What is Chronic Pain and How to Deal With Pain ?

Chronic pain is complex, and it can take a person some time to find the best pain relief methods that work for them. There are many options to try, such as hot and cold therapy, yoga, or drug treatments.

Chronic pain may develop after an injury or due to a medical issue. Healthcare professionals define pain as chronic if it lasts longer than 3 months, or beyond the normal healing time for the underlying condition or injury.

Chronic pain can affect every part of a person’s life, from work and social life to sleep and mental health.

10 ways to reduce pain

Whether your pain has just come on or you’ve lived with it for years, these tried-and-tested self-help steps can bring you relief.

Get some gentle exercise

Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain.

Activity also helps lessen pain by stretching stiff and tense muscles, ligaments and joints.

It’s natural to be hesitant if exercise is painful and you’re worried about doing more damage. But if you become more active gradually, it’s unlikely you’ll cause any damage or harm. The pain you feel when you start gentle exercise is because the muscles and joints are getting fitter.

In the long term, the benefits of exercise far outweigh any increase in pain.

Breathe right to ease pain

Concentrating on your breathing when you’re in pain can help.

When the pain is intense it’s very easy to start taking shallow, rapid breaths, which can make you feel dizzy, anxious or panicked. Instead, breathe slowly and deeply.

This will help you to feel more in control and keep you relaxed and prevent any muscle tension or anxiety from making your pain worse.

Talking therapies can help with pain

Pain can make you tired, anxious, depressed and grumpy. This can make the pain even worse, making you fall into a downward spiral. Be kind to yourself.

Living with pain is not easy and you can be your own worst enemy by being stubborn, not pacing your activities every day and not accepting your limitations.

Some people find it useful to get help from a psychologist or hypnotherapist to discover how to deal with their emotions in relation to their pain.

You can also find out more about talking therapies, also known as psychological therapies.

Distract yourself

Shift your attention on to something else so the pain is not the only thing on your mind. Get stuck into an activity that you enjoy or find stimulating. Many hobbies, like photography, sewing or knitting, are possible even when your mobility is restricted.

Share your story about pain

It can help to talk to someone else who has experienced similar pain themselves and understands what you’re going through.

Pain Concern, Action on Pain and Versus Arthritis all have telephone helplines staffed by people with long-term pain, who can put you in touch with local patient support groups.

The sleep cure for pain

Many people with long-term pain find it difficult to sleep at night. But it’s important to try to stick to a normal sleep routine so you’ve got the best chance of sleeping through the night.

Sleep deprivation can also make pain worse. Go to bed at the same time each evening, and get up at a regular time in the morning and avoid taking naps in the day. If sleep problems persist, see a GP.

Keep in touch with friends and family

Do not let pain mean that you lose contact with people.

Keeping in touch with friends and family is good for your health and can help you feel much better. Try shorter visits, maybe more often, and if you cannot get out to visit people, phone a friend, invite a family member round for tea or have a chat with your neighbour.

Aim to talk about anything other than your pain, even if other people want to talk about it.

Relax to beat pain

Practising relaxation techniques regularly can help to reduce persistent pain.

There are many types of relaxation techniques, varying from breathing exercises to types of meditation.

Ask a GP for advice in the first instance. There may be classes available locally or at your local hospital’s pain clinic.

What are Physical Techniques ?

Various physical methods can help relieve pain, including physical therapy, hot and cold therapy, massage, and acupuncture.

Hot and cold therapy

Hot and cold therapy is a common and safe technique to reduce pain.

Heat can help relax the muscles and dilate the blood vessels. It can also promote healing after an injury.

Cold therapy reduces blood flow and reduces inflammation that causes pain. It often involves applying an ice pack wrapped in a towel to the skin.

Massage

Massage is a type of soft-tissue manipulation. People may benefit from this technique when used with other pain management treatments, such as physical therapy and pain medication.

The benefits of massage include:

  • relaxation
  • increased flexibility
  • reduced inflammation
  • improved posture
  • improved circulation
  • reduced stiffness

A 2007 review on massage found that it may be effective for lower back pain. However, there is mixed evidence from examining its benefits for other chronic pain types.

