10 Tips for Managing Chronic Pain at Home

10 Tips for Managing Chronic Pain at Home: 

(Advice from a Physical Therapist and Mother of Child with Lyme, ME/CFS & POTS)

Defining Pain
Most Chronic pain suffers hate rating their pain, but health care providers need to know. Sometimes we refer to the "Pain Assessment" as the 5th Vital Sign (after Temperature, Pulse, Respiratory rate, and Blood pressure). When we're treating you for pain, your rating is the only way we can gage whether a patient is making progress or not. It's more difficult when trying to quantify how much pain a child is in. I find the Visual Analog Scale (VAS) works better than telling someone to "rate your pain on a scale of 0-10."

My Cup Theory
When I explain pain to my patients I use my cup theory. Every one has a different size cup, or a different capacity for pain. We are each only capable of handling so much. Once your cup is full you are essentially at a 10 out of 10 on your individual pain scale. You may have a constant headache filling your cup 1/2 way (or 5:10 on your pain scale), and then your knee starts hurting pushing you up to a 7:10, and then your lower back spasms, and BOOM--your cup is full!  If you've lived past your 30's you've experienced some form of pain. When you've lived with chronic pain for years, the brain becomes somewhat accustomed to it and our selective amnesia kicks in. Sometimes, with these patients you really have to ask specific questions like "is your neck pain better, worse or the same as last week." For instance, I injured my knee years ago while snow skiing. If I think about it, yes, it hurts but most of the time my brain chooses not to think about it.  What I've found is that if I can help Chronic Pain patient's empty their cup, just a little, we can start to make progress. I may not be able to get rid of their pain completely, but If I can lower the headache or make their back feel better, we've made progress.

How Can You Empty Your Cup?

1. Positioning. 

• Some people are comfortable laying flat, but I've found if you're in acute pain, lying on your back, head slightly elevated, legs slightly elevated is most comfortable.
• Use a large wedge pillow, plus one standard pillow, and a small pillow or towel roll under the knees. (see position below)
• If the shoulders are hurting, place a small pillow or towel roll under the elbows.  
• Tips for Parents: When my daughter was at her worst she found it difficult to breath when she was laying flat. I set up a portable massage table in our living room so that I could position her for comfort and work on her as needed. We had a soft pad under her body, kept the upper portion of the table elevated about 30 degrees and a soft blanked rolled under her knees.

• Another position for comfort is Side-lying 
• One pillow under the head, one pillow between the arms, one pillow between the knees, a pillow or large blanket roll behind the back/pelvis. If you are having a lot of lower back pain it's important not to twist the spine. (see position below)

2. Reduce the Headache First 

• For extreme migraine headaches you will need to black-out the windows during the day. 
• Large size icepack to the top of the head and a smaller gel pack for the eyes (if needed).
• A head/neck/facial massage that includes the ears and the base of the skull works wonders.  I have found the most effective pressure points for headaches on the face are LI-20 (along side the nostrils), ST2 (directly below the eye you'll feel a little notch at the start of the cheek bone), B2 (just below the inner border of the brown line there is a little notch in the bone) and GV245 (centered between the eye brows) *See Picture Below 
• If you are alone you can apply pressure to these points yourself. When you get the pressure point just right you will feel a little rush of relief or sometimes a clearing feeling in the sinuses. Some people respond to as little as 4 grams of pressure on facial points. Gradually increase pressure until you feel a tingling. Maintain for 1-3 minutes, then gradually decrease pressure. It should feel good. 
• Tips for Parents: When my daughter had encephalitis, I had to put black sheets on all the windows so that she could come out of her room during the day. Any amount of light was like a laser beam boring into her eyes and would cause a dramatic increase in her headache. At night we had to keep all the lights at the same intensity. If there was only one light on in the room her eyes would focus on it, causing more pain. It was better with multiple lights on, but only enough to dimly light the room. 

• Another great acupressure point for headaches is on the hand which you can apply to yourself anywhere, anytime.

