Managing your pain

Pain is usually a protective mechanism that alerts your brain when your body is being harmed in some way. The nerves in that area send signals through the spinal cord to the brain. The brain locates the injury and triggers a healing process.

疼痛信号可能是由：

• physical injury or damage to your body – for example, a sprained ankle or damage that occurs as part of a longer-term condition such asosteoarthritis
• chemicals produced within the body itself that can irritate the nerve endings – this may be linked to an infection, an overuse injury or a flare-up of a long-term illness such asrheumatoid arthritis
• 对神经的损害，导致他们在没有任何身体原因的情况下向大脑发射疼痛信号，有时会发生complex regional pain syndrome.

When we have an injury or tissue damage caused by an illness, the nerves in the affected part of the body become more sensitive than normal, so pain signals are triggered more easily and warn us if there’s any further threat to the painful area. Normally, as the injury heals, the nerves become less sensitive again and the pain signals lessen and then stop.

当疼痛干扰我们的日常活动时，止痛药可能会通过阻止或减少大脑的疼痛信号来帮助，即使它们不会直接影响伤害或损害。

Pain isn’t just a physical sensation – it can have emotional effects too, especially if the cause of the pain isn’t clear or it’s difficult to find effective pain relief. And our emotions or mood can in turn make the pain seem worse or better.

Doctors define long-term (or ‘chronic’) pain as pain that’s lasted for more than 12 weeks or that’s lasted for longer than would be expected for the type of injury or level of damage.

Sometimes it’s possible to find a specific cause of long-term pain – for example:

• an underlying condition such as arthritis
• 神经损伤或疾病。

However, with long-term pain, the sensation of pain isn’t always directly related to the injury or damage that caused the pain in the first place. Sometimes messages between the nerves and the brain can become disturbed so that the nerves remain unusually sensitive and continue to fire off pain signals even after a physical problem has cleared up.

由于我们的身体是“编程”的，以将疼痛理解为警告信号，因此我们的自然反应通常是为了保护受影响的区域免受进一步的伤害 - 也许是通过少于少于平常或支持它来完全放置它。

After a time, lack of use leads to weakening of the muscles. As we become less fit, we tire more easily and become more prone to strains and sprains, resulting in further pain. This can easily become a vicious circle.

Pain can make it difficult to get on with your everyday activities whether at home, at work or in your leisure time. It’s a natural instinct to try and protect whichever part of the body is painful and this can affect your everyday choices. You may try to avoid jobs that tend to increase your pain or you may turn down opportunities to do things you’d normally enjoy.

疼痛不仅是一种身体上的感觉，而且还具有情感上的影响。如果您几个月或几年的疼痛，它可能会开始影响您的情绪和自信心就不足为奇了。长期疼痛的生活与应对短暂的疼痛大不相同，尤其是如果疼痛的原因尚不清楚并且标准治疗无济于事。

与长期疼痛有关的其他问题可能包括：

• sleep problems
• 体育锻炼减少
• difficulty with everyday activities
• 减少参与家庭和社会活动
• 难以集中或记住事物
• symptoms such as疲劳or weight gain
• 药物的副作用
• missing work, difficulties at work, or having to retire early
• changes in your relationships or sex life.

如果你的医疗团队已经无法识别出痛苦的原因，因此您也可能会感到沮丧和失望。您可能会觉得其他人不了解您遇到的痛苦，甚至可能开始问自己痛苦是否是“真实的”。

用于治疗关节炎，关节或肌肉疼痛疼痛的大多数药物属于以下类别之一：

• painkillers
• 非甾体类抗炎药
• steroids.

However, other types of drugs may also be used in particular situations. All of the drug treatments below are designed to control symptoms – they won’t help to heal the damage or cure the underlying condition.

Finding the right pain medications is about striking a balance between the benefits and the possible side-effects. These will vary from person to person and will also depend on how long they’re used for. Stronger painkillers will also tend to have a greater risk of side-effects.

Depending on your own situation it may be advisable to limit the use of stronger pain medicines to times when the pain is particularly severe and to try some other pain management techniques as well to see what works for you. It’s also a good idea to review your medication from time to time to make sure you’re still happy with the balance.