Physical therapy

Physical therapy involves physical techniques to strengthen and stretch the muscles and joints. It can relieve pain throughout the body, while the specific methods will vary by body part.

Therapeutic exercise can have long-term benefits for chronic pain, including helping people cope.

Techniques may involve massage, exercise plans, and red light therapy.

Acupuncture

Acupuncture involves a practitioner applying thin needles to the skin at precise points in the body.

According to the National Center for Complementary and Integrative HealthTrusted Source, evidence suggests this technique could help people manage certain pain conditions.

This includes short-term relief from pain in the lower back, neck, knee, and osteoarthritis. However, there is little evidence to suggest it is effective over the long term.

The proposed benefits of acupuncture are:

  • pain relief
  • reduced inflammation
  • relaxation
  • reduced muscle spasms

Acupuncture is generally safe when performed by trained practitioners using sterile needles.

What is Mind-body Techniques ?

Methods that combine psychology and the body can help many people manage chronic pain.

Cognitive behavior therapy

Psychological treatments for chronic pain include talking therapies, such as cognitive behavioral therapy (CBT).

Psychological treatments aim to reduce the negative impact that chronic pain can have on a person’s mental health.

A 2013 review on the effectiveness of psychological pain management techniques concludes that CBT is effective at reducing pain immediately after treatment compared with using no strategies.

The review also found that there was no evidence that CBT can reduce long-term pain. However, the technique was useful for reducing anxiety around pain and for improving quality of life.

Yoga

Yoga aims to relax, strengthen, and keep the body flexible through stretching, with specific poses focusing on particular body areas.

A 2010 study into yoga’s effects on chronic pain found that it did not decrease participants’ pain, but it did help them cope, and they were more in control of how their pain affected their everyday life.

However, other studies have found yoga to be effective in reducing pain.

Yoga is a safe and accessible pain management technique that people can try at home, using online videos, or in a class with an instructor.

Tai chi

Tai chi is an exercise therapy involving slow, continuous, fluid body movements combined with breathing and relaxation techniques. The method is also gentle on the joints and muscles.

Tai chi can improve strength and joint stability, and the concentration it requires can improve a person’s mood.

What is Relaxation Techniques ?

Dealing with chronic pain can be stressful for many reasons, such as not feeling in control regarding a person’s discomfort.

Relaxation techniques can help ease muscle tension, muscle spasms, aches, and pains. They can also release endorphins, which are the body’s natural painkillers.

A person can help reduce stress through relaxation, which can ease some of the burden of chronic pain while promoting better sleep.

Relaxation methods for chronic pain include:

  • Deep breathing techniques: Slow and relaxed breathing methods, such as box breathing, help relieve tension.
  • Progressive muscle relaxation: Involves tensing and relaxing each muscle group in turn, for 10 seconds each, from the head to the toes. Focus on breathing and avoid muscles that feel painful.
  • Thinking calmly: Spend 5 minutes imagining a calming scene, such as a sunny afternoon in nature, surrounded by green trees and birdsong.
  • Calming activities: Set aside time for relaxing activities such as having a warm bath, reading a book, or crafting.

What is Drug Therapies?

There is a wide range of medications to relieve pain. Each class and type of drug work differently, while some may be more suitable for certain people than others.

Acetaminophen

Acetaminophen helps many kinds of chronic pain. One brand name is Tylenol. It is also found in many over-the-counter and prescription pain medicines. If you’re not careful, you could take more acetaminophen than is good for you. Too much acetaminophen can cause liver damage, especially if you drink alcohol. Tell your doctor if you have to take more than 2 acetaminophen pills a day.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that reduce inflammation and pain. They are available in capsules, tablets, or as creams or gels for the skin.

However, NSAIDs may cause issues with the stomach and the cardiovascular system in some people. Talk with a doctor before beginning treatment with NSAIDs.

Opioids

Opioids can treat moderate-to-severe pain and are generally only appropriate for short periods, as they can be addictive.

CDC guidelines recommend people should only use opioids when the benefits outweigh the risks.

