Pain Management: All Your Self-Help Options

This comprehensive guide will take you through pain management options and techniques for chronic pain, helping you make the best choices.

Chronic pain is defined as pain which lasts longer than three months, and the latest statistics show that it affects around 20.5% of the world population – that’s around 1.5 billion people!.

When we see medical professionals about our pain, typically this consists of brief appointments every few months. Meaning that the majority of managing your pain is done at home in your own time.

There are a wide range of ways that you can manage and reduce your pain, increasing your level of functioning and getting your quality of life back. This in-depth study explains that, “With effective self-management, the patient can monitor his or her condition and make whatever cognitive, behavioral, and emotional changes are needed to maintain a satisfactory quality of life.”

If you haven’t had the opportunity to see a pain specialist, or build a pain management plan, don’t despair – this guide is designed for you!

Pharmaceutical

Over the counter treatments

There are painkillers and non-steroidal anti-inflammatories (NSAIDS) which are available over the counter. Depending on your diagnosis and the severity of your symptoms, these may be able to reduce your pain. A wide range of topical creams and gels are available which produce a tingling, cooling or warming sensation; these can be applied to painful areas and interrupt pain messages to bring short term relief. Topical treatments can be particularly helpful to reduce pain enough to drift off to sleep.

Pros

  • Easily accessible
  • Reasonably priced
  • Can ease symptoms

Cons

  •  Don’t work for everyone
  •  Only work in the short term
  • NSAIDS can have side effects on the body

Prescribed Medications

Your doctor may prescribe you medications to help you deal with your pain. Your options could include:

  • Painkillers

Your doctor may offer you stronger painkillers than you can access over the counter. These are often opioids, or you may have heard of them referred to as narcotics.

  • Non-steroidal anti-inflammatories (NSAIDS)

Stronger NSAIDS are available on prescription. These can help reduce pain as well as inflammation.

  • Steroids

Corticosteroids may be offered in the form of tablets or injections directly into the painful area. Steroids work by preventing your body producing the chemical which causes inflammation.

  • Antidepressants

Three types of antidepressants are available which are thought to help with chronic pain. Tricyclic antidepressants (TCAs) raise levels of certain chemicals in your brain, which is thought to help with chronic pain. This study explains that TCAs, “inhibit the reuptake of serotonin and norepinephrine at the synapse” 

Serotonin is a chemical in your body which contributes to your general sense of happiness and wellbeing, as well as playing a part in regulating various processes within your body. Serotonin and norepinephrine reuptake inhibitors (SNRIs) affect how your brain absorbs and processes neurotransmitters. Selective serotonin reuptake inhibitors (SSRIs) affect how your body absorbs serotonin as this study states: (SSRIs) exert their efficacy predominantly through the reuptake inhibition of serotonin.” 

  • Anticonvulsants 

You might also hear this described as anti-seizure medications. They are thought to help manage pain by suppressing pain messages. More research needs to be done into the science behind the use of both antidepressants and anticonvulsants to treat chronic pain, as this study discusses.

Pros

  • May reduce pain
  • Antidepressants can help treat the mental health issues that often come with chronic pain

Cons

  •  Many prescribed medications have side-effects such as weight gain, heart problems, sexual dysfunction, nausea, dizziness etc
  • Can be addictive
  • Many require slow tapering over time to stop taking them
  • Don’t work for everyone
  • Don’t usually eliminate all symptoms, rather just reduce them
  • Can be trial and error to find a medication that works for you
  • Research is lacking around antidepressants and anticonvulsants

If you are offered prescribed medicines, be sure to ask questions and do your research, so you can understand why they are being prescribed and what side effects they have.

It’s important to take your prescribed medications regularly. It can be all too easy to forget to do so when you’re in pain or having cognitive difficulties, like fibro fog in my case. Asking a loved one to remind you to take medications or setting a reminder on your phone can prompt you to take them.

Manual and physical therapies

Massage

Before you begin massage therapy you will typically talk to the therapist about which areas of your body are painful and what you feel comfortable with. During massage the therapist will use varied pressure on specific areas of your body to help your muscles to relax, providing relief from pain and stress.

Sometimes massage can feel a bit uncomfortable, particularly if your muscles are very tight. If you are worried, talk to your massage therapist. They will be able to reassure you and make the experience as comfortable as possible for you.

Pros

  • Can help to relieve pain
  • Provides relaxation/reduces stress
  • Tailored to your individual needs

Cons

  • Can be uncomfortable
  • May not be offered readily through your doctor
  • Must attend a therapist’s office (need transport)

Physiotherapy

You might have heard physiotherapy referred to as physical therapy. A physiotherapist will work with you to build up your range of movement. They will teach you how to strengthen your body in a way that prevents pain flares. Typically, physiotherapists will carry out passive treatments, meaning treatments in which they do the work. These might involve them manipulating and moving your body to strengthen it and target specific muscle groups.

You will also engage in active treatments, meaning you take an active role while being guided by your physiotherapist. These are often specific strengthening and flexibility exercises. You will usually be given exercises to practice at home, to continue building and maintaining strength.

Pros

  • Reduces pain
  • Increases range of movement
  • Strengthens body
  • Tackles fear avoidance
  • Increases confidence
  • Has long term results
  • Increases level of functioning
  • Reasonably easy to access
  • Active treatments can be carried out using an online pain therapy program

Cons

  • Requires effort and dedication
  • Can be uncomfortable at times
  • Could cause flares during the learning period

Hydrotherapy

Exercising in water takes the weight off your joints, therefore making movement less painful. Often warm water will be used in hydrotherapy pools to aid relaxation and help with easing pain. You may attend hydrotherapy in a hospital pool or be referred to a specific hydrotherapy centre.

If specific hydrotherapy pools are not available, you could use a local pool to join in with an aqua fit class, or use a local spa. Ensure that you are moving at your own pace and speak to instructors beforehand about your diagnosis.

Pros

  • Allows you to practice movement with less weight on joints
  • Strengthens muscles
  • Aids in reducing pain
  • Increases mobility
  • Heated pool helps with pain reduction during exercise
  • Can be relaxing

Cons

  • Must travel to a hydrotherapy pool
  • Depending on where you live, access to hydrotherapy pools may be limited.

Chiropractors

Often focusing on the back and spine, chiropractors will use firm movements and manipulation to apply pressure and release tension in specific areas. They might manually move your body into different positions and stretch your muscles. Sometimes this can feel uncomfortable, but shouldn’t feel painful.

