Pain Management Options

Exercise and communication are key

So says Dr. Christopher Valley, a specialist in chronic pain and fibromyalgia. Listening to patients, educating them, and prescribing exercise regimens specific to patient symptoms are his specialty. Many chronic pain conditions, like fibromyalgia, mimic each other and patients can become frustrated by the lack of answers.

The absence of a diagnosis is a very challenging aspect of living with chronic pain. Treatments like physical therapy, exercise and diet are all ways to manage pain, even if the patient’s condition hasn’t been diagnosed—having a treatment plan can help not only pain levels, but frustration when lacking a diagnosis. In all cases, Valley works to deliver an accurate diagnosis. To do so, he pays close attention to information the patient is telling him; he looks at patient histories but does not take previous diagnoses made by other doctors at face value. Importantly, he performs a thorough physical exam on the patient. A careful intake of information from the patient and a good, complete physical exam are time-consuming—most primary care physicians do not have enough time to conduct thorough exams, said Valley, but he feels they are crucial in cases that are difficult to diagnose.

Education about pain and exercise is especially important, says Valley. He works to help patients know that pain can be manageable and that exercise is usually crucial in their recovery. Dr. Valley prescribes exercise just as a physician would prescribe a medication, writing it down on a prescription pad and starting with small doses. Valley takes into account the limits and boundaries of his patients and adjusts dosage of exercise accordingly. He also makes them schedule a time to do their exercise, writing it down in a planner. Condition-appropriate exercise is vital. Many seniors and those in chronic pain may look to gentle practices like swimming, walking, yoga, tai chi or exercises that can be done while sitting.

Clinical psychologist Sonya Wood offered a psychological perspective on pain management. Her work focuses on a holistic approach to pain by understanding how patients are feeling both physically and mentally. She evaluates all aspects of the patient’s life—relationships, school, work, etc.—to see which aspects are helping or hurting their pain levels. She adds that the patient’s attitude plays a huge role in their recovery... the way a patient thinks will determine how they feel and how they behave. Oftentimes, patients experience fear after having a surgery or an accident, which can prevent them from doing things to advance their recovery, like exercise and physical therapy. Furthermore, added stress in a patient’s life can make their pain worse and also impact their sleep schedule, further exacerbating the pain. Like Valley, Wood believes that taking the time to listen to patients and address their fears and stress aids in recovery.

Minimize use of opioids

As an anesthesiologist, Dr. David Burns offered insight about acute pain. Acute surgery-related pain often translates to long-term post-operative pain. If the acute pain is treated at the time of surgery, there is a lower chance of a patient experiencing chronic pain down the road. Burns works at Providence Anesthesia Services, which uses a ‘multi-modal’ approach to pain treatment. First, doctors deliver nerve blockers to prevent patients from experiencing the most acute pain after their surgery. Nerve blockers can last from several hours to days post-op. The patient’s lack of feeling for the worse part of the pain helps them in their recovery, in part, because they are more willing to participate in physical therapy. Physical therapy helps a patient’s chances of healing and gaining back their mobility. Burns discussed the importance of maintaining a healthy sleep schedule as part of the healing process, starting in the hospital. He advocates that hospital staff “cluster” patient care; instead of checking a patient’s vitals every hour throughout the night, for example, check them right before sleep-time, then minimize check-ins during the night. He advises keeping the blinds open during the day and providing an active regime of treatment and care when the sun is out.