Despite all our good intentions to alleviate our patients’ chronic pain symptoms and improve their quality of life, there are many challenges in the way. We have limited time to interact with each individual, and frequently, insurance does not cover the ideal multidisciplinary approach. Adding to these obstacles is the significant increase in prescriptions medications available and dispensed, which may contribute to new symptoms and may or may not effectively decrease pain.
When it comes to the variety of pain management techniques we can give to patients, I put exercise at the top of my list. It’s a low-cost and effective treatment for pain management, and I always make it a point to discuss with my patients incorporating a regular exercise program into their routines. Whether they enjoy hiking or swimming, physical activity has been shown to improve function, decrease fatigue, and decrease common health complications associated with a sedentary lifestyle, such as hypertension and diabetes. And while your patients may not need to know the specific mechanisms as to how exercise can decrease their pain, as providers, it is always good to remember why we make certain recommendations:
- – Aerobic exercise increases serotonin, which is known to improve mood and thereby decrease the incidence of depression. Serotonin also works to block the perception of pain and regulate sleep cycles—two jobs many people take medications to get done.
- – Exercise increases endorphins as well, which are the body’s way to protect itself from pain. These neuropeptides are specifically targeted at blocking pain, literally meaning “endogenous morphine.” Additionally, exercise decreases the production of certain inflammation-promoting factors that can increase the perception of pain.
- – Exercise will also alleviate musculoskeletal pain stemming from an imbalance of strength where the joints and joint structures are pulled in an unnatural way. This muscular imbalance can come from a neurological diagnosis or from an injury to a muscle or joint that results in a different movement pattern. Either one can then trigger a “pain cycle” in which the new movement pattern that a person has adapted to avoid pain (e.g. limping) causes a new set of pains in other areas. Exercise will strengthen the weakened muscles to better support joints, and will stretch out the tight muscles and joint structures, decreasing the cause of pain.
When it comes to the chronic pain population, there are certain factors to keep in mind when recommending exercise. Those with chronic pain may require longer recovery periods in order to decrease the risk of exacerbating any symptoms. It’s important to find exercise routines that don’t trigger an increase of pain. A physical therapist can help to tailor an exercise program to any individual’s needs and monitor the symptoms.
If patients’ pain persists even through exercise, over-the-counter (OTC) medicines are another helpful tool in our toolbox. And when it comes to pain medicine, many of our patients may be taking the most common drug ingredient in America: acetaminophen. It’s found in more than 600 different OTC and prescription medicines, including pain relievers, fever reducers, sleep aids, and cough, cold, and allergy medicines. As healthcare providers, we are patients’ primary source of information about the medicines they are taking, so make sure you have the tools you need at your fingertips to reinforce safe acetaminophen use among your patients. Here are some key things they should know:
- – Acetaminophen is found in OTC medicines like TYLENOL® and NyQuil®, and prescription drugs like Vicodin® and Percocet. Because it’s in so many different medicines, people might take more than the recommended amount without realizing it.
- – Acetaminophen is safe and effective when used as directed, but there is a limit to how much you can take in one day. Taking more than directed is an overdose and can lead to liver damage.
- – The U.S. Food and Drug Administration recommends taking no more than 4,000 milligrams (mg) of acetaminophen in a 24-hour period.
- – If they have questions about dosing instructions or medicines that contain acetaminophen, they should ask you.
- – They can learn more about acetaminophen at KnowYourDose.org, where they can view a list of common medicines that contain the ingredient.
When talking with your patients about pain management, educating them about a variety of treatment options—including regular exercise and medicines with acetaminophen—will benefit them for years to come. For more information on physical therapy and pain management, visit EBFitnessOnline.com. For more information on acetaminophen safe use education and to order free educational materials, visit KnowYourDose.org.