Chiropractic treatment is thought of as an ‘alternative’ therapy, which means that it might not be offered readily through your doctor, so you may need to ask specifically about this type of treatment or seek it privately.

Pros

  • Can help to ease pain
  • Can improve mobility/flexibility

Cons

  • Not readily available
  • Less scientific evidence than many other treatments
  • May be costly to seek privately
  • Treatment can be uncomfortable
  • Can cause aches, pains and stiffness after treatment
  • Must attend a therapist’s office

Osteopaths

Osteopaths physically manipulate areas of the body to promote healing, to strengthen muscles and to relieve muscle tension. Osteopathy is based on the concept that all of the muscles and tissues within your body need to work together in a healthy manner, to bring optimal levels of functioning for the patient.

Pros

  • Can help to relieve muscle tension
  • Can increase mobility
  • Thought to promote healing

Cons

  • Less scientific evidence than many other treatments, especially for chronic pain
  • Not readily available
  • Costly to seek privately
  • Can be painful during and after treatment
  • Must attend a therapist’s office

Acupuncture

During acupuncture, very fine needles are inserted into specific areas of the body, typically while you lie still in a calm atmosphere. The needles stimulate the nerves just below the skin. Research suggests that this works by encouraging the body to produce pain relieving chemicals.

Acupuncture shouldn’t feel painful; it should be a relaxing and pleasant experience. It’s thought of as an ‘alternative’ therapy, so it isn’t often prescribed by doctors. You can seek it privately or by asking your doctor or specialist specifically about acupuncture.

Pros

  • Not painful
  • Can reduce pain
  • Regular treatment can provide long lasting pain relief
  • Can be relaxing

Cons

  • Not readily available
  • Can be costly to seek privately
  • Must attend a therapist’s office

Pain Management Programmes

Pain clinics and self-management programmes

You may be referred to a pain management program or clinic by your doctor or specialist. These are in person programmes. Essentially, these programmes teach you how to cope with your pain and give you the knowledge and emotional tools that you need to carry on coping at home.

You may see a variety of specialists within the clinic, taking part in various treatments and exercises to cater to your individual needs. This article explains that, “Self-management education complements traditional patient education in supporting patients to live the best possible quality of life with their chronic condition.”

Pros

  • Give you the tools to manage your pain effectively at home
  • The opportunity to see a variety of specialists under one roof
  • Proven results in reducing symptoms for the long term
  • Commonly referred to by doctors

Cons

  • Must attend a clinic regularly (need transport)
  • Clinic may not be near your home
  • Can be costly if being privately funded
  • Long-wait times in government funded programs

Online pain management programmes

There are pain management programmes available online which you can carry out in the comfort of your own home. Some programs are designed for specific conditions, and others help with chronic pain in general. The structure of programs can also vary in terms of duration (e.g. 12-week programs), pricing (free, paid, freemium) and accessibility (website, app, both).

Our app incorporates evidence-based therapies (such as those included in this guide) to help you manage and reduce your pain. This is done through a combination of both mental and physical (mind body) exercises.

You’ll find other programs with varying focuses. For example, the Curable app focuses on pain psychology. The Kaia app focuses on back pain and gentle exercise. Meditation apps help to bring relief through mindfulness, relaxation and distraction.

Exercise

When you live with chronic pain, often the thought of exercise can become worrisome. It’s common to be concerned that exercising is going to worsen your chronic pain, which can sometimes lead to fear avoidance. This simply means you begin to fear movement and therefore start to avoid it.

In fact, avoiding exercise feeds into the pain cycle, leading to weakening muscles and deconditioning of the body’s general health, as well as increasing stress and pain as explained in this study. Gentle regular exercise helps to keep pain at bay, strengthens the body and helps with general health.

It’s important to pace yourself when dealing with pain, especially if you’re new to being active. You can build up the time and intensity of the exercise as you start to feel more confident. There are various low impact exercise options you could consider.

Pros

  • Maintains general health
  • Increases fitness
  • Builds stamina
  • Prevents deconditioning
  • Reduces inflammation
  • Tackles fear avoidance
  • Builds confidence
  • Helps to manage weight
  • Increases immune function
  • Increases energy levels
  • Aids in better sleep patterns
  • Reduces pain
  • Reduces cognitive issues
  • Reduces stress levels
  • Good for mental health

Cons

  • Must be built up to gradually
  • Requires confidence and willpower
  • Could cause a flare

Yoga

Yoga focuses on a series of movements or postures, typically combined with breathing techniques. These movements help to increase balance, flexibility and range of motion among other benefits. This low impact exercise can be as advanced or as simple as you like, meaning it can be tailored to your level of functioning and comfort.

Pros

  • Improves flexibility and range of movement
  • Strengthens muscles and joints
  • Improves balance
  • Can reduce stress/provide relaxation
  • Can be tailored to suit you
  • Doesn’t require specific equipment
  • Can be carried out in a class or on your own at home
  • Low impact

Cons

  • Need to practice yoga regularly, guidelines say twice a week, to gain full benefits

Tai Chi

Tai Chi utilizes calm deep breathing techniques, as within yoga. While yoga involves holding positions, tai chi involves moving your body in slow, flowing movements which are based on martial arts. As well as being good for your physical health, tai chi can aid in reducing stress.

Pros

  • Can improve posture
  • Increases muscle strength
  • Improves balance
  • Increases mobility
  • Can reduce stress/provide relaxation
  • Low impact
  • Doesn’t require special equipment
  • Can attend classes or practice at home

Cons

  • Not enough research on reducing pain

Pilates

Pilates focuses on exercises to specifically increase core strength. Special equipment may be used to provide resistance to strengthen specific muscles, or to provide support while carrying out exercises. Typically when this equipment is being used, you will be with a pilates teacher who will guide you.

Pros

  • Can increase muscle tone
  • Increases core strength
  • Can improve mobility
  • Can improve mental health
  • Some exercises can be carried out at home
  • Can vary in intensity to suit your needs when working one on one, or at home

Cons

  • Not a great deal of scientific research done into its effects on chronic pain
  • Some exercises require special equipment
  • Some classes can be high intensity
  • Could cause a flare

Swimming

Swimming can be a great exercise for general fitness! It takes the weight off your joints, making it low impact and often less painful to perform movements. You can go at your own pace and choose a swimming stroke that suits you. Some swimming pools offer swimming lessons and classes for those who may need guidance and encouragement. Often aqua aerobics classes are offered; these are classes within which you are taught exercises to do in the water. The water not only takes the weight off your joints but also provides resistance to build muscle tone when doing certain aqua aerobics exercises.

