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The other forms of treatment to manage pain

Without pain relief, you may not feel inclined to participate in any other form of treatment. This slows the rehabilitation process and may prolong the incapacity. You should consider the following options.

Rest is one of the body’s natural healing methods. Pain tells you to stop moving around while inflammation subsides or tissue regenerates. But, the longer you remain immobile, your joints can stiffen and your muscles weaken. Thus, you must learn to strike a balance between rest and activity.

Exercise can help to maintain or improve function. Controlled movement and strength-building are essential to encourage mobility both in a joint and to get you moving around the house. This reduces pain because your strength and flexibility in movement improves through practice. The “need” to rest must not be an excuse to avoid exercise. But, if you have arthritis or your joints are swollen or inflamed, the precise nature of the exercise must be agreed with your supervising doctor.

More research is required to validate many of the current physiotherapy techniques. What evidence there is suggests that exercise regimes for the treatment of acute pain are of little benefit over the natural cycle of injury and recovery. But, in the long term,  good results have been achieved through functional rehabilitation programmes designed to restore suppleness and muscle function.

There is also some evidence of success following chiropractic manipulation, but your attitude to this kind of treatment and the relationship you form with the chiropractor will significantly affect the quality of the outcome. Similarly, massage, as opposed to full physiotherapy, can deliver some pain relief, reducing soreness and stiffness in muscles, and helping in the reduction of inflammation and swelling. As the tension the musculature is relaxed, blood circulation improves and pain is reduced. But there is undoubtedly a placebo effect that can be enhanced by the personality of the masseur/se and your relationship with him/her. In a less formal environment, you might want to try hydrotherapy. Exercising in a warm pool or a hot tub is physically less demanding because you float a little in the water and this takes some of the weight off painful joints.

The basis of occupational therapy is found in physical medicine and behavioural psychology. The main purposes of the therapy are to:

help you understand more precisely which movements cause the pain;
teach you how to feel less pain, i.e. if you understand the mechanics of your body, you can learn how to move in ways that do not increase the pain, protect your joints from excessive stress, and improve strength and stamina;
more generally shift your mood from negative to positive. Instead of seeing only barriers and limits, you need to foster a can-do attitude. A part of this may be simple relaxation techniques to relieve muscle tension and help fight fatigue. This can help you to feel less anxious and stressed, and to get a better quality of sleep. Alternatively, you may wish to try the more comprehensive cognitive behavioural therapy which offers rewards for re-establishing movement rather than focussing on unhappiness and the perception of pain. Hypnosis and biofeedback may also be included as options by a pain management centre; and
introduce a lifestyle that allows the maximum quality for the least pain. This may involve adapting your daily activities, modifying the home and workplace to make movement easier, and teaching you how to use a range of different tools and devices.

You should also look at both acupuncture and transcutaneous electrical nerve stimulation (TENS). Both are somewhat controversial even though, in the hands of skilled practitioners, the procedures are simple and safe. What research there is suggests that acupuncture is effective. It has been a standard part of Traditional Chinese Medicine (TCM) for centuries but the West remains sceptical. There is certainly a very powerful placebo effect but clinical data on its analgesic qualities are inconclusive. TENS places electrodes on the skin to emit a low-voltage electrical charge. This appears to block pain signals to the brain and it is used primarily for chronic, localised pain which has proved intractable. Some studies do suggest performance slightly better than placebo, but the evidence remains inconclusive.

Finally, you should get support from fellow sufferers. If you stay locked away on your own, it is too easy to become negative and depressed. Meeting and talking with others who face the same problems shares the knowledge of how pain can be managed. It also lightens the psychological load, allowing each member of what can grow into a support network to offer encouragement and inspiration to the others. Even if you are housebound, with the internet, there is no barrier to joining very active social networks.