There probably will come a point in your chronic pain journey where you are either finding pain relief ineffective or the side effects from the strong stuff unpleasant, and you are advised to look to alternative forms of pain relief.
Now, the words “alternative forms of pain relief” might get you feeling anxious because it literally could mean anything, but if you’ve done your research or advised properly, you should feel more relaxed knowing that there are a few tried and tested alternative methods available.
Alternative forms of pain relief are often used in-conjunction with medication, so bear that in mind, and remember that everyone will have a different response to the items I discuss below – don’t be afraid to give it a go!
The use of heat is widely known to be beneficial to a number of conditions and symptoms. The fact that heat is also soothing and relaxing is an added bonus.
The main benefits of heat include increased blood flow to an affected area, which in turn brings lot of nutrients to aid healing, increases the viscosity of soft tissues allowing them to stretch and relax and decreases stiffness in joints. It also acts as a pain relief through stimulating thermoreceptors (the receptors in our skin that regulate temperature), which travel to the brain faster than pain relief.
Because heat encourages vasodilation – a process where blood flow is increased as vessels dilate and widen – it is best used for chronic pain or injuries that have lasted a while. It is particularly brilliant for pain that focuses within joints and muscles.
So who can use heat? Well pretty much everyone, but there are some precautions and contraindications you should bear in mind (the physiotherapist in me could not write this article without it being safe!);
- haemorrhagic conditions (those that include a lot of bleeding – NOTE: this does not include Endometriosis or Adenomyosis, as you won’t be applying it up in there!)
- acute injury or inflammation
- impaired sensation (e.g. you have pins and needles or numbness – important as you need to be able to feel if the heat you are using is not too hot!)
- malignancy to the local area
- skin disease to the local area
- pregnancy (NOTE: for specific advice on use in certain trimesters, please contact your GP)
For a complete list of the contraindications and precautions for the alternative forms I am discussing, please refer to this page from Physiopedia or consultant a GP.
If you are safe to use heat, then you can use it in the form of microwavable hot packs (commonly known as wheat bags), adhesive heat pads or a hot water bottle in it’s cover. Heat should only be used for 20 minutes, and then your skin should be allowed to cool before you reapply.
Ice Therapy (Cryotherapy)
Pretty much the opposite of heat, using ice has a number of benefits that we are probably all familiar with. Ever remember being told about the RICE principle for acute injuries (rest, ice, compression, elevation)? Well it can be applied similarly with chronic pain.
Using ice causes blood vessels to constrict, thus reducing the blood flow to an effected area and reducing inflammation. This reduced inflammation will lead to reduced pain and improved movement (if it’s a joint), and decreases any muscle spasms experienced. It also reduces the excitability of free nerve endings in the local area you are applying it to, meaning pain is reduced.
The contraindications and precautions for using ice are similar to heat. It is important with any application of heat or ice that you make sure you don’t use it if you have an adverse reaction to temperature changes.
Please refer to the link above for further information on safe use.
A TENS machine (which stands for transcutaneous electrical nerve stimulation) is a brilliant method of pain relief, and one that I have been using more and more.
TENs machines are often small devices that you can buy from your local chemist or even supermarket, and are used for a variety of injuries and conditions. They are really useful for those of us with chronic pain, as they stimulate nerve endings in a way that pain relief can’t. You can buy devices specific body part of type of pain. For example, I use the Ova+ device (available from Amazon here) which is designed for Endometriosis pain, but there is also the more expensive Livia device. However, most devices are very similar and you’ll find the main difference is the size of the unit or the sticky pads.
TENS works by stimulating the nerves on our skin, which travel to the brain quicker than pain signals – this is basically a form on pain inhibition. You can use various settings to achieve a constant stimulation or a pulsed ones, with each have slightly different effects. TENS can be useful for acute injuries on certain settings also.
The precautions and contraindications for TENS machine are again similar as those described above and on the link provided, although it is important to note that people with cardiac problems should seek GP advice prior to using them.
You apply TENS machines according to the manufacturers instructions, as each device will vary in regards the settings, but trust me, I have found it super beneficial for my Endometriosis and Adenomyosis pain
Having a massage is undoubtedly very relaxing and soothing, but it can have other benefits too.