Pros

  • Low impact
  • Can aid in preventing chronic illness
  • Can suit all abilities
  • Water takes weight off your joints/can reduce pain
  • Increases energy levels
  • Aids in better sleep patterns
  • Reduces pain

Cons

  • Need to travel to a swimming pool
  • Cost is involved for pool entry/to attend classes
  • Need to own/buy swimming costume or trunks
  • Chronic illness can make you sensitive to smells/environmental factors: may be sensitive to chlorine

Walking

Walking is a low impact exercise that you can do anywhere, at any time. You can go right from your door, and you can control the distance you go and how challenging the route is. Being out in nature can be great for your mood and can be so much fun!

I have been through a personal journey of exercise with fibromyalgia and arthritis, starting from barely being able to walk up and down stairs without flaring and building up to going on regular hikes of up to 9 miles. I have picked up some tips along the way that can help you when you’re starting out:

  • Take a comfortable backpack which is big enough to fit your supplies in, but which gives your back the appropriate support, for example one with a chest strap to distribute weight evenly.
  • Keep your backpack filled with supplies ready to pick and go, to ensure you have all you need.
  • Take prescribed or over the counter painkillers with you in your bag, in case you need them while you’re out walking.
  • Set goals which are realistic and don’t push yourself past that point even if you’re feeling pain free.
  • Take plenty of water to stay hydrated.
  • Take some healthy snacks in case your blood sugar drops, you need a little boost, or you need to take your medication with some food.
  • Take someone with you for support and encouragement, plus it’s more fun with a companion!
  • Keep your phone fully charged and even carry a power pack in case you need to call someone.
  • Use mobility aids if you have them, for example I have a fold down walking stick that I take with me in my bag.
  • Invest in a small walking stool if you can: this is a fold down stool you can fit in your bag to ensure that no matter where you are, you always have a place to take a rest.
  • Take regular rests, even if you feel that you are doing well; allow yourself that time to catch your breath and take a drink. This will help to prevent flares.

Pros

  • It’s free!
  • Reduces pain over time
  • Gets you outdoors
  • You can go right from your door, so don’t need transport
  • You don’t need special equipment unless you start hiking long distances

Cons

  • Can cause a flare in symptoms
  • You may require owning/buying support walking shoes, bag etc
  • Works many muscle groups but not the whole body.

Cycling

Getting out on a bike gets you outdoors and increases your fitness levels. It can be really great for mental health, and a handy way to get around! You can incorporate cycling in your day to day routine, such as travelling to work or to visit a friend. Cycling is certainly a more aerobic exercise than those we have previously mentioned, but is still low impact, so isn’t putting too much strain on your joints.

Pros

  • Gets you outdoors
  • Can be a form of transportation
  • Good for the environment
  • Works the lower body

Cons

  • More aerobic, may require already established sense of balance and core strength
  • Bikes and equipment can be costly
  • Need to take into account the cost of bike repairs in event of flat tyre etc
  • Can cause a flare in symptoms
  • Focuses on strengthening lower body rather than the whole body
  • Need to be careful on roads
  • Wrong bike size/frame can result in incorrect posture/injury

Dancing

You could attend dance classes, fitness classes which incorporate dance, or you could just have a good old dance at home. Dancing can be so much fun. The music can really add to your motivation and help to boost your mood. It can be a fun activity to do with friends. There are so many dance styles to choose from, so there’s something for everyone!

Pros

  • If it’s your thing, it can be really fun
  • Many dance styles work the whole body
  • Can be done at home with no equipment and no transport needed

Cons

  • Need transport to classes
  • Classes will cost money
  • Often more high intensity/high impact depending on the style
  • For some dance classes you may need to buy outfits/dance shoes

Attending a gym

Many people choose to become members of a gym. There are many machines and weights to choose from within a gym, and often many types of fitness classes. You may be able to use weight machines to practice strengthening exercises, and other exercise machines to work certain muscle groups.

If you’ve never been to a gym before you may choose to get guidance from a personal trainer who can talk you through what is safe for your specific needs and how to use the machinery.

Pros

  • Lots of equipment/exercises/classes all available in once place
  • Can work the whole body
  • Many gyms offer classes for the other types of exercises we mentioned and have swimming pools

Cons

  • Need transport to the gym
  • Gym fees
  • Using exercise machines and weights incorrectly could result in injury/increased pain
  • May need to pay for a personal trainer to guide you
  • Could cause a flare
  • Don’t get the mood boost that being outdoors can bring

Movement and activity

Setting goals

Setting goals for each day such as what you want to achieve and tasks you want to complete. These can be simple things like brushing your teeth or taking a shower, or more complex goals such as reaching a target at work. This study explains that, “Focusing on a specific problem, establishing realistic objectives, and developing an action plan for attaining those objectives are beneficial steps in managing chronic illness”. 

You can adapt the goals to suit your progress, your symptoms and your lifestyle. It’s important that you set realistic goals that don’t put too much pressure on yourself. It can even help to write them down on paper or set them as a memo in your phone so that you can tick each goal off as you achieve them.

Pros

  • Give a sense of achievement
  • Helps with motivation
  • Builds confidence
  • Keeps days organised
  • Realistic goals can prevent over pressuring yourself or causing flares
  • Encourages functioning
  • Gives a sense of empowerment
  • Can be anything big or small to suit the individual

Cons

  • Setting goals too high could knock confidence and make things feel unachievable.

Breaking things down

If there’s an activity that you find particularly difficult, you can break it down into bite sized pieces so it’s more manageable. For example, going shopping can be broken down into getting dressed and ready to leave the house, transport to the shop, walking around the shop and so on. Learn to tackle each aspect of this activity one at a time, planning where you might need help or need to take rests. Plan to take supplies with you just like with exercise, such as painkillers or mobility devices.

Pros

  • Bitesize tasks are more achievable
  • Promotes long term success
  • Builds confidence

Cons

  • Breaking things down can take more time

Pacing activity

Activities can be built up to and increased gradually. We have a habit of trying to ‘make the most’ of low pain days, trying to get everything done while our pain is low. This can make our symptoms flare and send us right back to not being able to function. This is known as the boom bust cycle.

