A CONSUMER GUIDE TO OPTIONS FOR MANAGING CHRONIC PAIN

This is a stressful time for people who take strong medicines for their pain. The withdrawal of two COX-2 non-steroidal anti-inflammatory (NSAID) medications and the more stringent, FDA-mandated warnings on all NSAIDS have created fear and confusion about what’s safe and effective for treating pain.

You may feel overwhelmed and confused. You may ask yourself, "What’s safe? What medications can I take? What can I do now that I can no longer take this medication? What things can I do to improve my quality of life?"

The important thing to remember is that you are not alone. Millions of Americans suffer from chronic pain and there are many organizations working to address this serious, life-altering, and profoundly difficult problem. Now, more than ever, is the time to educate yourself about your treatment options and empower yourself by doing what you can to care for yourself physically, emotionally, and spiritually.

The American Chronic Pain Association, the American Pain Foundation, and the National Pain Foundation have prepared this guide cooperatively to help people with pain and their families better understand the current situation and to regain a sense of control over the critical and very personal decisions involved in managing chronic pain.

You can learn more about the resources offered by these organizations at our web sites:

1. American Chronic Pain Association: http://www.theacpa.org  

2. American Pain Foundation: http://www.painfoundation.org  

3. National Pain Foundation: http://www.nationalpainfoundation.org/  

1. Find a knowledgeable health care provider who understands pain and work with him or her to decide what’s best for you. See the links below for help in finding a provider.

2. Take care of the things you can control. Part of being an active participant is caring for your body. Get adequate rest, eat a healthy diet and engage in physical activity—all vitally important to maintaining function and health. Ask your physician which exercises are safe for you.

3. In addition to a healthy diet and exercise, relaxation techniques such as meditation, visualization, hypnosis, and biofeedback may help you feel better. Your health care provider can help you decide which techniques may be beneficial for you.

4. Pay attention to your emotional health. Taking care of the emotional aspects of chronic pain is necessary to treat your overall pain condition. Your physician may want to prescribe medication for depression, anxiety, and sleep disturbances and, in addition, may suggest cognitive behavioral therapy (e.g., relaxation techniques, coping strategies, psychological therapy).

5. Share your thoughts and feelings with loved ones and allow them to share their feelings with you. People cannot read your mind—just as pain is an invisible disease, emotions can be difficult to discern.

6. Avoid isolation and loneliness by joining a support group. Rebuilding a life devastated by chronic pain is easier with the support and help of those who have been there and can help you find the way back. A good support group does not dwell on symptoms or losses, but rather focuses on positive actions you can take to improve the quality of your life—with a little help from your friends. See the Questions and Answers below to learn more.

Medications such as NSAIDs and selective NSAIDs (COX-2 inhibitors) are important tools in the management of chronic pain, but they are not the only tools available to help you. NSAIDs work by decreasing inflammation and pain. Traditional NSAIDs, such as ibuprofen and naproxen, tend to irritate the stomach and can lead to ulcers and bleeding. The COX-2 NSAIDs have become popular because they are less likely to cause ulcers and bleeding.

News that another NSAID has been withdrawn from the market and the fact that all NSAIDs will now have additional warnings on their labels can be frightening and disheartening. The first step in determining if NSAIDs and COX-2 NSAIDs are still an option for you is to speak with your doctor. You and your doctor are the only people who can determine whether a specific medication is the right choice for you.

If you are taking NSAIDs for pain, be sure your doctor knows your medical history, including any history of heart problems, high blood pressure, ulcers, and medication allergies. Be sure your doctor knows about all the medications you currently take, including medications prescribed by other doctors, over-the-counter medications, and supplements. This information will help you and your doctor weigh the overall risk-benefit of a medication.

It is up to you to educate yourself about your health and your treatment options. There are many options for your pain, including:

• prescription and over-the-counter NSAIDs;
• prescription medications such as opioids, anti-anxiety medications, anticonvulsants, antidepressants, muscle relaxants, and more, depending on your pain condition;
• complementary and alternative therapies, such as biofeedback, meditation, relaxation techniques, yoga, acupuncture, and more;
• physical therapy; and
• interventional treatments (eg, for arthritis, injections at the pain site containing a pain reliever and corticosteroid, or for back and neck pain, spinal cord stimulators and intrathecal drug pumps).

Talk with your doctor. Developing an open and trusting relationship with your pain specialist is important to helping you determine which treatment options are best for you.

Many primary care physicians are well informed about treating pain and can be relied on to provide excellent care. But if you and your primary doctor agree, a pain specialist might be appropriate in your case. Pain specialists, like neurologists, cardiologists, and other specialists, have additional training and experience that you may find valuable.

To learn more, you may wish to visit these sites of organizations that serve pain specialists:

• American Academy of Pain Medicine 

• American Academy of Pain Management

• American Academy of Neurology

• American Board of Pain Medicine

• American Medical Association

• American Pain Society

• American Society of Interventional Pain Physicians

There are physicians who prescribe medications only for pain, physicians who do only functional restoration without medications, physicians who do only cognitive behavioral pain therapy, physicians who perform only blocks or do surgeries for pain, and physicians who might do combinations of these therapies. Some physicians, in an interdisciplinary fashion, provide expertise in all of the above interventions to patients in pain. You should know the type of pain clinic that you have chosen to visit. Choose wisely!

You may also want to consider a multidisciplinary pain management clinic or program. The American Chronic Pain Association has guidelines for selecting a pain management program at http://www.theacpa.org/pf_02_05.asp.  

You have a right to be treated with respect and to have your concerns taken seriously. If your current provider does not measure up to your expectations, find another.

Many professional physician organization web sites have listings of their members available to the public. These directories can help you locate an appropriate pain medicine physician in your area. Print the directory and share it with your primary care physician to identify the best physician for your particular needs. You can call American Pain Foundation at 1-888-615-7246 (pain) for a list of pain specialists in your state or visit these sites for help:

• www.nationalpainfoundation.org/MyPain/TipsForFindingAPainPhysician.asp  to see a list of online physician directories.
• www.painfoundation.org/page.asp?menu=1&item=4&file=page_resources.htm  www.painfoundation.org/downloads/FindingCare.pdf  

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