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Chronic Pain: What We Know And How To Manage It!

Chronic Pain

It’s important to note that all pain is real! Chronic pain is not “all in your head.” It is pain that persists beyond the acute stage (greater than two months). It often occurs independent of actual tissue damage, meaning that there is no damage to muscle, tendon, ligament, bone, etc that is causing the pain.

Chronic pain involves changes that occur within the brain in response to pain that lasts for long periods of time. Areas in the brain that are not associated with perceiving pain begin to perceive signals as pain – meaning that activities that should not cause pain are now painful! This can significantly affect the quality of one’s life.

Chronic pain affects almost 1 in 3 people worldwide! The cost in the US is about $600 billion annually for medical treatment, lost wages, and lost work time. Chronic pain is the most common reason to seek treatment and the most common reason for disability and addiction. The cost of treatment for chronic pain in the US is even greater than those for cancer, heart disease, dementia, and diabetes care.

Currently, chronic pain is not managed well by healthcare providers. A common treatment is the use of opioids. Opioids (e.g. codeine, morphine, hydrocodone (Norco), oxycodone, fentanyl) are meant for short term management of acute pain. They are not meant for long term management of chronic pain. Medication alone cannot treat chronic pain. When other treatments are added in addition to medication, outcomes are shown to be better. Some people on long term opioid treatment actually experience the side effect of hyperalgesia (or hypersensitivity) which increases pain!

How to Manage

There are several other ways to manage chronic pain in addition to medication.

Exercise – start with light, painfree activities and increase as you are able

Reduce stress as stress causes increased inflammation which can lead to increased pain

Learn more about your condition – learn how others manage to control their pain and maintain their function

Keep up with normal activities as much as possible

Improve your overall health

Avoid bed rest and inactivity – Bed rest will not improve your pain and may make it worse, as it leads to other problems such as weakness, weight gain, and poor circulation.

Consume an anti-inflammatory diet
– Emphasizes plant-based foods and anti-inflammatory spices: turmeric, ginger
– Nutrient deficiency is common in chronic pain and can be worsened by long term use of analgesics (common deficiencies include vitamin D and magnesium)
– Make sure you have the correct intake of omega 3 fatty acids

Make sure you are hydrated
– Dehydration can amplify chronic pain symptoms such as headaches, muscle aches, joint stiffness, and fatigue
– Proper hydration is key in managing pain and improving our body’s function
– Caffeine intake to address loss of sleep, fatigue, and headaches can contribute to dehydration
– The recommendation for appropriate amount of water varies but 64 oz is a great place to start

Make sure you are getting enough sleep
– Position modification
– Stretching before bed
– See if there are other factors other than pain that are contributing to loss of sleep
– Caffeine intake
– Stimulants such as light or noise
– Use of cell phones or other electronics prior to bed

Physical therapy or occupational therapy to increase strength, increase mobility, and improve function as well as to address pain

Be your own advocate when seeking treatment. Only you know what you are feeling and how it affects you. Work to find the treatment that is best for you!

This blog was specially written by our friend and guest writer Rachel Zimmerman, DPT.

Rachel is clinic director at ATI Physical Therapy in Green Bay, WI. You can find out more about her clinic or find a location near you at ATIpt.com!

Dry Needling for Joint and Muscle Pain Relief

What is Dry Needling?

The name “dry needling” comes from studies that were done to determine the effectiveness of injections. The studies showed that just putting a needle into a trigger point (a small, tight, tender area in a muscle) was just as effective as injecting a pain relieving or anti-inflammatory medication into the trigger point. Since nothing is injected with dry needling, we refer to it as “dry.”

Is Dry Needling the Same as Acupuncture?

While the two are often confused, they are actually different treatments. Dry needling is performed in the dysfunctional area, whereas acupuncture may be performed in the hand to address a headache, for example. Dry needling also focuses mainly on the treatment of musculoskeletal conditions.

How is Dry Needling Done?

First, the area of pain or tension will be assessed in order to locate trigger points. Then a needle will be placed into the muscle, and then the needle will be moved around in small movements that cause the muscle to activate – seen or felt as a twitch in the muscle. Once the twitching ceases, the needle is removed from the muscle.

What is the Purpose of Dry Needling?

Dry needling helps to relieve pain, help muscles relax, and improve function. Usually dry needling is used on tense muscles that are causing pain and affecting a person’s function. It is a very effective method and the results can be seen quicker than other treatments such as massage. The effects of dry needling can be felt after just one session but may take more than one to fully resolve the issue. It is used in conjunction with other treatments such as manual therapy and exercise.

Is Dry Needling Safe?

The risks associated with dry needling are minimal which makes it a safe procedure when performed by a trained practitioner. Physical therapists are regulated by each state in the training they must receive for dry needling before they can use the treatment on patients. Physical therapists also use clean technique, meaning they wear gloves and make sure that they use hand sanitizer and alcohol to sanitize the area being needled. Also, needles are kept in sealed packaging until use so that they are sanitary and safe for use. After a single use they are disposed of in a sharps container and are never reused.

Does Dry Needling Hurt?

Every person is different, and each muscle responds differently to dry needling. The process can be uncomfortable, but is usually not painful. The needle used for dry needling is a very thin needle similar to those used for acupuncture, so there is usually no pain associated with the needle being inserted into the skin. The muscle twitches associated with dry needling can be uncomfortable but typically are not painful. There may be some lingering soreness afterwards but this usually lasts less than 24 hours. Drinking plenty of water after having dry needling done can help to lessen this soreness.

Is Everyone Appropriate for Dry Needling?

While dry needling is a very effective and safe procedure for most people, not everyone is a candidate for it. There are certain precautions that can affect someone’s ability to have dry needling done (for example, over the area of a pacemaker). There is also a timeline of when dry needling is appropriate after surgery so that there is no increased risk for infection. Talk to your physical therapist to see if you’re appropriate for dry needling.

This blog was specially written by our friend and guest writer Rachel Zimmerman, DPT.

Rachel is clinic director at ATI Physical Therapy right here in Green Bay, WI. You can find out more about her clinic or find a location near you at ATIpt.com!