Pacing activity can help to avoid flares. It’s also important that you take regular breaks, even if you feel that you don’t need them, to give your body a chance to recuperate. This study explains that, “The aims of activity pacing include to reduce overactivity–underactivity cycling (fluctuating between high and low levels of activity) in order to improve overall function and reduce the likelihood of exacerbating symptoms

You can start pacing by choosing an activity that you find tough but not impossible; it’s better to start off with something more manageable. You can figure out your baseline, which is what you will work from, by figuring out how long you can do this activity without causing a flare. Then reduce this amount by 20% and you have your baseline!

Do the activity in accordance with your baseline every day for a week. The next week you can increase that activity by a couple of minutes and so on, until you are building up your tolerance and ability. As you gradually increase your activity, you are learning that this activity doesn’t need to be feared and your brain is learning that it doesn’t need to send out pain messages in response to that activity. You can then incorporate this method to other activities throughout your day.

Pros

  • Prevents flares
  • Increases level of functioning
  • Builds self esteem
  • Helps to retrain the brain away from pain
  • Helps you prioritize tasks that are most important to you

Cons

  • Breaking down activities can take longer
  • It can be frustrating to learn not to try to do everything at once on low pain days

Utilizing mobility devices

Often people can view using a mobility device as ‘giving in’ or find it embarrassing, but using a mobility device is doing the exact opposite of giving up. It’s using every single available resource to ensure that you are being as mobile and active as possible, and that’s something to be proud of not ashamed about. For example, if using a walking stick helps me to be able to walk more with less pain, then that is a positive thing.

Pros

  • Increases mobility
  • Allows you to increase daily functioning
  • Makes life easier
  • Increases confidence
  • Allows you to perform tasks you might not otherwise be able to

Cons

  • Mobility devices can be expensive
  • Using mobility aids can be hard to come to terms with
  • If used incorrectly, can become a ‘crutch’

Wear comfortable clothes and footwear

Just as you adjust your environment at work and at home to optimize your level of functioning, you can also adjust your clothing to make things easier for yourself. Wearing comfortable clothes makes a big difference, especially if you experience allodynia. Allodynia means that things which shouldn’t be painful can cause pain or discomfort, such as the feeling of clothes scratching against your skin.

I experience allodynia as a symptom of fibromyalgia, so choosing clothes with softer materials which are baggier and more comfortable, makes me so much more comfortable and therefore makes me more inclined to move around and be active.

Choosing footwear that is comfortable and supportive is essential especially when you’re trying to exercise. Flat shoes with grips can help you with balance and good footwear can provide extra support.

Pros

  • Making functioning as comfortable as possible
  • Increasing functioning
  • Reducing pain
  • Giving your body appropriate support

Cons

  • Clothes and footwear can be expensive
  • Adjusting your wardrobe to comfortable clothes can be hard on self-image

Occupational Therapy

An occupational therapist may come to your home or to your workplace to help you make adjustments to the environment. Sometimes they will provide equipment to make things easier. Typically, they will talk to you in depth about your routine and which aspects of activity you find hard, helping you find ways to make things more manageable.

Pros

  • Helps you to adjust your environment
  • Can increase functioning
  • Can aid in reducing pain
  • Can increase confidence in daily activities

Cons

  • Can sometimes be embarrassing and time-consuming to have to make adjustments to your environment

Coping with a flare

Unfortunately, even if you do all that you can, sometimes flares do happen. When they do, learning how to deal with them effectively can lessen their impact and make them easier to cope with.

  • Utilize your pain killers, medications, and topical creams

Painkillers and prescribed medications can help to reduce your pain slightly and offer some relief. Topical creams can provide some comfort by interrupting pain signals.

  • Use the heat and cold we mentioned previously

Heat can help ease pain and make you more comfortable. Cold on painful areas can aid in reducing inflammation and pain.

  • Allow yourself the time to rest without feeling guilty

While being active is important, if you’re  flaring, allowing yourself time to rest is important.

  • Realise it’s ok to feel negative

You don’t always have to maintain a positive attitude; flaring can be emotionally draining as well as physically. Negative feelings are completely valid. Allow yourself to feel these emotions but only for a short time. When you’re ready, pick yourself up and keep going.

  • Ask for help

During a flare your level of functioning may be lower so ensure that you are reaching out for help. It’s a great idea to talk to someone you trust about what sort of help you might need during a flare, giving them practical advice so that they are prepared when you reach out.

  • Distract yourself

One of the most helpful things you can do, even though it is much easier said than done, is to distract yourself as much as possible. Watch a movie that keeps your mind occupied, put on some loud music that cheers you up or try and do some crafts. Whatever it is that brings you some joy and keeps your mind busy is useful. You could even make a ‘flare playlist’ on your phone if you have music apps, so you have it ready to just press play when you need it.

  • Have supplies ready

When you’re flaring it’s unlikely that you’re going to want to cook meals or go out shopping. Always having some frozen meals or long-life snacks in the cupboard that you can just grab when you need them to ensure you are eating can be helpful.

Sometimes it can be tough to think clearly about who you might want to call for help or what distraction techniques you could use. The last thing you want is to be searching for something you need. Preparing a ‘happy box’ in advance can make a difference. You could put anything into the box that is going to help you with relaxation and distraction, for example your favourite movie, craft supplies or a game to play.

Keeping an emergency list of numbers at hand of loved ones or medical professionals can be valuable. The more prepared you are the better!

  • Practice relaxation

Even though it’s hard when your symptoms are at their worst, trying to practice relaxation techniques like mindfulness meditation and breathing exercises can really calm you, making you emotionally more prepared to deal with the flare.

Self-care

Heat and cold treatments

Heat or cold on affected areas can be effective in relieving pain; sometimes alternating between the two can be helpful. You can use hot water bottles or microwaveable rice bags and heating pads. If you want a bit of extra comfort you can get teddies that go in the microwave which also smell like lavender; this can be very calming.

Ice packs or cloths dipped in ice water can be used as cooling options. You can also buy heat or cool pads which can either be applied to clothes or directly to skin; effects typically last for a few hours.

