A to Z of Effective Pain Management Therapy
Updated: Nov 25, 2022
Pain management is often not about eliminating pain but implementing strategies to better manage your pain and optimise your quality of life. Unfortunately, pain management is often ignored and doctors only refer to psychologists when the pain becomes chronic and cannot be managed effectively with just medication. Pain can be complex and involves our physical bodies, behavioural responses to pain, coping strategies and psychological health. Early referral for pain management can optimise treatment effectiveness and outcomes. Below is the A to Z of pain management from a psychological perspective.
We all experience pain in some form, whether physical or emotional. Sometimes, however, pain can become persistent and overwhelming. When we fight pain, we can create tension and magnify the perception of pain. Paradoxically, accepting your pain, and not fighting it, will reduce anxiety and help improve your mood. Chronic pain provides an opportunity for growth. Through cultivating awareness and compassion for our pain, we develop our awareness and compassion for others.
Learn breathing techniques. Breathing is something we take for granted. Focused and controlled breathing is a simple and effective pain management technique that can be done anywhere, any time. It is a great way of distracting yourself from your pain, optimising oxygen flow to your body, relaxing your muscles and calming yourself physiologically. Your pain Psychologist can teach you appropriate breathing techniques.
In consultation with your treating doctor, complementary medicine offers a wide range of treatments. They include acupuncture, supplements, vitamins, meditation, massage, herbal treatments, aromatherapy and naturopathy. Ensure the practitioner you consult is appropriately trained and qualified. Complementary medicines are not always safe and it is best to keep your treating doctor informed.
Be cautious of advertising and promises of miracle cures. There are many people profiting from ‘snake oil’ remedies. These are diets, supplements and treatments that have no scientific evidence to support their use or effectiveness.
Some natural medicines can also interact with prescribed medications. Speak to your pharmacist who can also be a good source of advice. Buy Australian. Australian complementary medicines are subject to strict safety and quality regulations.
Often we engage in unhealthy coping behaviours like smoking and drinking. Negative coping behaviours are likely to adversely impact on your mood and physical functioning over time. Pain can cause difficulties with sleep, and alcohol can make sleep problems worse. Reducing or eliminating negative coping behaviours and replacing them with healthy coping behaviours can change your quality of life and improve health and wellbeing. Your Psychologist can help you develop healthy coping mechanisms and reduce unhealthy ones.
It is natural for us to focus on our pain, but this can make the experience of pain worse. Try focusing your attention on something other than your pain, something enjoyable, entertaining, or distracting. Distraction can help manage pain for short periods of time. The more you practice, the better you will get at limiting your perception of pain. See my other blogs on activities we can all do.
Acknowledge and express your emotions. When you live with persistent pain, you can experience a roller-coaster of emotions. Your fluctuating moods can also impact on your family and friends. When we experience chronic pain we can feel frustrated, depressed, anxious, angry and irritable. Don’t ignore your feelings rather seek psychological counselling to learn how to manage your feelings and emotions.
Create an environment at home and work that is ergonomic and will not exacerbate your condition. Make your spaces enjoyable to boost your mood. Consider pleasing all your senses with light, sounds, scents, textures and so on. Think for a moment about where you are: Is your space comfortable? Does it provide you with all that you need to live and work without aggravating your pain? Avoid clutter, annoying noises, bright or dim light and things that will cause you any frustration or stress.
Living with persistent pain can be physically and mentally tiring. This tiredness, or fatigue, can make everyday activities seem overwhelming. Besides pain being tiring, lack of sleep, medications and depression can also contribute to low energy. Many of the strategies used to manage pain can be used to manage fatigue, including exercise, relaxation, being assertive and saying no, eating a healthy diet, pacing your activities, getting a good night’s sleep and talking with your doctor about your medications. Find a Counselling Psychologist who can help you manage symptoms of fatigue by learning appropriate psychological techniques.
At times you may go through a period where pain is worse, or more intense. This is called a ‘flare’ or ‘flare-up’. The causes of flare-ups are not always known and can be experienced randomly. Sometimes we can identity the triggers like being too active or exceeding our own limits. Flare-ups are temporary but can be frustrating and painful. Have a plan for how you manage a flare-up. Keep a record of events and possible triggers that you identify before flare-ups. This can help identify causes of flare-ups and then you can limit those triggers in future to prevent, or reduce the frequency, of flare-ups.