• I believe the best therapy for Chronic Pain is a weekly massage, but if you can't afford a Physical Therapist or a Certified Massage Therapist trained in CranioSacral Therapy, the "Still Point Inducer" is easy to use and portable. Lay on a firm surface, close your eyes, and relax for 10-20 minutes. *contraindicated for some medical conditions like head injuries and strokes. 

3.  Keep the Extremities Warm. 

• If you have Poor Circulation, Vasculitis, or Raynaud's Syndrome, you need to keep your extremities warm! I can not stress this enough. If the feet and legs remain cold for extended periods of time it can cause permanent damage to the nerves and blood vessels. 
• Frontgate makes a large foot warmer that when turned sideways is long enough to run under the knees to the feet. (pictured below)
• A Foot bath with Epsoms Salts is great for circulation and the magnesium can relieve leg cramps. 
• Tips for Parents: We keep the leg warmer in the living room on my daughters couch and have a small heating pad at the foot of her bed that she can turn on if her feet get cold at night.

4. Relax in the Bath with Epsom Salts

•  It's important that you can dedicate a full 45 min to the bath. Start with the water just over body temperature. The first 20 minutes you don't feel much, then right about the half way point you feel like you're breaking out in a sweat, it may feel a little uncomfortable, but it should pass. The bath stimulates the lymphatic system, improves circulation, loosens joints and just feels good. It's the same principal as a Sauna with the added benefits of magnesium sulfate. I recommend at least 1-4 baths per week. The skin is the largest organ in the body. Take care of it. 
• You will be very thirsty during and after your bath. Remember to Drink Plenty of Water!
• Tips for Parents: My daughter uses the master bath and wears a bathing suit so it's more like a Hot Tub to her. We add baking soda with her Epsom Salts and a few drops of lavender. When she was really sick, I would sit and read to her.  I bought a bath caddy (pictured below) that she uses for books, games, eating snacks or painting her finger nails. Other times she just wants to listen to music or scroll the internet on her smart phone which has a water proof cover.  
• *Never leave a sick child unattended in the bath!

5. Heat and Ice

• For acute pain or injuries I recommend Rest, Ice, Compression and Elevation (RICE). 
• As a general rule you want heat for muscles and joints that feel 'stiff' or 'tight', and Ice for sharp 'pain'.
• I almost always recommend moist heat because dry heat can dehydrate the muscles causing rebound pain later. They make rice filled microwavable heating packs or you can purchase a specially rated electric heating pad that comes with an insert which can be moistened (do not use water on or near regular heating pads) Heat is done for 15-20 minutes every 3-4 hours. Drink extra water before and after using any type of heat. 
• For Ice you can use gel packs or frozen vegetables with a paper towel placed over it. Ice packs are done for 9-15 minutes every 3-4 hours. 
• For TMJ or small joint pain I recommend whats called an Ice Massage. You will need to fill a Dixie Cup with water and freeze it several hours before. When ready, run the cup of Ice briefly under water and remove the Ice. Wrap a paper towel around one end to form a handle on the ice. Rub the open Ice over the joint for 3-5 minutes. The direct ice will numb the area and also act as a local anti-inflammatory. Place the ice back in the cup and re-freeze for the next use. 

6. Topical's for Sore Muscles and Joints

• Note: The active ingredients for topical pain medications are absorbed through your skin. Be sure to check with your doctor or pharmacist before using one of these. 
• Salonpas is FDA approved and uses three main active ingredients in various combinations. If you have thin skin or are sensitive to adhesives you may need to be careful with the stick-on pads. 
• Capsaicin - causes a burning sensation and depletes your nerves of a chemical that is needed to send pain messages to the brain. 
• Salicylate- is the same ingredient found in aspirin. 
• Menthol/Camphor- cause a sensation of hot or cold that temporarily tricks your brain into feeling less pain.
• Inflamyar cream (known as Flamyar in Europe) is a spagyric ointment made by PEKANA in Germany and is distributed by BioResource in CA. 
• What works for one person may not work for another. You may need to try several different products until you find the one that works for you. 
• Tips For Parents: When my daughters legs are really hurting, the only thing we've found that helps is the Inflamyar cream. I will sit on the couch and have her lay with her legs across my lap. Once I've massaged the cream into her legs, I will do passive motion (one hand under the foot, the other under the knee, bending and moving her legs for her for about 5 minutes). It helps. 