Pros

  • Easily accessible supplies
  • Can reduce pain
  • Can help you fall asleep

Cons

  • Only works short term
  • Must be careful of heat and cold burns if using for long periods of time
  • Can be tough to reach some areas of the body if you’re alone

Splints and supports

Your medical professional may provide specific splints or supports that you can wear either daily or during exercise which can help to support joints, especially if you have a diagnosis like osteoarthritis within which joints may need extra help. You can also seek these supports out online or in pharmacies if you feel that they could be useful for you.

Pros

  • Can provide extra support
  • Reduces pressure on joints
  • Can ease pain
  • Can reduce inflammation

Cons

  • Wide range of choices can be confusing
  • Appearance of splints can influence self esteem
  • Typically need guidance from a medical professional
  • Can typically only be used for short periods of time.

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS machines can sound scary but really it’s just a small machine with sticky pads which you are instructed to put on various areas of your body. The machine sends small electrical signals which interrupt the pain signals in your nerves to bring some relief from pain. 

This type of treatment isn’t painful, but you may feel a small sensation which you soon become accustomed to. Usually your doctor or specialist will show you how to use a TENS machine, and you will usually be permitted to take it home with you to integrate into your daily pain management.

Pros

  • Isn’t painful
  • Can reduce pain
  • Fairly easily accessed through doctor

Cons

  • Only provides relief for as long as you are actively using the machine.

Educating yourself on pain science

The more you learn about chronic pain, the more prepared you will be to tackle it. Understanding the science behind how the body processes pain, can give you the ability to see why and how various self-help techniques and professional treatments work. This knowledge can give you the confidence to tackle your pain in new ways.

Pros

  • Knowledge of what is happening in your body
  • Understanding that chronic pain doesn’t mean damage
  • Giving a sense of empowerment and confidence

Cons

  • Some aspects can be difficult to understand

Finding purpose

In some cases, chronic pain can make you feel worthless. It can reduce your level of functioning until you feel that you are just surviving rather than thriving. Finding a purpose in your life is so important, especially if you aren’t working. This could be things as simple as hobbies that you enjoy or adopting a pet, or more complex purposes such as getting back to work.

Pros

  • Gives motivation
  • Increases confidence
  • Gives a sense of determination
  • Brings more joy into day to day life

Cons

  • Can be difficult if you are not working

Maintaining a healthy diet

Giving your body the fuel it needs to function optimally becomes even more important when you have extra health challenges like chronic pain. Ensuring that you are limiting junk food and focusing on eating in a healthy way can provide your body with the right nutrients to function optimally.

Pros

  • Providing your body with the fuel it needs to function
  • Increases energy
  • Maintains weight
  • Good for mental health
  • Good for general health
  • Boosts immune system
  • Strengthens body

Cons

  • It can be hard to cook and plan meals when you live with chronic illness

A good sleep routine

Ensuring that you are sleeping well is vital for overall health. When your body is working against chronic pain and the fatigue that so often comes along with it, rest becomes even more important. 

Pain can often keep you awake at night so trying to relax and reduce pain before bed can be beneficial. Fatigue can be like a veil, tricking you into thinking your body is tired enough for sleep. It’s often easier said than done but here are some tips to help you engage in a good sleep routine:

  • Trying to go to sleep around the same time every night and wake up at the same time each day can help your body clock to get back on track.
  • Keep active during the day to tire your body out in a healthy way. When our bodies are inactive for long periods of time, even if we’re fatigued, the lack of activity can lead to restlessness at night.
  • Try not to nap during the day. I know this is easier said than done; sometimes when my fibromyalgia is flaring, I can’t keep my eyes open and so a nap is needed to continue functioning for the rest of the day. In this case, trying to minimize the amount of time you are napping can help your body to feel more tired at night.
  • Take your medications close to the time you go to sleep, especially if they have sedative side effects, so that you can make the most of them.
  • Make your bedroom comforting and relaxing: keep lighting dim, ensure you have comfortable bedding and surround yourself with things that calm you.
  • Use all techniques at hand to reduce your pain before bed, such as heat pads, painkillers or topical creams.
  • Use relaxation techniques to wind down before bed such as listening to audio books or calming music to help you unwind. Meditation can be really useful here. Body scan meditations can really help your body to fully unwind for sleep. This involves you going through each area of your body and tensing each muscle then relaxing it fully. You can find guided body scan meditations online or through an app like ours (download links in banner above).

One thing that I’ve found really useful to reduce frustration when I simply can’t sleep, is to understand that even if I’m not sleeping lying calmly and resting in bed is still allowing my body time to recuperate and re-energize. Once I realised this, I found that I was drifting off to sleep more often because I didn’t feel so much pressure.

Pros

  • Helps daily functioning
  • Fights fatigue and increases energy
  • Promotes strong immune system
  • Improves cognitive functioning
  • Good for general psychical health
  • Good for mental health

Cons

  • It can be hard to get to sleep when you are in chronic pain

Reducing stress

Stress feeds into the stress and pain cycle, increasing pain and worsening accompanying symptoms as this study explains: “Pain and stress are two distinguished yet overlapping processes presenting multiple conceptual and physiological overlaps

Reducing stress in your life as much as possible can help to reduce your chronic pain. Try to talk about things that are on your mind with someone you trust; sometimes sharing your worries can help you to see the way forward and lighten your load. Surround yourself with people who will encourage you and add to your life in positive ways. Practicing self-care can help you to lower stress levels.

Pros

  • Helps to break the stress and pain cycle
  • Reduces chronic pain symptoms
  • Helps mental health
  • Keeps the body functioning properly

Cons

  • Breaking the stress and pain cycle can be difficult.

Setting boundaries with others

When you live with chronic pain, you often cancel plans at the last moment because of a flare up in symptoms. Sometimes you can harbour a sense of guilt when you are not able to keep up with things around the house, daily chores or a regular social life with your friends. While it’s important that we do maintain social connections, it’s also vital that you do not push yourself too much, subsequently causing a flare through a sense of obligation or a need to please others.

Setting clear boundaries with loved ones and being assertive with saying ‘no’ if you feel that something is too much can be tough emotionally but is so beneficial. You have a right to put your own health first. Remember that the word ‘no’ is a sentence within itself; you do not have to explain yourself unless you feel comfortable doing so.

Encourage loved ones to educate themselves; send them links to articles that give them a deeper insight into your condition or have open conversations with them so that they understand that when you say no, it’s not because you don’t love them, it’s because you love yourself.