Setting goals helps having something to strive towards. Goals can relate to: career, finances, holidays, health and fitness, and so on. Goals motivate us, give us a focus and encourage us to plan and take steps to achieve positive outcomes. Speak with your counselling psychologist about DUMB and SMART goals.
This technique involves using your imagination to visualise a relaxing scene to distract you from your pain and relax you. You might focus on your favourite place, real or imaginary, that is safe, tranquil, and pleasant. You can even listen to scripts online.
A well-balanced diet is important. A good food regime can assist to optimise your digestion, achieve, and maintain a healthy weight, reduce fatigue, boost immunity, reduce inflammation and enhance mood. See our healthy eating information based on the CSIRO gut health diet for further information. Always speak with your treating doctor about dietary changes, especially if you already have gastrointestinal conditions such as Crohn’s Disease, Celiac Disease, Diverticulitis, and so on.
Heat and cold
Applying heat or cold to a painful area can be a simple and effective method to relieve pain. Some people prefer heat, others prefer cold. The level of heat and cold should always be comfortable and never extreme. Heat can relieve muscle spasms and tension. Take care though as heat, in some cases, can provide relief but then result in increased inflammation. Cold can reduce swelling. Physiotherapists can also provide advice and treatments that penetrate deeper into muscles and tissue.
Here are some methods of applying heat and cold:
Electric blanket Hand warmers Heat packs Heat patches Heat rubs Hot water bottles Warm bath, shower, or spa
Bag of frozen food Cold gels Gel cold pack Ice cubes Ice packs
At times you may need more support, or some help. You might need help with laundry or other household tasks, or a lift to a doctor’s appointment. Ask! Most people are happy to help. Do some research to find help and support services in your local community. You can also try speaking with your local community health service and council.
Obtain professional help from a psychologist who can help you learn to cope better and avoid negative thoughts and behaviours that can make pain worse. Asking for help is a sign of strength, not weakness.
More than half of your body is made up of water, so it’s important you get enough fluids daily to replace water lost through normal bodily functions. Water is lost constantly through sweat, urine, faeces and even through your breath. Ensuring good hydration is important for overall good health. Water lubricates and cushions your joints, aids digestion, prevents constipation, keeps your temperature normal and helps maintain your blood pressure. See the iflow psychology blog on hydration: Why hydrate? The secret health benefits of water for more information.
The amount of water needed varies from person to person and from day to day. There’s no ‘one size fits all’. Factors such as your age, gender, health, and environment will affect how much water you’ll need. You will need to drink more water in warmer weather and when you are physically active. Don’t wait until you are thirsty.
Alcohol and drinks containing caffeine (e.g. coffee, tea, cola) are diuretics. They make you go to the toilet more frequently and lose water through urine. Consume these in moderation.
Be informed. Knowing as much as possible about your pain and your condition means that you can make informed decisions and play an active role in the management of your healthcare. Access good quality, up-to-date information and stay informed. Quality information can be a powerful tool to help you take control of your pain. Ask questions. Who wrote or gave you the information? Are they qualified? Does it have the scientific evidence to support it? Is the information balanced? Does it provide you with a variety of options, or provide only one? Does your doctor and team of treating health professionals support it as a strategy?
Sometimes, it can help to track or record your pain experiences each day. Record changes in your condition, pain and fatigue levels, the effectiveness of medications, your mood, activities and thoughts. Information can help identify pain triggers and effective management techniques. This can provide valuable information to your treating health professionals. Consider rating your pain out of 10 points with zero being 'no pain'.
When we experience pain, we can become isolated. As pain affects our mood, we might not feel like engaging in activities or seeing people. Connection with others is positive for our wellbeing. Socialising is a good distraction and necessary source of support.
When you experience pain, laughing is probably the last thing you feel like doing. Laughing, however, can help manage pain. Laughter causes a variety of chemical responses in your body. The ‘feel good’ hormones (endorphins, serotonin and dopamine) are released into your bloodstream. They boost your mood, making you feel more positive. Endorphins are your body’s natural pain reliever. Laughter can also help boost your immune system. Try watching a funny movie, listening to a funny podcast, watching TikTok or googling jokes. Ask friends to tell you their funniest joke! Like.....Do you know how my partner got rid of her pain in the neck? She asked me to leave. Boom! Boom!
