Ways to manage chronic pain for military wellness

Chronic pain is a common experience in military and civilian populations. It can result from injuries, surgeries, joint conditions, or side effects from other conditions. The good news is that there are many treatments, techniques, and therapies to help manage your pain and bring relief.

Massage

Therapeutic massage can help reduce pain in your lower back and neck. There are many different massage techniques such as Swedish massage, deep-tissue massage, and sports massage. During a massage, a trained therapist applies pressure and other forms of manipulation (kneading, circular movements, or tapping) onto muscle and soft tissue. Massage can increase blood circulation, which can help reduce pain. Massages also help you feel calmer or less anxious, which in turn, can also reduce pain.

Massages can be more effective at reducing lower back pain when combined with a strengthening and stretching program. Deep-tissue massages can relieve some post-workout muscle pain too. A soft-tissue massage around your shoulders and upper back can increase range of motion and decrease pain as well.

Massages are generally safe, but make sure you seek treatment from a trained professional. Still, a massage isn’t without risk. In rare cases, too much pressure can fracture bones or incorrectly move your spine. A massage on broken, open, or irritated skin can be painful. If you’re pregnant or have a blood-thinning disorder, consult your medical provider before getting a massage.

If you have back pain, ask your healthcare provider about adding massages to your pain-management plan. TRICARE doesn’t cover massages, but ask if your massage therapist offers discounts for Military Service Members and Veterans.

Yoga

If your lower back hurts now and then, or if you struggle with ongoing pain in this area, consider yoga to help relieve the pain, lower your anxiety, and feel more relaxed. Lower back pain is common. For most people, the pain goes away in less than three months without treatment. For others, though, lower back pain doesn’t go away. When pain lasts longer than three months, it’s called “chronic” pain.

Practicing yoga and doing yoga stretches can be a good way to reduce the length, intensity, and frequency of lower back pain. Many people can feel the effects for a short time after they do yoga. For others, yoga can even reduce this type of pain in the long term. So far, serious side effects are rare.

Yoga typically includes three benefits. First, breathing retraining can help calm and focus your body and mind. Second, yoga can increase your flexibility, coordination, and strength. Lastly, meditation exercises can help you become more aware of your actions and feelings, lower your stress levels, and improve your mood.

Yoga isn’t a replacement for seeing your doctor about your pain. If you have a medical condition, talk with your healthcare provider before you start doing yoga. Some people complain they “aren’t flexible” enough for yoga. And others might avoid it because they think it will be really hard. However, yoga is really all about you, and any pose or stretch can be modified based on how your body feels. Keep in mind there’s no such thing as “perfect form.” The best yoga practice is what you commit to doing in that moment.

Adding yoga to your existing pain-management plan can help ease pain from injury or other painful conditions. As a mind-body approach, it often combines meditation and breathing with exercise and stretching. You can do yoga at home on your own (or with the help of a video) or in a class with an instructor. DoD recognizes yoga and other mind-body practices as treatment strategies to help members of the military community deal with stress and improve their ability to perform at their best.

The Defense Centers of Excellence evaluated the iRest® Yoga Nidra yoga program to help treat post-traumatic stress disorder (PTSD) in Military Service Members and Veterans. They also have a video of Military Service Members doing yoga.

Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous Electrical Nerve Stimulation (TENS) is a sort of "electrical massage" that works by sending more “traffic” to the brain to block pain signals. A TENS system includes a small power unit connected by wires to a pair of electrodes. The electrodes are placed on the skin near the location of pain. A mild, generally painless electric current stimulates the nerves in the skin when the unit is switched on.

Most people experience a sensation of tingling and warmth during TENS treatments. This stimulation is thought to block or interfere with pain signals as they travel to the brain. That is, TENS sends more "traffic" overriding the pain. It’s also thought to increase endorphins, or the body's natural painkillers, during treatment sessions.

Sessions typically are short, and TENS can be applied as often as needed depending on how bad the pain is and recommendations from your medical provider. TENS is non-invasive, meaning, it doesn’t go into your body. The TENS unit can be operated by the patient, and is easy to use once you’re trained.

TENS is a general treatment for some kinds of pain such as neuropathic/phantom, chronic, post-surgery, and arthritis pain. While offering very little long-term benefit, it does provide short-term relief.

  • A few TENS sessions per day might be helpful for neuropathic pain and stump/phantom pain.
  • It also can improve the effects of pain-reduction medications, allowing some people to take less medication.
  • TENS also might be helpful for post-surgery pain, even decreasing the need for pain medication.
  • Although TENS can provide short-term relief for chronic pain and arthritis pain, some studies find that its effectiveness is mixed.
  • Other research suggests that TENS might not be a helpful treatment for low back pain.
  • A special form of TENS treatment, electroacupuncture, is discussed in HPRC’s article on acupuncture. Electroacupuncture cannot be self-administered and must be performed by a professional acupuncturist.

According to the American Cancer Society, TENS is generally safe. Although TENS units are available “over the counter,” always ask your healthcare provider before buying and using one. Once you get a TENS unit, consult a physical therapist, healthcare provider, or other professional to learn how to use it and where to place the electrodes. Although TENS units are relatively safe, the electrodes can cause irritation or small burns if the power is too high or if you have sensitive skin.

  • Avoid placing TENS electrodes on certain parts of your body, such as near the eyes, on the front of the neck, on open wounds or infections, near tumors, on a pregnant belly, or on the genitals.
  • TENS isn’t advised for those with pacemakers, implantable cardiac defibrillators, or other implanted devices.
  • Those with epilepsy or undiagnosed pain also might want to avoid using TENS.