Pros

  • Preventing flares
  • Maintaining stronger connections with loved ones
  • Feeling more understood by those in your life

Cons

  • Loved ones can find it difficult to understand why you need to set boundaries
  • It can be hard to say ‘no’ to those you care about

Monitoring your symptoms

Keep track of your symptoms, whether it be writing them down, keeping notes on your phone or using a monitoring app, can allow you to see useful patterns. This helps you to keep medical professionals up-to-date, allowing them to see your condition in a clearer light.

Knowledge is power, and the more you learn about the ebbs and flows of your illness, the more you can counteract it and adapt your life to work around it.

Pros

  • Allows you to see patterns in your symptoms
  • Helps you to identify and tackle things that trigger flares
  • Aids medical professionals with diagnosis and treatment
  • Helps you to utilize low pain days without causing flares

Cons

Keeping a journal

Journaling can help you with monitoring your symptoms, but it can also be an emotional outlet. Sometimes it can be tough to talk to others about what we are going through, especially because we may not want to upset loved ones. Having a place that you can vent without feeling the need to filter your feelings can be freeing and cathartic.

Pros

  • Can help with monitoring symptoms
  • Helps to express emotions and feelings
  • Reduces stress
  • Can be good for mental health
  • Can express creativity
  • Promotes cognitive health

Cons

  • Can be tough to keep up regularly due to fatigue/other priorities

Writing notes and reminders

Often with chronic pain comes issues with cognition and memory; for me ‘fibro fog’ can make it tough to remember little things. One of the ways I tackle this is to set alarms and reminders on my phone. You could also leave post it notes around the house or make lists of anything that you need to remember.

Pros

  • Can help you to set goals for the day
  • Tackles cognitive symptoms practically
  • Helps you to be independent without asking for reminders from others
  • Reminds you of appointments, medication, etc

Cons

  • Writing things down can remind you that you struggle cognitively, can be emotionally tough to accept

Adjusting your environment to set you up for success

It’s important that your environment is conducive to keeping your pain levels as low and managed as possible. You can adjust things to make life easier for you, like adding support bars to help you get in and out of the shower like me for example.

Having a mattress topper or a new mattress that is specifically designed for support, depending on your resources, can ensure that you are optimizing your comfort and increasing your chances for a restful night’s sleep. 

Adding things like stools to your living room so that you can raise your feet up can be helpful to reduce swelling and provide extra comfort. Keeping things that you use regularly within your reach can be helpful.

It’s about what works for you and your routine. Take a look at your living environment and think about what would make things easier for you in your daily routine. While it’s important to keep active to tackle chronic pain and prevent deconditioning, it's also about increasing your level of functioning. If you can make some actions easier for yourself, then it saves your energy for other activities, increasing your functioning rather than reducing it.

Pros

  • Makes daily tasks easier
  • Increases functioning
  • Promotes independence
  • Encourages healthy behaviours

Cons

  • Can be hard coming to terms with needing to adjust your environment
  • Can be expensive to make adjustments

Being open and clear at work

If you work, it’s important that you are open and honest with your employers and colleagues about your condition and be assertive yet professional about what you might need. If you need guidance you may be able to arrange an occupational therapist to come to the workplace; they can advise and advocate for adaptations or accommodations that could make things easier for you. Just as with daily tasks at home, it’s about optimizing your level of functioning without causing a flare in your symptoms.

Pros

  • Increasing your level of functioning at work
  • Allowing you to keep working despite your pain
  • Maintains a good relationship with your employer
  • Gives you emotional support at work

Cons

  • Stigma means that not all employers and colleagues will be as understanding as you might like.

Support from others

Seeking support from others with chronic pain

There’s nothing quite like the support you can get from someone who truly understands what you are going through, because they have been through it themselves. You could join a local support group, or you can find communities of people on social media who share your diagnosis and can empathise with your experience. 

Search for hashtags and keywords that relate to your diagnosis in order to find people who are talking about topics of interest. I have found a group of people on Twitter who mean the absolute world to me. We support one another through tough times, provide guidance to each other and encourage one another to keep going. This sort of support is invaluable!

Pros

  • Gives a sense of community with others who understand
  • Learn coping strategies from each other
  • Build friendships and social connections
  • Support from people who really understand
  • Being there for others

Cons

  • Sometimes hearing others feeling negatively about their pain can impact your own coping strategies

Being social

Fear avoidance often means that people withdraw from their social life, avoiding getting out to see family and friends because they fear the activity may make their pain flare, or because they feel that their loved ones won’t understand what they are going through. This can lead to isolation, which has a significant impact on both mental health and worsens symptoms. 

Ensuring that you are maintaining social connections can make a big positive difference in your life. Having that support from those who care about you the most reduces loneliness, depression and anxiety, and provides you with a strong emotional basis to tackle your pain.

Pros

  • Provides practical and emotional support from loved ones
  • Encourages activity
  • Enhances mental health
  • Promotes good cognitive functioning
  • Good for general health
  • Builds self esteem

Cons

  • Pressure to ‘keep up’ with loved ones
  • Overdoing it could cause a flare in symptoms

Asking loved ones for help

Whether it’s talking through your feelings or more practical support like asking for help with household tasks or accompaniment to medical appointments, help from those in your life can make a big difference. Often we can feel like we don’t want to be a ‘burden’, but if you can realise that guilt and realise that those in your life want to be there for you, just as you would be there for them, you can learn to reach out for help.

Pros

  • Emotional support through hard times
  • Practical support with household tasks, attending appointments etc
  • Allows loved ones to feel useful

Cons

  • It can be hard emotionally to ask for help

Psychological treatments

These therapies can help to equip you with the skills you need to self-manage your pain. This study concluded that learning pain management skills from psychological therapies and then applying them in your day to day life, “increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress”.

Some of these treatments you can actively seek from your doctor or specialist while others you may need to find privately. With psychological therapies you could also find them online, or through our pain therapy app (like ours). This study concluded that, “existing evidence suggests that technology-assisted psychological interventions are efficacious for improving self-management of chronic pain in adults.”

Mindfulness

Mindfulness allows you to calm your emotions and parasympathetic nervous system, so you can reduce pain and feel more in control of your life. Mindfulness involves being present in the moment without judging the situation as good or bad.

Guided mindfulness meditations typically involve using imagery, breathing techniques or Progressive Muscle Relaxation (PMR). PMR focuses on each individual area of your body, instructing you to tense then relax each muscle to achieve complete relaxation.