Massage is a hands-on therapy that involves rubbing and manipulating the soft tissues of your body, especially muscles. Massage can improve blood circulation, ease muscle tension, and help you feel more relaxed. A massage is useful for helping manage physical pain, and also helps relieve stress and improve sleep. You can give yourself a massage or see a qualified therapist. A family member or good friend could also give you a gentle massage. As well as using your hands, try a foam roller, massage balls or other massage aids. You could even try electronic massage devices.
Medications for pain management
Medication can be important for managing acute pain and preventing chronic pain behaviours. There are different types of medication that your doctor might use to help you at different times and in different ways. They should be tailored to your pain condition and other health concerns.
Over-the-counter medications: can help with mild to moderate pain and include mild analgesic paracetamol, and anti-inflammatories like ibuprofen and aspirin. These medications may be combined (e.g., paracetamol and ibuprofen) but obtain advice from your chemist. All medications have potential side effects (or unwanted effects) and risks. The fact that you can buy these products over the counter doesn’t mean they’re without risk or completely safe. Talk with your pharmacist for more information.
Prescription medications: non-steroidal anti-inflammatories (NSAIDs) are available over the counter in low doses, others need to be prescribed. NSAIDs can provide temporary pain relief, specifically pain associated with inflammation, and reduce fever.
Opioids: are used to treat severe pain associated with cancer or acute pain (e.g., following surgery). They might also help some people with severe, persistent pain. Their long-term benefit is controversial. Opioids can have serious side effects (including constipation and breathing difficulties). They also produce physical dependence over time and can be addictive if not managed appropriately.
Anti-neuropathic pain medications: Medications that act on the nervous system associated with pain may be used where nerve injury or dysfunction produces pain (neuropathic pain) or when the pain system is sensitised (in part due to severity or duration of pain). These include older types of anti-depressants, anti-epilepsy medications, and some blood pressure medications. These medications typically have significant side effects (e.g., reduced concentration, sleepiness, weight gain), however, sometimes they may be prescribed for these effects (e.g., to improve sleep).
Always speak with your doctor and pharmacist when taking medication. Also learn what your medications contain and take care to ensure you do not take multiple medications with similar ingredients to prevent overdose, side effects and even death.
Learn to focus, and be, in the present moment using mindfulness exercises. Through practice, you can train your mind to focus and pay attention to the thoughts and sensations you experience, accepting them without judgement. Regularly practicing mindfulness meditation can relieve stress and pain, and improve: mood, sleep, and mental health. Your Psychologist can teach you mindfulness techniques.
Eating a well-balanced diet that includes a variety of foods, such as fruits, vegetables, whole grains, proteins and healthy fats, is important for good health. It gives your body the energy and nutrients it needs to work properly, helps you maintain a healthy weight, helps protect you against other health conditions and is vital for a healthy immune system.
Pain can lead to individuals eating more, or less, than is required. Pain may prevent grocery shopping and increase reliance on junk or fast foods. Pain might restrict your ability to stand or cook. Medications can also influence appetite.
Consider preparing meals in advance. You can also shop online and have groceries, or prepared healthy meals, delivered. Make your meals colourful, as various coloured fruit and vegetables have unique disease fighting chemicals called phytochemicals.
See the iflow psychology blog: Recipe for Better Health: Food, Water and Weight Change for more information.
Ointments, creams, sprays, liniments, rubs & gels
Temporary forms of pain relief come in the form of creams, gels, ointments, rubs, and sprays applied directly to your skin. There’s a vast array of them available, in many different forms and using different ingredients. These products can provide some relief and, in some cases, can be anti-inflammatory.
Topical products can include:
Counterirritants: such as menthol, methyl salicylate, eucalyptus oil and camphor. They act by creating a burning or cooling sensation that distracts you from the pain.
Medicated products: Many topical products contain non-steroidal anti-inflammatory drugs (NSAIDs). If you are taking other NSAIDs, consult your doctor or pharmacist before using a medicated topical pain reliever.
Pacing is important in pain management as it helps you to stay active, doing the things you care about and want or need to do, and helps you avoid pain flares. Pacing involves reducing activities into smaller parts. Pacing can help find the right balance between rest and activity (both physical and mental). This will help reduce your risk of pain flares and fatigue. Instead of mowing all the lawns in one day, for instance, you might choose to mow the front lawns one day and then the back lawn a week later. This prevents flare-ups from overdoing it.