Cupping

“Cupping” received more attention when Olympic athletes used the practice to relieve pain and improve performance. However, there’s not enough evidence that cupping is a good option for pain management. Cupping therapy is a traditional Chinese medical practice that is popular in Asia, the Middle East, and in some parts of Europe. During treatment, a cup is placed on the skin over muscles and a vacuum is created to remove the air inside the cup. The vacuum against the skin is thought to increase blood flow to the tissue underneath the cup, which might relieve pain and tension. Cupping typically leaves reddish to purple circles on the body where the cups were placed, and the bruises can take several days to weeks to fade.

Cupping is generally considered safe but should always be performed by a qualified professional. One obvious side effect is bruising. Patients also report feeling warmer during the treatment and sometimes sweat more. Cupping isn’t recommended if you are pregnant or menstruating, or if you have metastatic cancer or bone fracture. It also shouldn’t be applied to injured skin. There’s an increased risk of complications when treatment sessions last more than 20 minutes, and some patients have been burned during cupping therapy.

The jury’s still out on whether cupping is effective because there haven’t been enough studies comparing it to other pain-management options. So it’s crucial to talk with your doctor or healthcare provider before adding cupping to your pain-management plan.

Trigger Point Injections

Trigger points, commonly called “muscle knots,” are tight spots in your muscles. Not everyone with trigger points experiences pain, but some people have painful trigger points. Often times, you can treat trigger points on your own. At-home treatments include massage, using your hand or a massage ball, and foam-rollng exercises.

But what if your painful trigger points don’t go away? You might need further attention from a healthcare professional, which could include trigger point injections directly into the affected muscle. Trigger point injections (TPIs) are when a fluid or medication is injected directly into the trigger point. This injection can reduce pain or discomfort caused by irritated and stiff muscle fiber. TPI needles (or what’s in them) helps to reduce muscle inflammation so that the muscle fiber relaxes and lengthens, which causes the trigger point to get smaller or go away. TPIs apply a small amount of pressure to the irritated muscle fibers. They can contain fluids such as sterile water, an anesthetic, lidocaine mixed with a steroid, or botulinum toxin (such as BOTOX®). TPIs relieve some types of musculoskeletal pain, as well as chronic headache and migraines associated with trigger points. The effectiveness of TPIs for other types of pain (including other types of headaches/migraines) is still unclear, although some diagnosed with neck and shoulder pain, sciatica pain, or myofascial (connective tissue) pain benefit from TPIs.

The most commonly known and widely studied TPI is BOTOX®, which was FDA-approved in 2010 as a treatment for chronic migraine pain. Studies into the use of BOTOX® to treat other types of headaches, such as tension headaches, so far have mixed findings. In addition, the effectiveness of BOTOX® injections has been explored in (mostly small) trial studies for reducing pain of upper-back myofascial pain syndrome, cervical headaches, and pelvic pain in women, but other findings so far are mixed. However, none of these treatments are FDA-approved, and all need further study. The effectiveness of TPIs varies with the fluid or medicine used in the injection. Trials and studies are ongoing, but much is still unknown.

Another approach is “dry needling.” It involves inserting needles (such as acupuncture or hypodermic needles) into a trigger point without injecting a medication or other liquid. The thin needles apply pressure to the underlying muscle or tissue. Dry needling might reduce upper back pain compared to another technique of applying pressure. However, the effectiveness of trigger point injections and dry needling for pain management varies, and more research is needed. However, these treatments usually have very few side effects and typically provide short-term pain relief.

The most common side effects of TPI and dry needling are soreness, tenderness, bruising, and redness at the treatment site. Other side effects are specifically associated with BOTOX®. However, certain types of TPIs might cause tissue or organ damage if not done correctly. These treatments aren’t recommended if you have a bleeding disorder or an infection or recently ingested aspirin. Also, if you have an allergy to anesthesia, muscle trauma, or extreme fear of needles, TPI isn’t likely the best course of treatment for you.

TPIs and needling might lead to injury if not performed correctly, so it's important to seek a healthcare professional who is properly trained to administer these treatments.

Hypnosis

Hypnosis is a state of high relaxation produced from a heightened sense of focus. The American Psychological Association (APA) describes how hypnosis isn’t a type of psychotherapy and “is not a treatment in and of itself; rather, it is a procedure that can be used to facilitate other types of therapies and treatments.” It’s important for hypnosis to be conducted by a trained/certified hypnotherapist. However, everyone's experience with hypnosis is different, which means that people differ in how they respond and whether hypnosis works for them. APA states that hypnosis is “likely to be effective for most people” in managing different kinds of pain. It also might help reduce stress and improve quality of life, which can help those with chronic pain.

Hypnosis might help manage pain for cancer, jaw aches, fibromyalgia, irritable bowel syndrome, and other abdominal discomfort too. Additional studies are looking at combining hypnosis with virtual reality as a new way of delivering hypnosis and for combat-related issues. For example, one case study details how hypnosis might help control pain for combat-related spinal cord injuries, and another suggests that hypnosis might work better than biofeedback for spinal-cord injury pain. Those reviews also suggested that hypnosis might not work well for low back pain.

The military has used hypnosis for the treatment of various health conditions since the World Wars. Currently, DoD and Veterans Health Administration (VHA) have approved the use of hypnosis for pain after surgeries (see VHA/DoD’s clinical practice guideline for more information). To learn more about hypnosis for pain management, explore the following resources:

Visit the Defense & Veterans Center for Integrative Pain Management page for more information, videos, and other resources about pain management.


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References

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