Movement can be incorporated into mindfulness, which can often be useful for those who struggle to calm their mind when sitting still. Often mindfulness techniques are incorporated into other therapies, such as ACT, CBT and graded therapies in order to achieve the best results. This study explains that, Mind and body practices such as yoga, meditation, progressive relaxation, or guided imagery use mental and physical abilities to improve health and well-being.

Mindfulness can be integrated into your daily life, with proven results to help you relax and lower stress levels, in turn reducing pain. You could begin mindfulness meditations at home in your own time; the more you practice the more you can start to incorporate mindfulness into everyday tasks like washing the dishes or taking a shower. You can use mindfulness at night to improve sleep, in the morning to set your intentions for the day. 

Breathing exercises can help you to slow down and consider your options when you face a difficult situation, allowing you to figure out the best route forward. Mindfulness allows you to have a greater control over your emotions, to fear your pain less and to feel empowered to increase your functioning. This study explains that, “Meditation practice has been found to promote well-being by fostering cognitive and emotional processes

Pros

  • Reduces pain
  • Reduces stress
  • Helps you to control emotions
  • Aids in problem solving
  • Increases focus on the task at hand
  • Improves mental health
  • Helps to promote positive thinking and acceptance
  • Tackles pain catastrophizing
  • Aids in sleeping
  • Can be done anywhere
  • Doesn’t need special equipment
  • Different types to suit everyone
  • No side effects
  • Can be used alongside other treatments/medications
  • Easily accessible: face to face through doctor referral or privately, or online.

Cons

  • Can take time to get the hang of
  • Can be tough to learn to focus your mind on the present

Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy based on how our thought processes link to our actions. CBT helps you to see how your thoughts are influencing your behaviours. By addressing unhelpful or negative thoughts and behaviours head on, CBT helps you to replace them with more positive, helpful thoughts and behaviours. 

Once you have gotten the hang of these techniques you can then use them in your daily life to stop negative thoughts in their tracks, and to adopt much healthier coping strategies.

CBT can help to tackle fear avoidance, hyervilegence and catastrophizing. This allows patients to be more in control of their emotions and cope both emotionally and practically with their chronic pain in the future. This study concluded that CBT lead to, “Decreased negative emotional responses to pain, decreased perceptions of disability, and increased orientation toward self-management”

Pros

  • Scientifically proven
  • Helps you establish healthy coping behaviours 
  • Gives you greater control over your emotions
  • Tackles hypervigilance
  • Tackles stress
  • Treats catastrophizing
  • Tackles fear avoidance
  • Increases functioning
  • Reduces pain
  • Encourages self management
  • Builds confidence
  • No side effects
  • Can be used alongside other treatments/medications
  • Easily accessible: face to face, privately or online through a pain relief app like ours.

Cons

  • Takes time and dedication to pick up CBT skills
  • Patient’s can be skeptical of the results on pain relief

Acceptance and Commitment Therapy (ACT)

Rather than trying to change negative thoughts as in CBT, ACT focuses on understanding that a thought is just a thought and that it doesn’t have any power unless you allow behaviours to be formed around it. ACT gives you the skills to let negative thoughts pass without worrying about them or letting them influence your behaviour. 

ACT is about accepting your current situation, accepting that you are in chronic pain but at the same time, understanding that it does not have to control your life, and is not causing you damage. As well as this acceptance, ACT teaches you to commit to actions which will allow you to live the life you truly want. It’s about you taking the lead and being determined to put healthy coping behaviours in place, to live well despite your chronic pain. 

In essence, ACT focuses on changing behaviours rather than thoughts. This study concluded that ACT strategies can be integrated at home stating “the benefits of therapy are durable or may further integrate into people's lives after treatment is complete”

Pros

  • Scientifically proven
  • Promotes acceptance 
  • Promotes proactivity in own treatment
  • Helps you establish healthy coping behaviours 
  • Tackles hypervigilance
  • Treats catastrophizing
  • Treats fear avoidance
  • Increases functioning
  • Encourages self management and control of own condition
  • Builds confidence
  • No side effects
  • Can be used alongside other treatments/medications
  • Easily accessible: through doctor referral face to face, privately or online through a chronic pain relief app.

Cons

  • May not be an approach suited to everyone
  • Takes time and dedication to pick up ACT skills
  • Patient’s can be skeptical of the results on pain relief

Graded Exposure Therapy

Often patients can become fearful of situations they feel may increase their pain. This leads them to avoiding these activities (fear avoidance). This can lead to deconditioning, an increase in stress levels, emotional distress and fundamentally, actually perpetuate chronic pain!

Pain Neuroscience Education (learning the science behind pain) is a vital starting point of graded exposure therapy. This knowledge allows patients to understand what is going on in their bodies and how the therapy will work. 

Graded exposure therapy then tackles the fear of movement and unhealthy avoidance behaviours by facing each feared situation head on, but in a gradual way. This can sound scary but patient’s are guided by a therapist. Far from jumping in at the deep end, each situation is broken down into small, manageable parts and dealt with one at a time. 

A graded approach allows the brain to learn that each action does not need to cause pain and allowing the patient to understand fundamentally that the action does not need to be feared. This study explains that during graded exposure therapy, Patients are instructed to safely break the cycle of inactivity and deconditioning by engaging in activity in a controlled and time-limited fashion

Pros

  • Scientifically proven
  • Educates patients about pain science 
  • Tackles fear avoidance specifically 
  • Done in a gradual way to make the patient comfortable
  • Trains the brain away from pain
  • Increases functioning
  • Reduces/eliminates pain in specific situations
  • Builds confidence
  • Can be used alongside other treatments/medications
  • Can be accessed through your doctor, privately or online through a pain relief app like ours.

Cons

  • Not as widely known about as other therapies (less likely to be referred by doctor)
  • Patient’s can be skeptical of the results on pain relief
  • Could cause a flare during initial performance of movements

Graded Motor Imagery (GMI)

Our brains are neuroplastic, meaning that they are changeable; they learn and develop based on our experiences. Graded Motor Imagery (GMI) uses this neuroplasticity to the patient’s advantage. Our quarter of our brain is made up of mirror neurons. This simply means that these neurons start sending out messages even when you’re just watching other people doing certain actions, or when you’re imagining them! 

