Non-Drug Treatments for Pain: Nine Strategies
By Bruce Campbell
When you think about treating the pain of fibromyalgia and Chronic Fatigue Syndrome, you may think first of medications. After all, drugs are the treatment of choice for many problems and they are frequently used with fibromyalgia and CFS.
But, since many FM and CFS patients find medications of limited help, you might also consider another approach to pain, one that is complementary to medical treatment: the use of self-management strategies. The advantages of these alternate approaches are that they are low cost, have little risk and carry a good chance of being helpful as part of a comprehensive treatment plan. Here are nine strategies to consider.
A frequent cause of pain is overdoing or having an activity level that is beyond a person's limits. This often occurs as repeated cycles of push and crash, as patients try to ignore the limits imposed by illness and then are forced to rest when their symptoms intensify. Pacing offers a way to bring stability and control by keeping your activity level within the limits imposed by illness.
Pacing can involve a variety of strategies, including setting priorities, scheduling activity and taking rest breaks. Setting priorities means making conscious decisions about what to do and what not: delegating some tasks to others, simplifying necessary tasks and perhaps eliminating others. Activity scheduling includes several strategies. You may limit yourself to short activity periods. Knowing how long you can safely do something, you stop yourself at the end of that time.
Scheduling can also mean being sensitive to when you do something as well as how much. You may be able to avoid intensifying your symptoms by scheduling your activity for your good times of day. Lastly, you may learn to plan your days and even weeks in detail, controlling the number and timing of your active periods. Taking regular, scheduled rests, which we call pre-emptive resting, can be particularly helpful. People who use pre-emptive rests often take one or two rests a day, ranging in length from 10 minutes to half an hour. Whatever the length, the secret is to rest on a schedule, regardless of how you feel, rather than waiting for symptoms to intensify.
Pain, especially long-term pain, often triggers muscle tension and anxiety, both of which can intensify the experience of pain. Muscle tension is directly painful, while anxiety contributes to the experience of pain indirectly by increasing stress and a sense of helplessness. Relaxation is an antidote to both tension and stress. Also, it can improve sleep and offer a distraction from pain. (For more on sleep and distraction strategies, see sections 7 and 9 below.)
Relaxing activities may include exercise, mindful breathing, baths and hot tubs, massage, rest and listening to tapes. You might also consider practicing a formal relaxation or meditation procedure on a regular basis. As with other treatments, you will probably have to experiment to find what works for you. Typically, some techniques work well for one person and other techniques work better for another. In particular, techniques using imagery seem very helpful for some people but not useful to others. Also, you may find that a particular technique works for a while, then becomes ineffective. If that happens, try something else.
3) Problem Solving
You can gain some control over your pain by identifying the situations that trigger your pain and then taking steps to change the situations. For example, you might find that you are not able to keep up with household chores as you used to. Using problem solving, you brainstorm a variety of solutions, such as spreading the chores out over several days, doing them on one day but taking rest breaks, and getting help from others, either family members or hired help. You then try a solution to see whether it works, evaluate and try again.
If you have a job and find that your pain increases when you work under deadlines, problem solving could take several forms. You may train yourself to take time to relax your muscles. Looking at your situation more broadly, you may identify work overload as a recurring problem and consider reducing your hours, changing your responsibilities or taking time off from work.
Strong emotions like fear, anger, grief and depression are common reactions to having chronic illness. Such emotions are a normal and understandable response to being in a situation in which life is disrupted and routine is replaced with uncertainty. Unfortunately, our subjective experience of pain is increased by emotions. Worry, frustration and anger create muscle tension, which makes pain more intense. Relaxation procedures can reduce pain both directly by easing muscle tension and indirectly through reducing stress.
People who are depressed have a lower threshold for pain. To the extent that we feel helpless, our experience of pain is likely to be worse. Self-help strategies, sometimes in combination with medications, can help manage the emotional aspects of chronic disease. The chapter in our textbook on emotions lists twelve actions to take in response to depression and eight strategies for anxiety.
5) Mental Adjustments
Thoughts can have a dramatic effect on our moods and then in turn on our perceptions of pain. This can be a vicious cycle. An increase in symptoms may trigger negative thoughts like "I'm not getting anywhere," "I'll never get better," or "It's hopeless." Such thoughts can then make us feel anxious, sad, angry and helpless, intensifying pain and triggering another round of negative thoughts and more muscle tension.