Massage has been shown to be effective in managing anxiety, digestive disorders and fibromyalgia, to name a few. A bit like heat, massage brings a lot of blood flow and nutrients to the affect area, which aids healing and eases tension within muscles. With some massage techniques, such as lymphatic drainage, you aid decrease swelling and excessive fluid build up also. With regards my background in physiotherapy, massage has been clinically proven to help build rapport with patients, as the general sensation of being touched or having hands-on treated restores a sense of touch and confidence (which might explain its use with anxiety).
You don’t have to pay or go somewhere fancy to have a massage – if you’ve got someone at home or a close friend, you can ask them to massage your back, shoulders or feet (or wherever you need it!) gently for around 20 minutes. Massage shouldn’t be painful, so keep an eye out for that. And if you are wanting to go to a specialist or spa centre, let them know about your health conditions as often they can tailor the treatment to your needs or be wary of certain techniques.
There are some precautions and contraindications associated with massage, but it’s likely that each place or person has their own list. As a general rule those in which the following apply should refrain from having it done or seek GP advice;
- blood disorders (DVT, haemophilia)
- some cardiac problems
- local malignancy
- local infection
- skin disorders
Acupuncture involves having tiny specific needles being inserted into certain points on the body, either muscles or meridians (a pathway in the body said for energy to flow). There are two main types of acupuncture; Chinese, which is the more traditional approach which focuses on promoting natural self-healing through stimulation of specific body points, and Western, which is the more medical approach that incorporates current knowledge on anatomy and physiology.
Acupuncture is well-known for it’s improvement in pain, and up until recently was part of the NHS NICE Guidelines for the management of chronic back pain. Therapists train for a long time in either type – I looked into training in 2016 before I became unwell as it is a popular adjunct alongside being a physiotherapist.
Acupuncture has also found to be beneficial for chronic neck pain, headaches and osteoarthritis pain. I underwent treatment with Chinese acupuncture for a while before I was diagnosed, and my pelvic pain and digestive symptoms improved no end.
You can access acupuncture either by finding one locally (be warned – it is vital you do your research on your acupuncturist before you go!), or seeing if you can be referred to one on the NHS (normally within physiotherapy or chronic pain departments), however this is a service that is becoming more and more diminished due to reduction in NHS funding.
As with all of the above, there is a list of cautions and contraindications that must be assessed before having acupuncture, but it can vary between acupuncturist to acupuncturist, so it is really important you disclose your medical conditions before having any done.
Cognitive Behavioural Therapy (CBT)
I know, I know – CBT is often one of the first things GPs or even your friends and family might jump to when they know that either your pain is not improving or is becoming a problem, but CBT has its place in pain management.
CBT is a form of talking therapy that aims to help people identify and develop skills to change negative behaviours and thoughts, ideally looking at how we can improve our emotions, thoughts and actions related to pain so that we can use strategies to put the pain into better context.
Sometimes in patients with chronic pain – and I see this a lot in my job – people develop negative thoughts or emotions related to pain that makes them avoid certain things out of fear of making pain worse, which in turn leads to stiffness, muscle weakness and other small complications that can actually make pain worse. There is also the population that see pain as causing damage, therefore they avoid anything that hurts because they don’t want to damage themselves in further. Now, this is where CBT is really useful, because it helps these people realise that not only does pain not equal harm, but that by changing the way they think and feel about pain will then enable them to get back to participating in normal activities.
It is beneficial for all sorts of pains and conditions.
Anyone can have CBT – often therapist or psychologists are trained in it, so you can find your own one if you are interested. Some services are offered on the NHS. For example, CBT was offered as part of my M.E./CFS treatment, and I suspect it will be offered again when I head to the pain clinic.
Another simple form of alternative pain relief, but distraction can work wonders for some.
The simple theory behind it is that being distracted when you are experiencing high pain levels can take your mind away from focusing on it, and increase positive hormone levels that make you feel good and have pain relieving effects (e.g. oxytocin, endorphins).
To perform distraction, you just need to do something that you enjoy to distract yourself with – this could be reading, colouring or going for a walk, or even socialising with friends.
I find that this technique works well when you are waiting for pain relief to kick in.
If you are experiencing trouble managing your chronic pain, then it might be worth having a look into the above mentioned techniques to see if there is any that might be appropriate for you. Remember to seek GP or other appropriate advice as needed before starting them, and let me know how they work for you!