Pain Management

Dr Thanh-Tam Pham - 25/7/2020


Pain can be acute or chronic.  Chronic pain sometimes cannot be cured and when you are in pain, it is natural to feel angry, frustrated, sad, hopeless and depressed. Pain can disrupt your sleep, change your personality and mood and affect your work and relationships.

By learning how to accommodate your life to pain, you can improve your quality of life significantly.

Drug treatment includes simple analgesics like paracetamol, non steroidal anti-inflammatory drugs like ibuprofen and the stronger opioid drugs. If you rely too much on taking strong pain killers, when the effect of the medicine is wearing off, you are more sensitive to the pain and you need to take it again and again. That is why many people ending up being addicted to opioids.

Opioids can regulate pain both in the spinal cord and in the brain. The body can produce endogenous opioids to interact with the opiate receptors in the brain to reduce your perception of pain similarly to morphine and codeine.

There is evidence that shows the connection between the mind and pain perception. You may hear stories of soldiers who were shot but still could manage to walk to safety or sometimes managed to help their friends who were more badly injured. The mind at that time was completely focussed on staying alive and the pain was not registered. When they reached safety, they fainted due to the perception of excruciating pain. When I was young in 1963, there was a monk Thich Quang Duc who burned himself to death in Vietnam just opposite my primary school.  He could sit in meditation while his body was engulfed in flames.

There are benefits of not taking medicine as medicine can cause side-effects such as upset stomach, drowsiness, dizziness, increase risks of kidney damage and addiction.


Non drug management of pain:

1-   Acceptance and commitment:

You accept your condition and commit yourself to manage it in a goal oriented way in order to live your best life in spite of your pain. You learn how to stop identifying yourself with your condition and to prevent pain from setting limitations on what you can achieve.

Some people may catastrophize the pain and this leads to a more intense pain experience which is linked to depression, higher levels of self reported pain and disability.

You need to be able to accept what you need to do at the present moment and to replace non constructive thinking by more positive self talk to reduce negative emotional components like anxiety, depression and stress. You need to believe that things may change for the better and you can improve your ability to cope with pain so it becomes less debilitating in your normal daily activities.


2-   Stress management:

Reduce stress in your life as stress intensifies chronic pain. Negative feelings like depression, anxiety, anger, stress can increase your body’s sensitivity to pain.

Meditation can help you to relax and achieve an inner sense of calm and peace. You can follow the breath in and out and when any thoughts come up, try not to judge or follow them or push them away. You just simply acknowledge them. When pain arises, do not be upset with the pain, do not identify yourself with the pain, just be aware of the pain and you notice the intensity may wax and wane.

Relaxation and deep breathing exercises: we tend to breathe short breaths when we are in pain so learn to breathe deeply and slowly.

Music can help to relax such as listening to music, composing music, playing an instrument or singing.

Laughing with friends can also help with the release of endorphins and improve a sense of wellbeing.

Aromatherapy can help with relaxation and reduce stress.


3-   Regular exercise:

Exercise may be the last thing in your mind when you have pain. But gentle exercise such as walking, cycling, swimming can reduce stiff muscles and improve blood flow to help with the healing process.

Moderate intensity exercise increases the heart rate and breathing and stimulates the release of endorphins in the body to modulate pain perception. Exercise improves blood flow to the tense muscles and induces relaxation afterwards.


4-   Physical therapy:

As muscle pain is the most common type of pain:

-      Stretching and strengthening the affected muscles will help with relieving pain and can prevent further injury in the future.

-      Massage the muscles: putting pressure on the acupressure points with your fingers or using a tennis ball by lying on the floor with the ball applied to the painful spots. Foam roller can also be used but do not use it on the lower back.

-      Hot and cold therapy: hot to help with relaxation of muscles and cold to reduce inflammation. Hot bath helps with muscle relaxation and increase sense of wellbeing.

-      Splints and braces can provide support and relieve pain

-      Sunlight exposure can boost endorphins levels.

-      Pain can disrupt sleep. You may feel that pain is worse at night as during the day you are too busy with other activities so the mind registers the pain less. Before sleep, you can practice to follow the breathing by putting hands on the abdomen to feel the rise and fall movements and try not to be upset with the pain. In my experience, it is best if you sleep on your back and try to have the habit of not moving. The minute you turn the body in your sleep, the pain will wake you up again.


In summary, most pain is the result of a physical disorder with considerable psycho-social components so you can use your head to control the pain.  With practice you can use the mind to train the brain to process pain differently and reduce the intensity of pain that you feel. By doing so, you can improve your confidence and give yourself some power to control your life.