What is 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.
- 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.
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.
What is long-term pain?
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
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.
- sleep problems
- difficulty with everyday activities
- symptoms such as疲劳or weight gain
- missing work, difficulties at work, or having to retire early
- changes in your relationships or sex life.
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.
Types of painkillers (analgesics) include:
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can be given as:
- tablets(usually prednisolone), which are often prescribed because nothing else works, as in polymyalgia rheumatica (PMR)
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.
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
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.
Physiotherapists, osteopaths and chiropractors may use a variety of different manual techniques, including:
- manipulation and stretching
- technologies such as ultrasound, laser or interferential treatment
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)
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.
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.
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.
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 (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.
- Whatever you’re doing, stop for a few minutes.
- Look around and notice five things you can see.
- 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。）
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
- 帮助控制体重 - 如果您有腿痛，这一点尤其重要。
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.
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.
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.
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.
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.
- 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.
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.
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
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
- 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.
Is your pain management right for you?
- I spend more time thinking about
- I spend less time thinking about
- 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
- Taking time off work
- Trying to relax
- Chiropractic treatment
- Seeing your GP
- Denying you have pain
- Asking for help with tasks
- Stopping painful activities
- Seeing another doctor
- Pacing activities
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。
Weigh up the benefit you got from each method against the time and energy you put into it. Use this to decide:
- whether to try something different.
- Do you feel that the ways you’re trying to manage pain are successful?
- Do they improve your life?
- Does trying to control pain actually stop you from doing what you want to do?
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:
- What looks clear and what looks blurry?
- 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.