There is a lack of evidence that this treatment works for chronic pain, as people typically use opioids for short periods.

Antidepressants

Some antidepressants, such as amitriptyline, can help with pain relief.

Amitriptyline is an antidepressant that, at lower doses, people also use for chronic pain, such as diabetic neuropathy and fibromyalgia.

It can take 2–4 weeks for a person to feel the effects of the medication.

Side effects of amitriptyline can include:

  • dizziness
  • dry mouth
  • fatigue
  • headaches

Anticonvulsants

Your doctor may want you to try an anticonvulsant medicine. It may help reduce some types of chronic pain, such as low back pain. Examples of anticonvulsants are:

  • gabapentin (Neurontin)
  • carbamazepine (Tegretol)
  • phenytoin (Dilantin)
  • pregabalin (Lyrica)
  • topiramate (Topamax)

Like antidepressants, your doctor may start you on a low dose of anticonvulsants. This helps prevent or reduce side effects. The doctor may increase the amount over time. Contact your doctor right away if you have suicidal thoughts. Minor side effects may include:

  • drowsiness
  • nausea or vomiting
  • restlessness
  • dizziness
  • loss of appetite
  • weight gain
  • itching or swelling

Anti-seizure medications

Medications for epilepsy interrupt pain messages to the brain.

Types include gabapentin (Gabarone®) and pregabalin (Lyrica®).

These medicines can ease nerve pain and fibromyalgia.

Muscle Relaxant

Healthcare providers in the United States can currently prescribe the following antispasmodic skeletal muscle relaxants:

  • Carisoprodol (Soma®, Vanadom®).
  • Chlorzoxazone (Lorzone®, Parafon Forte DSC®, Relax-DS®, Remular S®).
  • Cyclobenzaprine (Fexmid®, Flexeril®).
  • Metaxalone (Metaxall®, Skelaxin®).
  • Methocarbamol (Robaxin®).
  • Orphenadrine (Norflex®).

Antispastic skeletal muscle relaxants that providers can currently prescribe in the U.S. include:

  • Baclofen (Lioresal®).
  • Dantrolene (Dantrium®).

Two skeletal muscle relaxants have both antispastic and antispasmodic effects. They include:

  • Tizanidine (Zanaflex®).
  • Diazepam (Valium®).

Beta-blockers

Beta-blockers slow down the heart and stop hormones, such as adrenaline, from working. Some people use them to treat migraines.

A study shows that beta-blockers at low doses can temporarily improve chronic pain in females with fibromyalgia and temporomandibular syndrome.

However, beta-blockers may not be suitable for everyone. Consult with a doctor before using them for chronic pain.

Cannabis

Medicinal cannabis and cannabidiol (CBD) are increasingly common pain treatments.

A 2017 review states that cannabis may ease neuropathic pain, but not pain due to fibromyalgia, headaches, or rheumatoid arthritis.

In addition, cannabis for medicinal purposes may not be legal everywhere. High doses can trigger side effects, so it is best to check with a health professional before using cannabis CBD for pain relief.

Do I Need to Stay on the Same Brand of Gabapentin?

Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy.

Gabapentin Neurontin
Gabapentin Neurontin

Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles).

Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down).

Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

Most people do not have to stay on the same brand of gabapentin as there’s very little difference between brands.

Talk to your doctor if you have been asked to switch to a different brand and are worried about that.

If your epilepsy has been hard to control in the past and the brand you’re now taking is working well for you, your doctor may recommend you stay on the same one.

Forms and strengths

Generic: Gabapentin

  • Form: oral capsule
  • Strengths: 100 mg, 300 mg, 400 mg

Brand: Neurontin

  • Form: oral capsule
  • Strengths: 100 mg, 300 mg, 400 mg

Dosage for postherpetic neuralgia

Adult dosage (ages 18–64 years)

  • Typical starting dosage: Day 1, 300 mg; day 2, 600 mg (300 mg two times per day, spaced evenly throughout the day); day 3, 900 mg (300 mg, three times per day, spaced evenly throughout the day). Your doctor may further increase your dosage after day 3.
  • Maximum dosage: 1,800 mg per day (600 mg, three times per day, spaced evenly throughout the day)

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years has not been established.

