Chronic Pain Management
© 2003 Theresa Lorraine

How many times have you uttered any of the above comments or similar ones? I know there are days for me when life just seems too hard and it was worse before I spent a year working with a counselor who specializes in chronic pain management. I have been diagnosed with Ehlers-Danlos syndrome and Fibromyalgia and managing the invisible pain that accompanies this diagnosis has been one of the greater challenges in my life.

One of the first things I learned to do was make an "I'm desperate" note to myself. When I'm feeling overwhelmed by the pain and the hopeless feelings that accompany it, I'm not always able to remember what works and what doesn't. The little note to myself helps me focus on doing something proactive to help myself so I don't fall into the, "Oh my gosh, I'm never going to be well and this is all there is" trap. My note has changed over the years because I've found new and different things that work and tossed out some of the things that just don't seem to anymore. Your note will be different from mine. And there may be days when nothing on your note will help you at all. The following article is for those days.

None of us has complete control over our lives, so even though there are preventive measures we can take to avoid high pain days there are times when life spirals out of control or the weather changes and we're back to crisis management; getting that pain down so we can at least watch an old movie on TV without squirming in pain through the whole thing.

Long Term Strategies for Coping with Chronic Pain

I've set up my life to be as flexible as possible. When I make plans with my kids or my good friends, it's understood that I really want to do this thing but it will depend on pain levels. I've notices that if I "do it anyway" I pay for far too long and it's no longer worth it to me. I've also been keeping a pain chart and a pain diary in an effort to figure out patterns. This has been a wonderful tool for figuring out the triggers for high pain days and also for working with my doctor. He can't possibly know what my pain feels like or what it's doing to me and my life unless I can show him in concrete form. Both the pain chart and the pain diary can be given to him in a fraction of the time it would take for me to sit in his office and try to remember and then verbalize what the past month has been like for me. It's also a lot less emotional than sitting there in tears because the light at the end of the tunnel looks like the headlight of an oncoming train.

Along with the pain chart and pain diary, I also have my medical history form on my computer so when the doctor suggests something that I've already tried that didn't work, I have that information ready. In fact, I keep a copy of my Medical History form in my purse with my insurance cards. This way if I find myself at the emergency room, I don't' have to fight through the fog and the pain to remember what on earth I'm allergic to and when I had all those surgeries. It's there written out for them.

Physical Therapy: I've talked about physical therapy with a lot of chatters over the years and found their experience was as negative as mine was at first. I discovered that all physical therapists are not equal in the realm of fibromyalgia treatment. The physical therapy I was exposed to at first was devastating. I just kept getting worse. I tried it 3 different times before I finally went to a doctor who seemed to "get it". I started physical therapy at his clinic and made incredible progress. That physical therapist was able to give me a few exercises to do at home for pain relief and I keep them in my arsenal. The "no pain, no gain" mindset has to go when you're dealing with fibromyalgia. If you're going to do physical therapy, which I strongly recommend, have a talk with your physical therapist first and make sure you're working with a person who understands that when it hurts you stop. Now I'm not talking about muscle burn. That's going to happen. It shouldn't' get above a 4 on a pain scale of 1 to 10 though. When you reach 4 with muscle burn, it's time to stop. If you experience a sharp, sudden pain, stop immediately and don't try that exercise again for a few days.

Magnets: One of the things I do on a regular basis is sleep on a magnetic mattress pad. I've talked with many people with fibromyalgia and comfortable sleep is one of the hardest things to come by. I've been sleeping on this mattress pad for 10 years now and I swear by it. My high pain levels don't last overnight. This is not to say that the pain doesn't begin again the next morning but I usually wake up without noticeably high pain levels. When I travel, I don't have my magnetic mattress pad with me and I see a big difference. I also use the smaller magnets during the day for stubborn aches and have found them to work wonders. Don't let anyone tell you this is a cure though. It's not. So far there is no cure for fibromyalgia and we're just talking about how to cope with high pain levels here.

I'll talk about pain medications at the end of this article. For those lucky ones who don't have a lot of medication sensitivities, they can be life savers. I've spent most of my life without them, however, because so many of them make me feel worse than the pain does. The longer I chat, the more common I find this problem to be.

Heat: A hot shower immediately upon waking and anytime during the day when the pain is unmanageable.

Heating pad where ever it hurts (and, yes I KNOW it actually takes an electric blanket. I'm talking about the worst spots here)

Ice: Ice on my lower back over the disc between L4 and L5. (ice on for 15 minutes and off for 45 minutes)

Frequent changes of position. I co-own a chat room and I can find myself typing for hours on end. This is murder on high pain days and can actually bring on a flare. To avoid that, I sit at the computer and as soon as I begin to feel uncomfortable, I walk around the room, move to my favorite chair, do up the dishes or just about anything else I need to do in order to be in a different position for a bit.

Water: I know it sounds too simplistic to be true but plenty of water is actually a great pain reliever. I have a lot of theories about why this would be true but for here just remember that those 8 glasses of water a day seem to lubricate everything and in a few days pain level goes way down. My rheumatologist tried to tell me it was all in my head but I swear to you, it's really in my body. Through keeping my pain diary, I've discovered there are some foods that trigger a higher pain level for me. I cheat though and then find myself paying for it. Extra water on those days seems to wash away my sins and bring the pain level down again.

