Understand the critical distinction between ‘hurt’ (a painful sensation) and ‘harm’ (actual tissue damage or worsening injury) to reduce fear and anxiety, and to guide appropriate activity levels.
For chronic pain, set small, incremental activity goals (e.g., adding 50 feet to a walk daily) and adhere to them consistently, even on good days, to avoid overexertion and subsequent setbacks. This prevents a ‘roller coaster’ of activity and inactivity, which can lead to fear of movement and increased disability.
Engage in psychological and behavioral therapies like Cognitive Behavioral Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), or Acceptance and Commitment Therapy (ACT) to learn skills for managing pain. These therapies teach how to recognize and interrupt unhelpful thought patterns, set goals, pace activities, and use relaxation techniques (e.g., deep breathing, biofeedback) to calm the sympathetic nervous system.
For chronic pain, work with physical and occupational therapists, especially those trained in chronic pain, to improve physical functioning and quality of life. They can help distinguish hurt from harm, set safe activity levels, correct biomechanical issues, and improve endurance and strength.
If experiencing chronic pain, particularly gut pain, systematically identify and avoid specific food triggers through careful observation, potentially using an elimination diet and journaling. Certain foods can act as triggers, causing prolonged pain, and avoiding them can significantly improve quality of life.
Cognitively reframe the meaning of your pain by actively distinguishing between ‘hurt’ (a temporary sensation) and ‘harm’ (actual injury or damage). This is a critical aspect of pain management and a foundation for cognitive behavioral therapy, helping to reduce fear and anxiety around pain.
Engage in distracting activities like reading a book, going for a walk, or spending time with friends and family to shift your focus away from pain. Attentional distraction can significantly reduce pain by engaging specific brain networks.
Approach pain with a nonjudgmental, accepting mindset, simply noting its presence without assigning positive or negative value to it. Mindfulness-based stress reduction (MBSR) has been shown to be effective for pain, including low back pain.
Consider treating pain when it significantly impacts your quality of life, ability to perform daily activities, or engage with family, friends, and work. This impact serves as a reasonable threshold for deciding whether to take medication or seek other interventions.
Use either heat or cold therapy for pain relief, based on individual preference and what works best, aiming to numb the area with cold for temporary relief. Avoid prolonged application (e.g., two hours) to prevent frostbite, and note that both can reduce pain (cold reduces inflammation and slows nerve firing; heat increases blood flow and relaxes muscles).
Dissolve one packet of Element (containing sodium, magnesium, potassium) in 16 to 32 ounces of water first thing in the morning and during physical exercise. Proper hydration and adequate electrolytes are critical for optimal brain and body function, as even slight dehydration diminishes cognitive and physical performance.
When taking NSAIDs like ibuprofen (typically no more than 3x/day) or naproxen (typically no more than 2x/day), always ensure you have food in your stomach and drink plenty of fluids. This helps mitigate side effects and adverse consequences; consult a clinician if you have GI, bleeding, kidney, or heart issues.
If using Tylenol (acetaminophen), do not exceed 4,000 milligrams (4 grams) per day in divided doses, and be mindful of liver function, especially if consuming alcohol. Tylenol is safer on the stomach than NSAIDs but can have adverse effects on the liver if the daily dose limit is exceeded.
If using NSAIDs like ibuprofen or naproxen, experiment by rotating them to discover which one is most effective for your individual pain. There is significant individual variability in how people respond to different NSAIDs.
For acute pain, rub or shake the affected area, or run it under water (hot or cold) to activate touch fibers and modulate pain signals in the spinal cord. This ’neuromodulation’ reduces nociceptive signals and provides effective pain relief.
When experiencing acute pain, swearing can be an effective, albeit socially contextual, method to reduce the pain sensation. Studies have shown that swearing works to reduce pain.
Incorporate regular movement and exercise into your routine. Exercise can change pain thresholds over time by building up increased inhibitory tone in the nervous system.
Engage in cognitive control and training to potentially change your pain thresholds over time. Pain thresholds are influenced by cognitive factors and can be manipulated through training.
When others, especially children, experience pain, respond with lightheartedness or humor rather than fear or distress. Individuals often take cues from those around them, and a calm, positive response can influence their perception of pain.
When addressing pain in yourself or others, avoid distinguishing between ‘psychological’ and ‘physical’ pain, and instead treat all pain as valid and requiring attention. Distinguishing between types of pain can lead to unhelpful value judgments and does not serve the person experiencing pain.
Recognize and actively avoid catastrophizing about pain, which involves exaggerating the threat or negative consequences of pain. Catastrophizing is a significant predictor of pain amplification, worsening pain, and poor treatment response.
Understand that opioids are a tool for pain management, best used in specific circumstances for some individuals, typically after other therapies have failed, and not as a first-line treatment. This approach acknowledges their potential for both benefit and harm, emphasizing individualized, later-stage use for severe, intractable pain.
For neuropathic pain, consider supplementing with acetyl-L-carnitine at higher oral doses, typically 2,000-3,000 grams. It has shown disease-modifying properties by improving mitochondrial health and nerve conduction velocity, particularly in diabetic neuropathy.
For neuropathic pain, consider supplementing with alpha-lipoic acid. It acts as a free radical scavenger and a T-type calcium channel modulator, which can benefit nerve pain, though it can cause stomach upset and may affect heart rate during high-intensity exercise.
If undergoing nerve-related surgery, consider taking vitamin C prophylactically. Vitamin C has been found to reduce the likelihood of developing certain nerve pain conditions post-surgery.
Consider supplementing with fish oil (omega-3s), as they have been found to be beneficial for chronic pain. Be aware that high levels may reduce blood viscosity.
For fibromyalgia and similar conditions, consider supplementing with creatine. Small pilot studies have shown some benefit for these conditions.
Consider exploring ‘Empowered Relief,’ a brief two-hour intervention developed by Dr. Beth Darnell, as an additional tool for pain management. It offers an abbreviated way to access principles of cognitive behavioral therapy.
Practice yoga nidra or non-sleep deep rest (NSDR) sessions, even short 10-minute ones, using an app like Waking Up. Yoga nidra and NSDR can greatly restore levels of cognitive and physical energy.
Contact your congressperson and congresswoman by phone or letter to advocate for the full implementation of the National Pain Strategy. Legislative action driven by concerned citizens can lead to significant improvements in pain care, education, and public communication.