Painkillers

Types of painkillers (analgesics) include:

• 简单的镇痛药，例如扑热息痛
• 更复杂的镇痛药在化学上与吗啡相关（有时与扑热息痛结合，例如共二莫，共氨基酚，共二氨基酚）
• 曲马多，羟考酮，慢释吗啡或含有芬太尼或丁丙诺啡的斑块。

非甾体类抗炎药（NSAIDS）

Types of NSAIDs include:

• 阿司匹林或ibuprofentablets, which you can buy over the counter at chemists and supermarkets without a prescription
• diclofenac, naproxen or indometacin tablets, which are available with a doctor's prescription
• gels or creams which can be applied to the painful joint (for example, ibuprofen, diclofenac)
• a newer type of NSAID commonly called 'coxibs' (for example celecoxib), which are designed to control pain and inflammation but with a lower risk of digestive problems than with the older NSAIDs.

类固醇

类固醇can be given as:

• tablets(usually prednisolone), which are often prescribed because nothing else works, as in polymyalgia rheumatica (PMR)
• 注射到关节本身或关节周围的软组织中。

Steroid injectionsaren’t generally used in the treatment of long-term pain because of potential side-effects. However, occasionally a steroid injection may be offered to help deal with a flare-up of a long-term condition such as osteoarthritis.

Other drugs used to treat long-term pain

Alongside painkillers, there are other drugs that can be used to help manage pain, some of which were originally used for other problems. The ones most often used are:

• antidepressant drugs such asamitriptyline- 当它用于缓解疼痛的情况下，该剂量比用于抑郁症时的剂量较低。这些可以通过帮助大脑控制身体其他部位的感觉来帮助疼痛。如果疼痛影响您的睡眠，它们也可以提供帮助。
• anticonvulsants or anti-epilepsy drugs (for example, gabapentin, pregabalin). These can be particularly helpful for pain caused by nerve damage.

神经阻滞和其他注射技术

Injections to block pain are becoming more widely available. They usually combine a local anaesthetic with a steroid and act directly on a nerve. They're not suitable for all types of pain, but they're sometimes helpful for:

• osteoarthritisof the small joints between the bones of the spine
• 下脊柱中神经的压缩。

Special scans such as magnetic resonance imaging (MRI) or computerised tomography (CT) are often needed so the specialist can decide the exact site for the injection.

手动疗法

Physiotherapists, osteopaths and chiropractors may use a variety of different manual techniques, including:

• manipulation and stretching
• technologies such as ultrasound, laser or interferential treatment
• 锻炼计划以增强肌肉并改善一般健身。

重要的是要去合格的从业者，最好在医生的指导下去。

In some conditions, for example back pain, the亚历山大技术may also help. The Alexander technique teaches awareness of posture and relaxation to reduce muscle tension.

Transcutaneous electrical nerve stimulation (TENS)

TENS是一种使用小电力脉冲来产生刺痛感的技术。它的目的是通过降低脊髓中神经末端的灵敏度来破坏疼痛信号。有些人发现它非常有效，尤其是当疼痛是由于神经损伤引起的。

It's best to get advice from a physiotherapist on where to position the pads, the frequency and strength of the pulses and the length of treatment.

Acupuncture

Acupuncture由医生和其他从业者使用，通常会非常有效。非常细的针头插入体内的特定点。人们认为，通过转移或改变发出大脑的痛苦感觉并刺激身体自身舒张的激素（内啡肽和脑肾上腺素）来起作用。

水疗

Many people with long-term pain find exercise in warm water is a comforting and effective way of moving the joints fully and stretching and strengthening the muscles. The warmth of the water soothes pain and because the water supports your weight it reduces the stresses on your joints.

A lack of hospital therapy pools means that access may be limited. However, many facilities offer out-of-hours access on a paid basis – contact your local hospital for details.

当地的游泳池往往比水生治疗池凉爽，但是诸如Aqua-Aerobics之类的运动课可以提供一种安全和有趣的锻炼方式。另外，具有水疗或水上性治疗设施的当地酒店可以提供游泳或水上课程。

Splints

Anoccupational therapist (OT)may also suggest wearing a splint. The term ‘splint’ covers a variety of devices, which are mostly for the hands but can be for other parts of the body such as the neck or foot. They can be ready-made from soft, flexible material such as neoprene, or tailor-made by the OT from a type of plastic to specifically fit your joints.