Physical therapy and occupational therapy
These two specialties are important components in pain management. Physical therapists, like physiotherapists, guide you through a series of exercises designed to improve your strength and mobility. Occupational therapists can help you learn to perform a range of daily activities in a way that doesn't aggravate your pain.
Plan the tasks you want to achieve in your day or week. If you have a big job that needs a lot of energy, try breaking it into achievable tasks that can be spread through your day or week. Plan to do bigger tasks at a time of the day when you tend to have more energy. Plan lighter activities and rest breaks around them.
It’s also important to plan enjoyable activities, it’s not just about getting tasks and chores done. Taking part in activities you enjoy can improve your mood and energy levels.
Try to stick to your daily plan, but don’t beat yourself up if you can’t do everything. Your healthcare team should be able to help you set and review realistic goals.
Posture is more than just how straight we sit or stand. Posture refers to the correct alignment and positioning of your body. Good posture means your body is arranged so that no structure is overstressed, that the pressures on your body are evenly distributed and that your muscles aren’t strained or tense. A good posture does not mean standing straight and rigid like a soldier. To achieve good posture, place your body in correct alignment, but loose and flexible. Bad posture can cause, or aggravate, existing pain. It can also cause general aches and pains, muscle fatigue and other health problems.
Many pain conditions start with poor posture, including wrist, arm, shoulder and neck pain from working on computer that has not been set up correctly. Fix the cause of the pain and you can often resolve the issue. If you do not fix the cause, then no amount of medication, treatment or surgery will assist you. Consider all situations where you spend time like at your desk, watching television, driving, you bed (mattress and pillow) and so on.
If you have a list of activities and cannot get them all done, then prioritise them, so the urgent and important ones get completed first. Over time, you can increase your paced activities as you build tolerance. Through understanding and expanding your limits you can better manage your pain and fatigue and gradually increase your capacity.
While you’re planning your day or week, put activities into an order of importance. Ask yourself: Does this need to be done? Does it need to be done today? When does this task have to be completed?
It's helpful to identify triggers of stress, pain and fatigue. Once triggers are identified, they can be seen as problems to be resolved. Take a solution-focused approach. Can tasks be broken down and completed over a longer time? Can you take more breaks? Can I ask for help from someone else? Can I get someone to help me with parts of the task? Can you pay someone to do chores? Can you shop online and have groceries delivered?
Progressive Muscle Relaxation (PMR)
A whole body experience. When we experience pain, often our muscles become tense and sore, adding to overall pain. PMR helps ease this muscle tension. It’s also a very useful technique to help you fall asleep. A Counselling Psychologist can assist you learn effective PMR techniques.
We know smoking is bad for health. As well as increasing your risk of cancer and lung disease, smoking has been linked to back pain, neck pain and rheumatoid arthritis. Smoking causes fatigue and slows healing, which can make pain worse. It also reduce the effectiveness of some medications. Quitting smoking has health benefits such as breathing easier and improving energy, making it easier to engage in exercise and daily activities.
Reduce your activities as necessary but do not stop them completely. See pacing. Waiting until you feel 100% before returning to activities or to work is not a good approach. Small, gradual steps allow you to stay connected and engage in activities important to you, sooner rather than later.
Learn Relaxation Techniques. When we experience pain we often focus on the pain, become stressed and tense our muscles which can then make the pain worse or even result in muscle spasms. Deep breathing and progressive muscle relaxation are techniques that help your body relax, which may help ease pain. A Psychologist can teach you appropriate exercises in therapy.
Some stress is normal and can even help motivate us. Excessive stress, however, can increase pain levels. Reduce stress in your life. Learning to effectively manage stress, can assist in finding some relief from chronic pain.
Everyone needs support. Don’t withdraw and isolate yourself. Support from family, friends, and those around you is important. People who have positive social support cope better with pain. Also consider talking with someone who knows what living with pain is like.
Establish a team of health professionals to support you. When identifying health professionals ensure they are registered with the Australian Health Practitioner Regulatory Agency (AHPRA). Your team can consist of a range of health professionals including: doctors, psychologists, physiotherapists, occupational therapists, nurses, and so on.
