Persisting Through Pain

Going from ‘Ouch!’ to ‘Ahhh’

Whether you’ve broken a bone, bumped your head, pulled a muscle or pinched a nerve, pain is the unwelcome messenger telling you something is wrong. And it’s the most common symptom of thousands of conditions.

Types of pain

Not all pain is the same. The many types can be classified into different categories:

Acute – This type of pain is sharp and usually results from an injury. Acute pain improves when the injury or disease that caused it is treated. Conditions like burns, bone fractures, muscle spasms, appendicitis and shingles lead to acute pain.

Chronic – Pain lasting more than six months is considered chronic. It’s usually due to an untreated injury or disease, or to arthritis, fibromyalgia or nerve damage. A common example is lower back pain.

Beyond how long it lasts, pain is also classified by its cause.

Nociceptive – When you have damage to a tissue, like breaking a bone or pulling a muscle, nerve cell endings called nociceptors send pain signals to your brain. Nociceptive pain can be sudden and temporary (acute) or long-lasting (chronic).

Neuropathic – This kind of pain happens when nerves send pain signals to the brain because they’re damaged — or in error, when there’s no injury or condition to cause it. Multiple sclerosis, HIV and diabetes are some conditions that lead to neuropathic pain.

Less pain means Brenda Tibbens gets more play time with her kids.

Kicking pain to the curb

To manage aches and pains, your options are as diverse as there are different types of music. Some you can DIY, and some require teaming up with a healthcare professional to get you dancing again.

Ways to alleviate pain on your own:

Home treatments such as the RICE method (rest, ice, compression and elevation) are good for acute pain due to an injury.
Lifestyle changes like losing weight, eating a balanced diet and managing stress can reduce chronic pain.
Exercise, if recommended by your doctor, can reduce pain and improve your body’s general condition. Yoga, swimming and walking not only benefit your physical health, but can positively impact your mental health as well.

So what happens when at-home treatment isn’t cutting it? If the pain doesn’t get better, gets worse, keeps recurring or prevents you from sleeping or doing your usual activities, it’s time to get help.

Depending on what kind of pain you have and the cause of it, your doctor can recommend one or several approaches to treat it. Your primary care physician (PCP) may manage your pain or refer you to a specialist.

Pain management options include medications, injections and therapies. Your PCP or specialist can help you find the treatment — or combination of treatments — that will help you get back to doing the things you love.

Managing pain with meds

Chronic pain can often be controlled with medication, but finding the right prescription for your specific needs might take some time.

Geisinger’s award-winning Medication Therapy Disease Management (MTDM) program works closely with patients and their physicians to find the right medications that reduce the risk of complications and drug interactions.

“Patient education is key,” says Leeann Webster, RPh, Geisinger clinical pharmacist and director of the MTDM program. “Studies have shown that by educating patients about their medications, they are empowered to be more involved in their healthcare, which results in reaching their treatment goals more easily.”

Several types of medications can reduce pain, such as:

Acetaminophen
Nonsteroidal anti-inflammatory medicine (NSAIDs)
Antidepressants
Antiepileptics
Local anesthetics, like lidocaine
Opioids (for severe pain)

Work with your healthcare provider to find the right medication and the right dose to manage your pain. Just remember, you may need to try different medicine before landing on one that works for you.

Sometimes surgery is the answer

For some conditions, surgery can help to correct the problem that’s causing the pain when other methods don’t work. Back, neck and shoulder/arm pain, for example, don’t always respond well to therapies or medication. Surgical treatment may be the best option in those cases.

Brenda Tibbens, 42, of Salladasburg, was sidelined by pain from a lumbar disc injury. With a busy life of work and babysitting children, she needed to get back on her feet. Minimally invasive spine surgery performed by Sanjay Konakondla, MD, a Geisinger specialist in endoscopic surgery for spinal disc repairs, had her home the same day with instant pain relief.

Unfortunately, Ms. Tibbens had a fall the following year and reinjured her disc. This time, Dr. Konakondla performed a more traditional type of surgery involving screws and a titanium graft.

Though Ms. Tibbens still has some lower back problems, they’re nothing like they were before. “I like to be on the floor with the kids, doing a lot of imaginary play and interacting with them at their level,” she says. “Geisinger gave me my life back.”

Alternative treatments for chronic pain

Pain is complex — and every person’s causes and perceptions of it differ. That’s why taking a comprehensive, holistic approach is often the best way to manage pain. This strategy also helps reduce using opioids and other pain medications. The Multidisciplinary Pain Management Program (MPP) at Geisinger is an innovative example of this method.

“The MPP is a holistic educational approach to chronic pain management,” says Leyna Kipp, MSN, RN, a clinical nurse educator in pain medicine at Geisinger. The MPP uses different modalities for treating pain, such as:

Stress management
Relaxation techniques to desensitize the nervous system
Behavioral pacing to help improve function and activity levels
Stretching and movement
Energy conservation
Sleep
Nutrition
Alternative thinking approaches
Self-management

The goals for the program: to decrease pain levels and to improve function, overall mood and quality of life. “We’ve seen firsthand how it changes people’s lives and helps them get back to enjoying their favorite activities,” Ms. Kipp says.

Don’t suffer in silence

If pain is a constant presence in your life and restricts what you do, talk to your doctor about it. Be open and honest about how pain affects your daily activities. Let your doctor know if you feel depressed or anxious. Understand that it may take time to find a treatment that works. You may not even get rid of all your pain, but working with your healthcare team can help manage it so you can get back to living your best life.

See how other Pennsylvanians have found relief from pain.

Pain management during the opioid crisis

Pennsylvania has one of the highest rates of death due to drug overdose — mostly due to opioids. That’s why Geisinger takes proactive steps to reduce opioid addiction and misuse, including:

Educating patients about the risks of opioids and other forms of pain relief
Helping patients find safe, effective ways to manage chronic pain
Following evidence-based prescribing guidelines
Identifying patients at risk of opioid addiction and providing interventions
Providing treatment and recovery services for patients who need help
Participating in the Pennsylvania Prescription Drug Monitoring Program
Coordinating care between primary care providers and specialists to keep pain management safe

Naomi Johnson, 75, of Lewistown, had radiating nerve pain due to a degenerative disc condition. She took an opioid pain reliever, but it only helped so much. “I was getting up every night crying, walking the floor in pain,” she says.

Her doctor, concerned about long-term use of the opioid, took her off the drug and referred Ms. Johnson to Geisinger’s Medication Therapy Disease Management program. There, clinical pharmacist Eva Gerhart worked closely with her to manage her pain using gabapentin, a non-narcotic nerve pain medication.

It took some time to land on the correct dosage. “We finally got the perfect regimen for her after one year,” says Ms. Gerhart. Now Ms. Johnson is pain-free, and she can do the things she loves, like delivering meals for the Lewistown Senior Center.

This story originally appeared in PA Health, our quarterly full-color magazine filled with wellness tips, inspiring stories and more.