Splints可能出于各种原因提出建议，例如休息关节并减轻疼痛或正确定位关节以防止畸形并改善功能。OT会建议您何时戴上夹板以及需要多长时间。过度使用夹板会导致由于缺乏使用而导致肌肉损失。您还应该定期将其取下，以使您的皮肤呼吸。

认知行为疗法（CBT）

Cognitive behavioural therapies (CBT) is a term used for a wide range of psychological approaches designed either:

• to manage the symptoms of health problems, or
• to change behaviour to improve your ability to function on a day-to-day basis.

所有形式的认知行为疗法是基于这个想法,我们的thoughts, beliefs, feelings, behaviour and the situations we’re in are all inter-connected. Our thoughts and beliefs can influence our behaviour; our behaviour can influence our feelings; and the situation we’re in can affect our behaviour. CBT includes assessing and understanding these connections and then finding ways to modify them to tackle the problem.

CBT isn’t right for everybody but it is a well-established approach that’s effective for improving people’s mood, health and ability to get on with their daily lives. It isn’t simply about talking or seeking advice, but about learning new skills that should help you to handle challenges in your life more effectively. For example, if fear of pain is causing you to avoid physical activity, then these methods can help in facing those fears.

Psychologists in particular often teach coping skills. These can include:

• relaxation techniques
• goal-setting and pacing
• ways of working on thoughts and beliefs and especially discouraging moods.

Mindfulness

Mindfulness (or mindfulness meditation) is another approach that’s becoming popular to treat health problems. It aims to help focus your attention on present-moment experiences rather than on the thoughts you may hold about those experiences. It can help us to think through our choices rather than acting on impulse when we’re feeling distressed. It’s difficult to understand mindfulness fully just from a description though – it’s better to try it to see if it works for you. There are many psychologists and other professionals who provide training in mindfulness.

如果您想进行非常简单的正念型练习，请尝试以下操作：

1. Whatever you’re doing, stop for a few minutes.
2. Look around and notice five things you can see.
3. 仔细听，注意您可以听到的五件事。
4. Focus on sensations on the surface of your body and notice five things you can feel.

您可能会发现自己更加专注，并且在进行此练习后似乎不太忙。（这项练习是基于一位名为Russ Harris的医师和治疗师所描述的，包括Tobias Lundgren，Joanne Dahl和Steve Hayes，包括您可能会发现有用的数字或书籍和工作簿。）

长期疼痛会极大地影响您进行日常活动的能力。您可能会发现某些动作特别痛苦，因此您完全避免了它们。但是，重要的是要尽可能活跃，因为缺乏使用可能会导致力量和协调损失。尝试以下一些想法可能有助于最大程度地减少您需要服用的止痛药。

Exercise

Long-term pain affects the way you move your body. You may stop using specific joints as you normally would, or you might reduce your level of activity overall. This results in a steady loss of joint mobility, muscle strength, co-ordination and balance – and it probably won’t stop the pain. And by trying to protect the painful area you may put strain on other parts of the body, resulting in secondary pain.

Increasing your physical activity and maintaining a good posture can help you cope more effectively with pain by:

• improving your ability to carry out daily tasks
• 让你感觉更好
• 给你更多的能量
• 改善睡眠
• 帮助控制体重 - 如果您有腿痛，这一点尤其重要。

我如何增加体育锻炼？

Simple things like aiming to walk a little more each day will lead to gradual but important improvements in your physical fitness. But more structured forms of physical activity will increase the benefit.

Community activity or exercise groups are an excellent way of increasing physical activity and have the added benefit of meeting other people. Leisure or community centres, libraries and GP surgeries often hold details of local activities.

Walking is particularly good for your health. The ‘Walking for Health’ scheme has over 600 local groups, so there’s likely to be one close to you. Walks are designed for all abilities. Stand tall with your stomach pulled in when you’re walking as good posture minimises the strains on your body.

Other community activities that offer significant health benefits and may help with pain are t’ai chi and qigong. Both consist of gentle low-impact movements that you can do either standing or sitting, so they’re suitable for anyone.