Senior dosage (ages 65 years and older)

Your kidney function may decrease with age. Your body may get rid of this drug more slowly. Your doctor may start you on a lower dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous. Your doctor may change your dose based on how well your kidneys are working.

Dosage for partial-onset seizures

Adult dosage (ages 18–64 years)

Typical starting dosage: 900 mg per day (300 mg, three times per day, spaced evenly throughout the day). Your doctor may increase your dose to 2,400–3,600 mg per day.

Child dosage (ages 12–17 years)

Typical starting dosage: 900 mg per day (300 mg, three times per day, spaced evenly throughout the day). The usual maintenance dose is 900–1,800 mg per day, divided into three doses daily. Your doctor may increase this dose to 2,400–3,600 mg per day.

Child dosage (ages 3–11 years)

Typical starting dosage: 10–15 mg/kg/day, divided into three doses, spaced evenly throughout the day. Your child’s doctor may increase the dosage to meet your child’s needs.

Child dosage (ages 0–2 years)

Dosage for people younger than 3 years has not been established.

Senior dosage (ages 65 years and older)

Your kidney function may decrease with age. Your body may get rid of this drug more slowly. Your doctor may start you on a lower dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous. Your doctor may change your dose based on how well your kidneys are working.

How Long Does it Take Gabapentin to Work?

It can take several weeks for gabapentin to reach its full effect, but this depends on the condition being treated.

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking gabapentin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor. Dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.

If you are taking the tablets and your doctor directs you to split the tablet in half, take the other half-tablet at your next scheduled dose. Discard half tablets if not used within several days of splitting them. If you are taking the capsules, swallow them whole with plenty of water.

It is very important to follow your doctor’s dosing instructions exactly. During the first few days of treatment, your doctor may gradually increase your dose so your body can adjust to the medication. To minimize side effects, take the very first dose at bedtime.

Gabapentin is approved to treat:

      • Nerve pain
      • Some types of seizures
      • Restless legs syndrome (RLS)

It also depends on your individual response to the drug. The time gabapentin takes to work is not the same for everyone.

The effective dose of gabapentin is also very different for each person. It may vary from 300 mg per day to up to 3,000 mg per day.

Another reason gabapentin takes time to work is that the dose is usually started low and gradually increased over time to reach an effective dose.

For example, when used to relieve nerve pain, the initial dose may be started at 300 mg and increased by 300 mg daily over several days, gradually reaching up to 600 mg three times per day. Studies for nerve pain treatment show that pain relief may begin within 1 week, with the maximum effect reached after about 4 weeks.

Gabapentin is in a class of medications called anticonvulsants. It is not completely known how this drug works. When used to treat a type of seizure disorder, called a partial onset seizure, gabapentin decreases the abnormal activity in the brain that causes the seizures. When used to treat nerve pain, or neuralgia, following a herpes zoster (shingles) infection, gabapentin may reduce the response to painful stimuli. It is unknown how gabapentin relieves symptoms of restless legs syndrome.

Even though it may take up to 4 weeks to get the full effects of gabapentin, it is important not to stop taking it suddenly. That could cause withdrawal symptoms such as:

      • Anxiety
      • Insomnia
      • Nausea
      • Pain

If you are taking gabapentin to control seizures, stopping suddenly may increase your risk of a seizure.

Common side effects of Gabapentin

These common side effects of gabapentin may happen in more than 1 in 100 people. They’re usually mild and go away by themselves.

There are things you can do to help cope with them:

    • Feeling sleepy, tired or dizzy
    • Feeling sick (nausea)
    • Being sick (vomiting)
    • Diarrhoea
    • Mood changes
    • Swollen arms and legs
    • Blurred vision
    • Dry mouth
    • Difficulty getting an erection
    • Weight gain
    • Memory problems
    • Headaches
    • Getting more infections than usual

Keep taking the medicine, but talk to your doctor if this advice does not help and the side effects bother you or do not go away.