Thoughts can be a source of stress if they reflect unrealistic or inappropriate expectations for ourselves. For example, we may hold ourselves to housecleaning standards that may no longer make sense. One patient wrote an article explaining how she was able to free herself from the idea that she should do more by making a "NOT TO DO list". She used humor to adjust her expectations, referring to dust as a substance that "protects my furniture."
You can learn to recognize and to change your habitually negative thoughts using a three-step process described in the article Taming Stressful Thoughts. Similar treatments can be found in books like Feeling Good by David Burns or Learned Optimism by Martin Seligman.
6) Exercise and Movement
Exercise is one of the most-commonly prescribed treatments for people with fibromyalgia and may also be helpful for people with CFS. A comprehensive exercise program includes three types of exercise. Flexibility training (stretching) reduces stiffness and keeps muscles and joints flexible. Strengthening exercises maintain or increase muscle strength, thereby reducing pain. Endurance or aerobic exercises strengthen the heart and lungs. They help lessen fatigue by increasing stamina.
FM patients especially can help reduce their pain by experimenting with how they hold their body and how they move. Try different postures to find which ones minimize pain. Also, note how long you can maintain a posture without creating problems. Many patients find that staying in one position for an extended period of time increases stiffness and intensifies pain, so moving periodically can help you avoid pain. Limiting the length of time spent doing repetitive motions like chopping can help, too. Experiment to find how long you can work without creating pain and how long you have to pause before returning.
7) Pleasurable Thoughts and Activities
Chronic illness can be isolating. We spend time alone with our thoughts and can become preoccupied with our symptoms. Immersing ourselves in pleasant thoughts and activities can lessen symptoms by providing distraction.
Imagery can be especially helpful, as you visualize a pleasant scene. The imagery will be more effective if you can involve as many senses as possible. If you want to transport yourself to the beach, see the light shimmering on the water, feel the warmth of the sun on your skin, hear the waves crashing and smell the mustard from the hotdogs.
Engaging in activities that bring pleasure can also provide distraction from pain. Examples include reading a book, watching a movie, listening to or playing music and spending time in nature.
8) Heat, Cold & Massage
Heat, cold and massage can be used for temporary relief of pain. Heat is best utilized for reducing the pain that results from muscle tension and inactivity. The warmth increases blood flow and thereby produces some relaxation, reducing pain and stiffness. For localized pain, you might use a heating pad or hot packs. For overall relief, people often use warm baths, soaks in a hot tub or lying on an electric mattress pad.
Cold treatments are helpful in decreasing inflammation by reducing blood flow to an area. They also may numb the areas that are sending pain signals. You might use gel packs, ice packs or even bags of frozen vegetables. With both heat and cold, you should not use the treatment for more than 15 or 20 minutes at a time.
Massage of painful areas can also provide temporary relief from pain. Like heat, massage increases blood flow and can also relieve spasms. You can consider three different forms of massage: self-massage using your hands, massage using a handheld device, and massage by another person.
9) Improving Sleep
Pain and poor sleep can interact in ways that intensify them both. Pain can make it difficult to sleep well. Lack of good sleep, in turn, intensifies the experience of pain because fatigue amplifies pain. The relationship can work in the other direction as well. Gaining some control over pain using medications, self-management strategies or both can contribute to better sleep, which in turn further reduces pain.
Similarly, taking steps to improve sleep will also reduce pain. CFS and fibromyalgia patients often use sleep medications. Self-management strategies for improving sleep include limiting the use of daytime naps, having a comfortable and quiet sleep environment, going to bed and getting up at consistent times, and avoiding stimulants like coffee, chocolate and smoking.
Note on Seeking Medical Attention
If you are experiencing a new pain, such as pain in a new part of your body, or pain with a new intensity, it's appropriate to seek medical help. The strategies described in this article are designed to be used as part of a comprehensive response to pain that has been medically evaluated.
Two keys to effective pain control are experimentation and a comprehensive approach. The former means trying different treatments to find what is effective. The latter means utilizing a variety of strategies. Complementary approaches can be a helpful supplement to medications, since they are usually low-cost and low-risk, and carry a good probability of being effective.