Yoga has been shown to be helpful for low back pain, reducing pain and helping people to perform everyday activities more comfortably.

无论您喜欢什么类型的体育锻炼，都可以检查您的讲师是否有资格适当。在开始活动之前，请花一些时间与他们谈谈您的特定需求。

增加你的活动是best long-term strategy to manage and cope with persistent pain. But there may be times when you need help from a physiotherapist – for example, if you have difficulty with particular activities, if you’re prone to falling, or develop new problems.

您的physiotherapistwill assess your difficulties before showing you specific exercises to move your joints, strengthen your muscles and improve your coordination and balance. Follow the instructions you’re given carefully to get the most benefit from the exercises.

共同保护

It’s important to understand how your condition affects your joints and causes pain so that you can think about how best to move without unnecessary strain.

Anoccupational therapist (OT)will be able to offer further advice on joint protection techniques. Joint protection doesn’t mean you should stop using your painful joints but it may involve finding different ways of doing particular tasks or using gadgets to help you.

您的OT will be able to advise you on the gadgets available and may also make suggestions on how to reorganise your home or work environment to reduce unnecessary strain.

Pacing

If you have long-term pain then you may also experience extreme tiredness (疲劳）。管理疼痛和疲劳的一个关键方面是在活动和休息之间找到适当的平衡，也称为起搏。

Too much rest is likely to increase stiffness and over time can result in the muscles weakening, so that getting active again becomes harder than ever. On the other hand, pressing on to get everything done when you’re having a good day is likely to lead to more pain and fatigue the next day.

Try taking short breaks of 3–5 minutes every 30–45 minutes to sit and rest your joints. Or you might find that even shorter breaks of 30 seconds every 5–10 minutes might suit your lifestyle better.

Try also to switch between jobs that you find tiring and those you find easier or more enjoyable. Finding time for the things you enjoy in between the things you need to do will be good for your mental wellbeing.

您的occupational therapist,physiotherapistor psychologist can offer further advice on pacing your activities. You may find it helpful to make a note of your daily activities and highlight times when pain or fatigue caused difficulties. This will help you to spot any patterns and may suggest possible solutions.

Relaxation

Many people find that learning relaxation techniques can help in managing pain and reducing stress. There are a number of options available.

Some approaches take you off on a scenic journey describing restful locations (this is known as guided imagery), while others focus on tensing and relaxing various parts of your body (progressive muscle relaxation). It’s worth trying a few different approaches to decide what works best for you.

自我指导的放松形式包括：

• meditation, which involves concentrating on breathing or a sound (called a mantra) that you repeat to yourself
• breathing techniques which, once mastered, can be performed anywhere to relieve anxiety.

You may need to attend a class to learn some of the techniques, but regular practice will increase the effectiveness of relaxation.

最好以支持您想做的活动的方式应用放松技术。通常，您可以将其纳入活动中最有效的简短放松咒语。较长的放松练习可以作为逃避现实的一种形式，也许不太有用，尽管您可能想偶尔尝试一下。

睡个好觉

Pain may make it difficult to get to sleep or it may wake you from your sleep. If you often lose sleep this can make the pain seem worse, which in turn can disturb your sleep even more.

建立常规的就寝时间例程可能有助于打破这个周期。上床睡觉之前，您可能想尝试温暖的浴缸，平静的音乐或放松技巧。一个支撑枕头，避免咖啡因或在附近看电视也可能会有所帮助。您的职业治疗师可以帮助您确定可能有助于改善睡眠的其他事物。

睡眠药物通常仅对大多数人有效，并且对于长期睡眠问题而言并不理想。但是，有改善睡眠的非常有效的心理方法。

If modifying your night-time routine isn’t enough on its own, then cognitive behavioural therapies (CBT) may help you to establish a regular pattern of sleep. Ask your GP to refer you if you’d like to try CBT for your sleep problems.

Coping better at work

如果您长期疼痛，继续工作可能是一项挑战。学习可以帮助管理疼痛的实用方法，例如联合保护，节奏，运动和放松，将有所帮助。如果您的公司有职业健康顾问，则可能需要与他们讨论。

Occupational therapists can help by assessing work tasks in order to modify and reduce the effort required. They may recommend changes to your physical working environment and can provide support by liaising with your employer. Some may carry out workplace assessments with you.

