress and overdoing it. It’s about proactively preventing flares, as well as finding ways to make pain easier to cope with.
Here’s seven things that can be helpful for managing chronic pain that don’t involve painkillers…
Many people find acupuncture effective for reducing pain, as well as stress and anxiety. Paul Battersby, CEO of the Acupuncture Association of Chartered Physiotherapists (AACP), says the Nice announcement referencing acupuncture as one possible pain-management option “reconfirms its effectiveness as a viable and medically proven treatment to reduce pain”.
Battersby says: “Differing from traditional acupuncture, medical acupuncture focuses on eight key parts of the brain that modulate pain. This enables acupuncture-trained physiotherapists to devise tailored treatment plans that specifically target a patient’s area of pain.”
2. Relaxation techniques
Stress is a huge factor in chronic pain. This absolutely does not mean the pain isn’t real, is just ‘in your head’ or that you are somehow to blame. It’s about recognising that stress can trigger pain, intensify our experience of it, and make it harder to live with. Seeking out practices or techniques that aid relaxation can be really helpful. “It could be mindfulness or meditation, even something like tai-chi. Things that help you with breathing and relaxation,” says Quinn.
3. Exercise and keeping active
It’s important to approach this in a way that’s right for you, so always speak to your own doctor, but as physiotherapist Ben Lombard (benlombardphysiotherapy.com) says, “regular movement and exercise are essential in pain management for several reasons”.
Physically, it helps “increase strength and bone density to improve movement quality and confidence, also aiding independence [for those] living with a chronic condition”. Improved blood flow, quicker recovery and flexibility are all benefits too – not to mention the release of ‘feel-good’ chemicals in the brain, known to reduce pain and bolster mental wellbeing.
Vitally, it “empowers people to take care of their own health”, adds Lombard. “Regular exercise may enable you to gain confidence to exercise with others in a similar situation too, and this can be socially and mentally stimulating, as well as physically. Conversely, isolating yourself with chronic pain may worsen your outlook mentally.”
4. Counselling and therapy
“Living with chronic pain is traumatic, stressful and isolating in itself,” says Counselling Directory member Thalia Joyner (counselling-directory.org.uk/counsellors/thalia-joyner), who became a counsellor following her own experiences of chronic pain.
Counselling can provide a safe space to talk about all this. Joyner says there’s also evidence that “when we have experienced trauma or long-term stress”, the body’s baseline functioning can be impacted, which may have a role in things like chronic pain.
“Counselling can help you become more aware of what this functioning is for the individual, where it has come from, and learn more about the mind/body connection. This empowers clients to find what works for them, understand their own functioning and address flare-ups,” says Joyner.
5. Cognitive Behavioural Therapy (CBT)
CBT is a type of talking therapy with a focus on addressing how we think and respond to things – helping us move away from unhelpful belief systems where we’re doomed and helpless, and towards more useful patterns and coping strategies.
Quinn says it’s normal to go through a “grieving process” when you’re coming to terms with chronic pain, especially when it feels like so much is out of your control, and it can take time before people feel ready to try psychological therapies. “With something like CBT, you can start to think about what there is that is within your power, what you can do to manage your condition in certain parts of your life, and get yourself in a better place with it,” says Quinn.
“Pacing is definitely something that needs a bit of time,” says Quinn, “and planning things to make sure you don’t overdo it. As soon as you overdo it with any chronic pain condition, you could end up paying for it for days. So, this might mean looking at a task or activity and spreading it over three days, rather than doing it all at once.”
7. Boundaries and saying no
Getting comfortable with setting boundaries comes in here too. “One of the things we talk about in our support groups is how it’s important to learn to say no. No to other people, and also no to yourself sometimes,” says Quinn.
“It could be: can I go to that social event, when I know I’ve got something with family a couple of days later and that’s the one that’s really important? So I’ll say no to the first one. It’s easy to fall into thinking, ‘I never get to go out, I should go out’ – so you go and then you end up paying for it.”