7. Braces and Splints. 

• Unless you are recovering from surgery I don't recommend wearing braces 24/7. Typically you want to wear support during any activity that increases your pain or if you are experiencing pain that is helped with pressure. For many situations a good old fashioned Ace Wrap works just fine. I like the 2 inch for wrist, elbow and ankle, and the 4" for the knee. 
• Wrist Braces - I find the flexible neoprene braces with the thumb support work great. The larger braces with all the velcro are cumbersome and should only be used for severe tendonitis where you need to completely immobilize the joint. If the thumb joint is really hurting I like the brace with the thumb spica. (When you try it on wait a few minutes to make sure the fingers don't turn blue. If so, try another size or style) 

• Knee Sleeves/Braces - Unless you recovering from surgery or have a torn tendon you don't need one of the fancy braces with side hinges. I like the neoprene brace with a center cutout over the patella (knee cap) and one velcro above and one below the knee. Or a simple neoprene sleeve if you just need a little support. Functional or rehabilitation knee braces can be expensive. (If your doctor writes a prescription it should be covered by insurance.) 

• Back Braces. For lower back pain you want to get one with broad support. I like the adjustable braces with a tapered cut in the front, a main elastic band of at least 9 inches and a second outer velcro strap that you can adjust for comfort. 

• Tips For Parents: Braces are something you need to try on before purchasing. It should feel snug but not tight. If it's not comfortable they aren't going to wear it. With children make sure to watch carefully for changes in circulation. 

8. Laughter Is The Best Medicine

• Humor - Honestly, I believe the key to happiness is laughter. Laughter reduces stress hormones like cortisol and releases endorphins, the body's natural pain reliever. My Advice: Avoid things that cause you Stress, Fear or Anger.  Watch Comedy. Do Not Watch the NEWS! 

9.  Music Soothes the Soul

• Music - Research has shown that music helps the brain release dopamine our "feel-good hormone."  I think the music should suit the situation and the person. I almost always have music on. At work, I like adult contemporary, when I'm house cleaning it's retro-disco, when I'm in the bath, soft jazz lets me float away; when relaxing on the back patio, country music feeds my soul. 

10. Finding your ZEN with Yoga and Meditation

• Yoga - The great thing about yoga is there are levels for every person. Before signing up for a class I recommend speaking with the instructor about your activity level. Frequently, the restorative yoga is great for chronic pain sufferers but if you have severe fatigue following activity your instructor may need to modify. Sometimes I think the prenatal yoga class are better for those with sever fatigue. 
• Meditation - One of the things you'll learn in Yoga is breathing. Breathing is the key to Meditation. When I was taking Lamaze they taught us breathing and mediation. One technique was to focus on an object and then imagine you are in your favorite place. Once you've mastered relaxation breathing you can try finding, what I call "your happy place."  
• Suggested Techniques
• Sharon Salzberg- Body Scan Meditation
• Joh Kabat-Zinn - Mindfulness Meditation & Full Catastrophe Living 
• Jyothi Meditation - is a very simple technique that involves gazing at a candle. 
• Tips For Parents: My daughter decided from day-one to keep a good attitude. We started recording shows that made her happy and would watch them together every evening without commercials. Her favorites are: Ellen, Jimmy Fallon, The Voice, Americas Got Talent, and The Big Bang Theory. We will also watch re-runs of Disney, Say Yes to the Dress, What Not to Wear, HGTV, DIY and the Food Channel. You get the idea--no drama, no stress. Every night we do a little homework, then she takes a bath, then before bed she watches a movie with a happy ending, then listens to music (or plays her guitar), then goes to sleep. We found if she does the same thing every night she sleeps better. 

Note: I am a licensed Health Professional, but I AM NOT A DOCTOR. I cannot diagnose nor can I prescribe individualized treatment over the internet. While I will attempt to provide citations the basic information contained in this blog is simply my opinion.