GMI reduces pain and retrains the brain away from pain by using imagined movements to gradually build up to performing a full movement. Any movement that the patient finds painful can be focused on. Essentially, your brain is learning that it doesn’t need to send out pain messages in response to these movements. The results of GMI are long lasting as explained in this study.

Pros

  • Scientifically proven
  • Provides pain science education
  • Can reduce/eliminate pain
  • Has long lasting results
  • Increases confidence
  • Aids in overcoming fear avoidance
  • Increases functioning
  • Increases confidence
  • Done in a gradual way to make the patient comfortable
  • Trains the brain away from pain
  • No side effects
  • Can be used alongside other treatments/medications
  • Can be accessed through doctor, privately or online.

Cons

  • Not as widely known (less likely to be referred through your doctor)
  • Takes time and dedication
  • Patient’s can be skeptical of the results on pain relief

Biofeedback

During biofeedback a therapist will teach you how to be aware of your bodily processes (such as heart rate and respiratory rate) through the use of monitors. They will introduce the association between these biological processes and your levels of stress and chronic pain. The therapist will then teach you how to calm these biological processes to reach a state of relaxation. 

Biofeedback can also be used to become aware of tension within your muscles which may be contributing to pain and in turn help you gain the tools to relax those muscles. These tools can then be used in your day to day life to reduce stress and lessen your pain levels as this National Institutes of Health report explains.

Pros

  • Reduces pain
  • Reduces stress
  • Gives you greater control over your symptoms
  • Provides tools to implement into your daily life
  • Can be used alongside other treatments
  • Can be accessed through a doctor/pain clinic

Cons

  • Not as much research as other treatments
  • Not as widely used as other therapies

Art and Music Therapy

Art and music therapies provide relaxation and stress relief. Having a form of creative expression allows patients to get their feelings out in a new and often very cathartic way.

Music therapy can involve listening to music, writing songs, playing instruments or singing. Art therapy often involves painting, drawing or other artistic crafts. 

This study explains that, “The idea behind this type of therapy is that the stimulation of creative activities promotes the healing process and rehabilitation.” Art or music therapy can be done in classes or one to one sessions with a therapist. It can also be done in your own home.

Pros

  • Promotes relaxation and stress relief
  • Allows expression of feelings
  • Lots of variety to suit each individual
  • Can encourage social bonds if done in classes
  • Provides distraction from symptoms
  • Can be done at home
  • Doesn’t require a lot of supplies

Cons

  • Doesn’t actively reduce/cure symptoms in the long term
  • Not as much research done on it as other therapies

Weighing up the pros and cons of each type of available management technique and medical treatment can help you to figure out what is best for you. Remember that even though it’s difficult, there are options out there; your situation is not hopeless.

Other online resources

References

  • Innovations in Primary Care,Thomas Bodenheimer, MD; Kate Lorig, RN, DrPH; Halsted Holman, MD; et al, (2002), “Patient Self-management of Chronic Disease in Primary Care”
  • National Institutes of Health, U.S. Department of Health and Human Services, (2018), “Non-Drug Pain Management”
  • American Family Physician, Mary Thoesen Coleman, M.D., Ph.D., Karen S. Newton, M.P.H. et al, (2005), “Supporting Self-management in Patients with Chronic Illness”
  • The Clinical Journal of Pain, Volume 31, Number 6, pp. 470-492, Heapy, Alicia A; Higgins, Diana M.; Cervone, Dana; et al, (2015), “A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain”
  • Pain Medicine, Volume 15, Issue S1, Pages S76–S85, Courtney Lee, MA, Cindy Crawford, BA, Steven Swann, MD, (2014), “Multimodal, Integrative Therapies for the Self-Management of Chronic Pain Symptoms”
  • Psychology Research and Behaviour Management, Daniela Roditi, Michael E Robinson, (2011), “The role of psychological interventions in the management of patients with chronic pain”
  • BioMed Research International, Maddalena Boccia, Laura Piccardi, Paola Guariglia, (2015), “The Meditative Mind: A Comprehensive Meta-Analysis of MRI Studies”
  • The Clinical Journal of Pain: Volume 29, Issue 3 , p 276–279, Walz, Andrea D. MSc; Usichenko, Taras MD; Moseley, G. Lorimer PhD; Lotze, Martin MD, (2013), “Graded Motor Imagery and the Impact on Pain Processing in a Case of CRPS”
  • Pain Medicine, Volume 13, Issue 7, Pages 861–867, Lance M. McCracken, PhD, Rosie Jones, BSc, (2012), “Treatment for Chronic Pain for Adults in the Seventh and Eighth Decades of Life: A Preliminary Study of Acceptance and Commitment Therapy (ACT)”
  • Spine: Volume 27, Issue 22, p 2564-2573, McCracken, Lance M., PhD; Turk, Dennis C., PhD, (2002), “Behavioral and Cognitive–Behavioral Treatment for Chronic Pain: Outcome, Predictors of Outcome, and Treatment Process”
  • Chadi G Abdallah, Paul Geha, (2017), “Chronic Pain and Chronic Stress: Two Sides of the Same Coin?”
  • Quality of Life Research, Deborah Antcliff, Philip Keeley, Malcolm Campbell, et al, (2018), “Activity pacing: moving beyond taking breaks and slowing down”
  • Manual Therapy, Volume 20, Issue 1,Pages 216-220, Jo Nijs, Enrique Lluch Girbes, Mari Lundberg, et al, (2015), “Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories”
  • Psychiatry (Edgmont), Sansone, R. A., & Sansone, L. A., (2008). “Pain, pain, go away: antidepressants and pain management.”
  • Müller-Busch HC, (1991), “Art therapy in chronic pain.”
  • NHS, (2017), “Chiropractic”
  • NHS, (2018), “Benefits of exercise”
  • NHS, (2018), “A guide to pilates”
  • NHS, (2018), “A guide to tai chi”
  • NHS, (2018), “A guide to yoga”
  • NHS, (2018), “Physiotherapy”
  • NHS, (2018), “Osteopathy”
  • NHS, (2019), “Eat well”
  • NHS, (2019), “How to get to sleep”
  • NHS, (2019), “Acupuncture”
  • NHS, (2019), “NSAIDS”
  • Versus Arthritis, (2018), “Splints”
  • Versus Arthritis, (2018), “Hydrotherapy”

Please note: This article is made available for educational purposes only, not to provide personal medical advice.

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