Learn about your condition and pain. Knowledge can remove stress by understanding the cause of pain, removing misunderstanding, fear and stress. Knowledge allows you to make informed decisions and play an active role in managing your condition.
Visualisation uses the imagination to reduce pain and stress. It’s similar to guided imagery, however, instead of being told what you see, hear and feel, visualisation is up to you and your imagination. As with guided imagery, it’s a chance to distract your mind from your pain and take time out. Visualisation won’t eliminate your pain, but it can help you deal with it better when you’re having a flare up, when you’re feeling stressed or tense, or when you’re having problems sleeping.
Maintain a healthy weight. Avoid responding to pain by reducing activity and engaging in comfort eating, overeating and making poor food choices. Becoming overweight and physically de-conditioned, places more stress on your body increasing the risk of further pain, injury and inflammation. Being overweight also increases the risk of developing other medical conditions.
Being underweight can also be an issue. When we experience pain or a low mood, we can experience a loss of appetite. An insufficient diet can result in us not consuming sufficient nutrients. This can reduce the effectiveness of the immune system, result in lower energy levels and increased fatigue.
Avoid fad diets. Instead, develop a healthy food regime that can be sustained. Your counselling psychologist can provide more information on healthy eating. More information on healthy eating is available in the iflow psychology blog: Recipe for Better Health: Food, Water and Weight Change
Ok! I cheated, it’s ‘Exercise’, I know! Exercise does not have to be strenuous, simply begin increasing your daily activity level. Often people restrict their movement due to pain. This can lead to stiff muscles, stagnation, reduced activities, weight gain, low mood and ultimately worse physical fitness and pain. Exercise releases natural endorphins, brain chemicals that help improve mood while blocking pain signals. Exercise can reduce pain through strengthening muscles and helps prevent further injuries.
Exercise can include walking, swimming, gardening, bike riding, yoga, pilates and so on. Take public transport to work and when you drive park further away at your destination, so you must walk part of the distance. Take stairs, when possible, rather than an elevator or walk-up escalators. Play sports and choose fun activities. This gives you a greater chance at sticking with them. Start small and gradually increase your activity level. Establish a routine and exercise with others to increase your commitment and also have a social aspect. Aim for moderate exercise for about 30 minutes a day. This helps maintain fitness, energy levels, weight, and mood.
Exercise should include elements of flexibility, strengthening and cardiovascular or aerobic exercises.
Flexibility exercises involve stretching and 'range of movement' exercises that maintain or improve the flexibility of joints and muscles and eases joint stiffness.
Strengthening exercises build muscle strength, provide stability to joints and improve your ability to perform daily tasks.
Cardiovascular, or aerobic, exercises increase your heart rate improving the health of your heart and lungs (cardiovascular system) and helps with endurance, weight control and prevention of other health problems, such as diabetes.
Your inner voice
Negative self-talk or ANTs (Automatic Negative Thoughts) can affect our mood, quality of life and self-esteem. Being pessimistic can make the pain experience worse. Be aware of negative thoughts and learn to engage in positive thinking through mindfulness and gratitude. A more positive mood can change the pain experience for the better.
A psychologist can assist you develop more positive ways of perceiving and thinking about the world to optimise mood and pain management.
Pain often affects sleep. Pain, muscle tension, anxiety and other factors might interfere with falling asleep, staying asleep or the quality of sleep. Conversely, not getting good quality sleep can affect pain levels, muscle tension and stress levels. This can become a vicious cycle. Discuss sleep strategies with your Counselling Psychologist.
If you, or someone you know, is experiencing difficulty with chronic pain, support is available. If you need further assistance please contact iflow psychology or book an appointment. You can book an appointments online, or by calling my friendly admin staff on 02 6061 1144.
iflow psychology offers in-person (face-to-face), telehealth and telephone counselling. We are registered psychologists. We also offer Medicare Rebates when you have a doctors referral and Mental Health Plan. We would love to be part of your journey to a healthier lifestyle.
Location Details: iflow psychology is located in Leichhardt Inner West Sydney NSW Australia
Disclaimer: The information provided in this article are suggestions only. It is always advisable to speak with your treating doctor and health professionals before making changes. This is particularly important if you have health concerns or have existing medical conditions.
(c) 2021 Dean Harrison