Other self-help tips

Other pain-relief techniques that might help include:

• a heat pad, heated rice pad or a hot-water bottle
• 冰袋或冷水压缩
• 按摩（有或没有乳霜会产生温暖感）
• rest and good quality sleep – disturbed or unrefreshing sleep can increase pain, so speak to your doctor if you have this problem.

These techniques are often helpful after an injury and for sudden flare-ups of arthritis or back pain.

因为没有其他人能体验到您的痛苦或完全了解与之生活的感觉，所以只有您可以决定哪些治疗方法或疗法适合您。但是，如果您感到沮丧或焦虑，或者您不知道您所在地区有什么支持，那可能会很困难。

花一些时间思考有效的内容，没有的工作以及您的优先事项可能有助于做出更好地适应您的生活方式的选择。制定疼痛管理计划的有用的第一步是考虑疼痛如何影响您的生活。

尝试完成以下每个短语。“自从我的痛苦开始以来……”：

• I spend more time thinking about
• I spend less time thinking about
• 我花更多的时间做
• I spend less time doing

Below are some of the methods people use to deal with ongoing pain. Which ones have you tried?

• Taking drugs
• Distracting yourself
• 寻找信息
• 修改您的房屋
• 顺势疗法
• Taking time off work
• Resting
• Trying to relax
• 使用牙套或艾滋病
• 寻求明确的诊断
• Massage
• Chiropractic treatment
• Seeing your GP
• 其他替代治疗
• Complaining
• Denying you have pain
• Asking for help with tasks
• Stopping painful activities
• Seeing another doctor
• Exercise
• 寻找答案
• Pacing activities
• 手术
• 水疗
• Acupuncture

列出的这些方法不一定是好是坏 - 其中一些可能对某些人有用，但这并不意味着它们适合您。您的列表中也可能还有其他内容。

当您考虑自己的列表时，请问自己以下有关每种方法的问题：

• 诚实地做到了这一点，以持久的方式有助于您的痛苦？
• 它是否帮助您过着想要生活的生活，尤其是从长远来看？

Weigh up the benefit you got from each method against the time and energy you put into it. Use this to decide:

• 是否值得更频繁地尝试特定方法
• whether to try something different.

当我们遇到问题时，我们会自动尝试解决它们。有时，即使我们没有到达任何地方，我们也会拒绝放弃问题。在另一个极端情况下，当我们有问题，放弃或什么都不做时，我们有时会感到困惑或害怕。当您查看疼痛管理方法时，请查看您是否注意到自己这样做。

问问自己以下内容：

• Do you feel that the ways you’re trying to manage pain are successful?
• Do they improve your life?
• 您是否曾经觉得自己在挣扎和无处不在？
• Does trying to control pain actually stop you from doing what you want to do?

寻求治疗疼痛是有用的，但是它可以使您退缩，并且可以创造一种专注于痛苦的生活，而不是您真正想做的事情。

如果您认为某些方法不起作用，请与您的医疗团队讨论此问题。您可能需要继续控制特定状况或其他不应突然停止的治疗方法。但是除了您确实有选择的人。

If you find yourself stuck in a trap, trying things that aren’t helpful or don’t suit your lifestyle, then try refocusing on your goals. Think about the circumstances that will get you there. Try not to let pain,疲劳或其他症状分散你的注意力。

Try the following exercise to remind yourself that you can determine your own focus:

1. 将食指放在脸前，凝视着它。
2. What looks clear and what looks blurry?
3. Shift your focus beyond your finger. What looks clear and what looks blurry?

Which view shows you more of what is around you and gives you a more complete picture?

Sometimes we focus on one issue that feels close, like the finger. These issues don’t always affect us in the same way if we look at a wider view.

当你做这个练习,也不考虑much or try too hard to figure it out. It’s enough to simply notice what the experience is like of switching focus and seeing what’s in front of you in a different way.

这些练习并不总是能帮助您找到正确的答案，但是它们可能会帮助您更有信心让自己的体验成为指导，并利用生活质量作为衡量疼痛管理方法的成功。