Most of the advice I give for pain management is based on experience gained from reading, talking to other experts, and treating patients.
But I recently had shoulder surgery myself, and the experience gave me the best possible opportunity to relearn many lessons, this time from the patient's perspective. Here are four of the most important ones:
Lesson #1: Stay ahead of the pain
When I came out of surgery, my shoulder was numb from anesthesia. I was able to give myself pain medicine as needed, but hardly used it at first. Several hours later, when the numbness went away, I experienced the most severe pain I can ever remember having. I rated it 9.5 on a scale of 1 to 10. I was in agony for a couple of hours, and was starting to wonder if I would ever get comfortable again.
After that, I mostly took my medicine on schedule, and did pretty well. But, believe it or not, I still managed to miss the occasional dose, and then I needed extra medicine to calm things back down. I also quickly learned to take a dose of medicine prior to doing activities that were sure to make the pain worse.
Lesson #2: Cold and heat really work
My best friend during the first week was ice - I used it nearly 24 hours a day. Not only did it reduce the inflammation, but it reduced the pain and allowed me to use less medication. Later, once I started to do more activity, heat turned out to be the fastest and most effective way to relax my muscle spasms, increase my range of motion, and reduce my pain.
One caveat: For safety, be sure to place a towel or clothing between your skin and the ice or heat. I actually got a mild case of frostbite at one point because I wasn't careful enough.
Lesson #3: Physical therapy is hard, and it is worth it
My first assigned exercise was to flex and extend my fingers, wrist, and elbow 10 times each, plus dangle my arm and make small circles from the shoulder. These may seem like trivial tasks to most people, but it took all of my energy just to barely carry them out. After each day's session, I needed a strong dose of medicine and a nap. My dominant arm was essentially useless to me. It was demoralizing to realize how handicapped and dependent I had become overnight.
On the bright side, the only direction to go from there was up. I was soon able to complete the assigned exercises every day. It still hurt, but I was thrilled to realize things were, indeed, improving. The same thing happened with each new step in therapy. At first, I had pain, limited ability to accomplish the task, and plenty of frustration. Some of the treatments my therapist did in the office hurt a lot, too.
I stuck with the exercises, using heat, cold, medication, and perseverance to get through them. At times, I didn't feel like I was making any progress at all but over time, thinking back to my first day out of surgery, I could see there was really no question that things were getting much better.
Lesson #4: Don't overdo it on a good day
About 10 days after surgery, I was starting to feel a lot better. I sat down at the computer and began trying to catch up on all the work that had piled up. I was quite pleased with how much I got done, and celebrated by going out to dinner that night. It was a great day and it felt terrific to get out of the house. Unfortunately, the next day I had a major setback. I needed a lot more medicine and ice, and spent the entire day resting and sleeping.
I relearned what I have told patients countless times before: If you pace yourself and only try to do a little bit on your good days, you're much more likely to feel up to doing things the next day, too. Ultimately, you'll probably feel better and accomplish more by taking it slowly than if you try to catch up all in one day.
My experience was with acute pain from surgery, not chronic pain. Chronic pain usually takes longer and more intense therapy to improve. And, of course, people respond differently to specific treatments. Overall, though, I think you'll find that these four principles have at least some application for just about any kind of pain.