Being cold raises my pain level in a heartbeat. So my goal is always not to get cold. Unfortunately, life often takes over and I do get cold. I actually keep a pair of clean sox in my purse for those times when I'm out and my feet begin to freeze up. I carry a sweater with me, even August and I always have a coat with me in the winter. I wear gloves and have a hat with me whether it's in style or not. I've discovered I have a different "style" now that I have Fibro but it's really not so bad. You can go retro, be comfy and look a million bucks if you don't mind being a bit "out of the mainstream". Frankly, not being in pain is much more important to me than what Mrs. Kadiddlehop thinks of what I'm wearing. Sometimes, clothes just don't keep the chill away. At that point, a hot shower upon reaching home is in order for me. The sooner we interrupt the pain cycle, the easier it is to control. I just don't let anything go any longer than I have to anymore.

One of the things I learned at the beginning of this journey was that pain causes my mood to take a downward plunge and that mood plunge seems to increase the pain. It's a vicious cycle so on top of the physical gymnastics I go through in order to control pain, I've also got some emotional tricks in my basket.

Short Term Strategies that work for me

Laughter really is the best medicine and I've found it can change my pain cycle as fast as anything else. I have some funny things available that I can read, favorite movies that bring on the giggles and I chat. My kids are always ready for a good laugh fest and since they also deal with chronic pain, it beneficial all the way around.

Venting: Laughter doesn't always do the trick and during those times it's usually because life is overwhelming and I hurt to much to even figure out why, much less come up with a fix for the problems. At that point you just can't laugh away the trouble. I find a good vent is efficacious and I several places in which to vent so I don't wear out my welcome anywhere. Chat is my first choice because everyone who chats there understands. I also have a few friends who know when I'm venting all I need is a cheerleader; someone to tell me I can do it and to hang in there and yes, my life is unbelievably hard but look how strong I must be, I'm surviving it. When the pain gets really bad and life is just too hard, it's difficult to remember we're strong people. I often need someone to remind me. Also in the venting sometimes solutions present themselves. We tend to go 'round and 'round in our heads but when we get the words out there where we can see them on the screen or hear them back, we often see the solution, whereas it was unavailable to us while we were trying to cope on our own.

Writing it out: I also find that writing out what's going on in my life takes my mind off the pain (even though I may be writing about that very thing) and gets me thinking about solutions. Writing has the added plus of being a bit record of what's going on with us. I keep all the things I write and either pass them along to others or use them for my counseling sessions or medical appointments.

Meditation and Visualization help on an ongoing basis. I find the days I'm not able to start with a visualization are much more difficult for me. One of my favorites can be found at

Pain Medication: Now to the pain meds. None of this works for me all of the time. There are times when the barometer changes, one of my kids is in a high stress space, my husband is "in a mood" and the money is short that these short term coping skills just don't work. For those of you who can take pain meds, there are ways to be on regular pain meds and reclaim big pieces of your life. If you are seeing a family practitioner who's nervous about prescribing, ask him/her to refer you to a pain clinic or rheumatologist. Devin Starlanyl has written a great overview of medications for Fibromyalgia. Sometimes, when talking to your doctor it helps to be armed with what's available and what has worked for others.

For those of you who are like me and seem to be sensitive to every medication on the market, here are a few tips I've garnered throughout the years.

Sometimes a "grownup" dose of a medication is just too much for my system to handle. There is also some indication that I'm allergic, not to all the meds I've tried, but to one of the tableting agents the manufacturers use to keep the med in pill form. I was not able to take Lortab for pain but after the doctor prescribed Lortab elixir and I cut my dose to a tiny amount, I found I could take it and the relief from the flare was heaven. In the hospital, when the nurse comes at me with her syringe full of pain medication, I always ask how much and ask her to cut it in half. There have been times I wasn't in a position to do this and ended up paying for it. Anti- anxiety medications seem to act in an opposite way for me and after chatting with so many, I'm finding this is often the case with those who suffer from fibromyalgia. I've been blessed to have a doctor who will work with me. Both Benadryl and Vistaril come in elixir form and when I need something to calm me down, a child's dose of Benadryl will do the trick without putting me out. This has come in handy in light of the incredible number of medical testing a person with fibromyalgia goes through. I still have to do open MRI's but before I discovered the calming effect of Benadryl even those were out of the question.

There are many other things that work for some and don't work for others. Chronic pain is individual. No two people respond to the same remedies the same way. Some of the things those I chat with swear by are:

The things for you to remember when pain gets overwhelming are:

#1 It's NOT all in your head and if your doctor has suggested therapy, make sure he's thinking in terms of learning coping skills and not curing pain that isn't real. Your pain is real.

#2 You ARE entitled to pain relief. Family practitioners tend to be afraid of addiction but there is actually very little chance someone in chronic pain will become addicted to pain killers. Addiction is in fact very rare in patients with chronic pain. They do not take narcotics to avoid life's problems, but to get rid of the pain, and do not take them when they no longer have the pain. The problem of physical dependence to opiates, can be tackled by slowly reducing the dose prior to stopping the drug.

#3 The pain itself will not kill you but it is destroying your life and you have a right to be validated and taken care of based on your reporting of the pain and not what the doctor thinks about your pain. If you are running into validation issues or issues surrounding medication for pain, it might be time for you to consider changing doctors. There are many, many doctors out there who are willing and able to treat chronic pain with compassion and intelligence. If you remember that the pain is real and you have a right to be treated, you'll come to a place where you will want to insist that your pain be treated. One doctor's opinion is not the last word.