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Baby Boomers Health & Retirement

How chronic pain builds invisible walls

Aug 04 2016

As many as two-thirds of Americans over the age of 65 have lived with chronic pain. And it’s not just older people who suffer. Chronic pain is the most common cause of long-term disability among middle-aged people. Generally, chronic pain is pain that goes on six months or more.  Too often, says an Aetna pain specialist, people with chronic pain are missing out on the mix of care that could ease the pain and help them lead happier, more active lives.

Chronic pain can build walls around us

“Pain is a highly emotional experience,” said Jeff Livovich, M.D., an Aetna medical director and pain specialist. “Chronic pain actually becomes part of your personality. It can change your behavior, your outlook on life, your daily habits and your activity level.”woman looking out a window

If you stop doing certain things – playing tennis, walking your dog, visiting places with lots of stairs, lifting your grandchild or even standing long enough to cook dinner — because of fear they will trigger pain, you can become even more isolated and inactive, Livovich said. That creates a vicious cycle. Being inactive can make pain worse, not better.

“Pain can build a wall around you,” he said. “When chronic pain enters your life, it doesn’t just affect you. If you’re still working, it can affect how well you can focus on your job. It can keep you from being involved in your family, your community and your favorite activities.” It’s no wonder that depression is twice as common in people who have chronic pain.

Here’s the important thing to know, though: It doesn’t have to be that way.

Where to seek help for chronic pain

The first stop for many people dealing with chronic pain is their primary care doctor. That’s a good start, Livovich says. Depending on your doctor, though, you may get very different recommendations.

“If your doctor just gives you painkillers, you need to push for different options,” he said. “Painkillers are not a long-term answer. You build up tolerance to opioids, you need more and more of them to be effective, they have complications of their own, and you can end up dealing with even more significant problems. Pain block injections alone aren’t the answer either, although they can be valuable combined with physical therapy. There are better solutions.”

What might help?

  • Physical therapy is often the most effective intervention. You also may benefit from chiropractor visits or even a pain block injection to help ease the pain while you begin physical therapy. Yes, sometimes you feel more pain when you start physical therapy or other exercise, but that should quickly ease as you strengthen your muscles and gain flexibility. Most health plans cover physical therapy; check with your plan on any limits.
  • Chiropractic treatment can also ease some pain, but its effects are often temporary. Many health plans cover a certain number of chiropractic visits a year, so you should check with your plan before going. Some people also try massage therapy and acupuncture for temporary relief; health plan coverage of these is generally limited. While these treatments seldom provide a cure, they can provide comfort and relief, and that is important when you’re in pain, Livovich said.
  • Multidisciplinary pain programs are available in some areas of the country, and Livovich recommends looking for one if you are not getting the relief you need from traditional medical care. Such centers bring together many different approaches, so a patient can get customized care that will work in their life. They also can help you get off your painkiller medications, if you have been taking opioids for your pain for a long time and are dependent on them.

Pain is not just physical, it’s mental, too

“Pain is in the brain,” Livovich said. “It has an emotional as well as a physical component. Even if you can’t fully control the physical component of pain, you can control how you respond to it.” Our behaviors and thoughts can create negative feelings, and negative feelings can make us more sensitive to pain, he explained.

Even if you can’t fully control the physical component of pain, you can control how you respond to it.

Learning to break this cycle can actually lessen pain. Visiting a psychologist or someone trained in cognitive behavioral therapy can be the key to success of whatever other treatment you undertake.

“A psychologist can gather up all the factors in a person’s life, such as what beliefs he/she has about their limitations, and what is going on psychosocially, and work to reframe the situation,” Livovich says. “The care becomes much more personalized then. When I was in practice, we would have the patient’s significant other come to the appointment as well, to get that insight.”

Mindfulness, meditation, yoga and other practices also can help people deal with pain.

All of these therapies and practices can help you learn coping skills, gain confidence in ways to manage your pain, and change the way you respond to pain. And that, Livovich said, can make a big difference in your life.