Chronic Pain

Consider drug-related options for your pain very carefully. There may be side effects and interactions with other drugs you’re taking.

Keeping a diary of your pain can help you and your doctor understand any patterns that emerge.

Some people with disabilities find pain relief with alternative therapies and mind-body therapies.

What Is Chronic Pain?

Pain is the body’s signal that something is wrong and needs attention. It is very important to our survival. However, chronic pain is pain that persists for extended periods of time. It may accompany a disability or health condition. Or it might result from an injury that has not resolved within the expected period of time.

Why Do People with Physical Disabilities Experience Pain?

Pain may be one of the primary symptoms of a disability or diagnosis, such as arthritis. In other cases, pain may be a secondary condition that results from treatment for a disability. For example, people who have a cranial shunt due to their spina bifida often experience headaches. 

People with physical disabilities may experience two kinds of pain:

• Musculoskeletal pain is pain that occurs in the muscles. It may be the result of poor posture (for example, a wheelchair may not be correctly fit) or overuse of the muscles (for example, people with cerebral palsy may overuse some muscles to compensate for other muscles that don’t work). 
• Neuropathic pain occurs when the nerve fibers themselves are injured, damaged, or somehow have become dysfunctional. The nerves keep sending pain signals back to the brain. The pain signal may come from the site of the injury (for example, the location of a spinal cord injury) or below the site of the injury (for example, “phantom pain” experienced with an amputated limb).  

How Do People with Physical Disabilities Successfully Deal with Chronic Pain?

Successful strategies for dealing with chronic pain might be very different depending on your individual circumstances. Problem solving and talking over possible strategies with your health care provider is important. If your health care insurance allows it, you may be able to go to a pain management clinic. These providers specialize in chronic pain and can help with a combination of medical and non-medical solutions. Here are options for both approaches to pain. 

Medication-Related Solutions for Chronic Pain

You should talk over medications for chronic pain with your health care provider or your pain management clinic. 

• Pain Medications. Over-the-counter (OTC) pain medications such as acetaminophen, ibuprofen, aspirin, or naproxen, can be very effective for musculoskeletal pain. (These generic medicines are also known by brand names like Tylenol and Advil.) If OTC medicines do not seem to work, your doctor can prescribe stronger drugs or treatments such as steroid injections at the site of the pain. 
• Nerve blocks. Sometimes, it may be possible to inject a nerve-numbing substance into the local area where the pain is experienced. However, a nerve block may not be possible in some parts of the body or may be too dangerous.
• Trigger point injections. Another medical solution is injecting local anesthetics or other drugs (like steroids or Botox) into a knot of muscles that won’t relax.
• Surgical implants. Surgical implants might be a last-resort solution. This involves making a pocket under the skin to hold a pump that the patient uses to deliver pain medication directly to the site of the pain, such as the spinal cord. 

All of these different drug-related options carry many pros and cons. You need to consider them very carefully. Find out about side effects and drug interactions. You need to know just how much of these drugs you can take in a day so that you don’t overdo it and cause side effects such as liver damage. Also find out the consequences of using any drugs over an extended time period.

Non Drug-Related Solutions for Chronic Pain

A number of other options might be helpful to reduce chronic pain, either taken along with drug therapies or instead of them. You could talk over with your health care provider a number of options:

• Understand your pain. You may find it useful to keep a diary of your pain episodes. You can record the time of day when you feel more or less pain, what you were eating, what physical activities you were doing, the temperature, any other physical conditions (such as your menstrual period), and any stresses or anxieties you experienced. You can talk this over with your health care provider to see what patterns emerge. These patterns might help you and your provider understand how to relieve the pain.
• Physical therapy and exercise. A physical therapist can teach you a number of pain-reducing strategies, including stretching, muscle strengthening, and flexibility exercises. If your doctor thinks it is appropriate, you can maintain your overall health with strength-building and aerobic exercises.
• Psychological treatments. Talking with a psychologist doesn’t mean that your pain is not real – we know that it is. However, for some people, the fear of pain can make it worse.  For others, their pain might be worse because they are facing other issues in life, or have anxieties that make them feel “tied up in knots.” Understanding these stressors can help reduce the pain.
• Alternative therapies. These include seeing a chiropractor, getting regular messages, and acupuncture. People with different physical disabilities have reported pain relief from these therapies for short terms.
• Nutritional supplements and diet. While there is not scientific proof, some people think certain vitamins or other nutritional supplements, as well as dietary changes, can help with their pain. People who are overweight can experience some relief in their pain by losing weight. Others may experience pain relief with dietary changes if their pain is connected to food allergies or intolerances. Here is where a careful pain diary can help you determine if changes to your diet would make a difference.
• Mind-body therapies. Meditation, biofeedback, guided imagery, and hypnosis are useful approaches to dealing with pain. This also includes relaxation techniques and yoga, which some people find helpful for managing pain.
   

NOTE: This fact sheet is for informational purposes and is not meant to take the place of health care services you may need. Please see your health care provider about any health concerns.