I run a Facebook page for adults who had Perthes Disease, a childhood hip disorder that affects the growth of one or both of the hips. Many experience painful after effects of having an undersized, deformed and weak hip. One of the most frequently asked questions to my page is about how to manage the pain, not only hip pain, but often other pains that have arisen from years of walking and standing incorrectly. A limp can lead to posture issues often resulting in pain in the lower back, neck and shoulders. The tension in my shoulders eventually got so bad it travelled down my arms causing tennis elbow. Some experience knee pain from walking crocked and even ankle joints can be affected for some.
Over the years I have tried many different things to help with my pain. These are some ideas and thoughts on the things I have come across for pain. What kind of pain relief helps often depends on the type of pain and where it is on the body. Muscle pain can be different to treat to nerve pain, and pain actually in the joints can be different again. It can take time to find what works for an individual and can be a matter of trying different things till you find what works for you. Not everyone responds the same to pain relief and some should be used carefully especially for the first time. Most of these things are total cures, but can help reduce pain. Most of my ideas are of course based on hip and chronic joint pain, but some can be effective for other kinds of pain as well.
Pain Killer Medications
Over the counter medication is enough for many people. There are several kinds available. Classic ones include paracetamol, which I find helpful for headaches, general aches and fever. Ibuprofen is good for inflammation in the joints such as with arthritis and I have found it very helpful over the years. It must not be taken on an empty stomach though as it can over frequent use lead to stomach ulcers and eventually damage the lining of the stomach, but taken with food or a fatty drink such as milk it is fine. Co-codamol is a mix of codeine and paracetamol. You can only get a lower dose over the counter and you can not get pure codeine without a prescription. It is a strong drug and I only use it when regular paracetamol is not enough for the pain. I find it makes me drowsy so mostly only take it at night to help me sleep when I have a pain flare up. It is very handy when in a lot of pain, but shouldnt be used too often as codeine can be addictive with prolonged use. Some people still use aspirin for pain, but it is not recommended so much now by doctors or pharmacists since other more effective pain medications have become available.
Often for those with chronic pain issues over the counter medications are not enough and a prescription medication might be helpful. You should always see your doctor and take only what they prescribe for you, never take pain killers prescribed for someone else. Amitriptyline and gabapentin are used specifically to help with nerve pain such as sciatica and multiple sclerosis. Pure codeine or stronger dose Co-codamol is often prescribed, but usually only short term. The strongest pain killers a doctor may prescribe are morphine based or morphine like (such as fentanyl and oxycodone). They are sometimes only prescribed after seeing a specialist pain doctor as they have some serious side effects long term as they are so strong.
Topical medications are absorbed through the skin often in the form of a gel, cream or occasionally a spray. They can be helpful for joint pain, such as arthritis and for muscular pain. Some work with heat, usually a cream and some work with cold, usually known as freeze gel. Some contain ibuprofen and can be useful for a quicker pain relief than tablets directly on the area that hurts. However I found topical ibuprofen was not effective for as long as tablets. I have found some topical medications useful as a short term gap between tablets when they have worn off, but you are not yet supposed to take another dose. There are some prescription only ones often used as patches for things like morphine, but I have never been prescribed any myself.
Cortisone Injections/ Steroid injections
I have never had these because my surgeon did not think they would benefit me much. They work as an anti-inflammatory on a specific area of the body. They are most commonly used for joint pain, arthritis and sciatica. I have come across many people in hip replacement groups online who have had them. The results seem very varied and can come with side effects. Some people experience several months of pain relief from them, some just a few weeks and some hardly anything at all. You can only have up to three a year in the same area and some people report that they become less effective with each use. There are recent studies to suggest that they may actually increase the onset of arthritis if you have them more than once. They sound worth trying for some people, but you should be aware of the side effects and that they are not a permanent solution to pain.
Heat can be helpful with sore muscles, helping them to relax and relive tension. There are various ways to apply heat. There is the classic hot-water bottle, but I found a microwave wheat bag wraps around the joints better and often has lavender oil infused with it so it smells nice when heated up. I find it most useful at night. Stick on heat patches last between two to four hours and are very handy during the day when you have to move about. When first applied they can get really hot and must not be applied directly to the skin. There is no need to buy expensive brand name patches; I found the cheap store brand ones just as effective. A warm bath can also be good to relax both muscles and mind.
Whilst heat is good for muscles, cold can help against pain caused by swelling. After my hip surgery I used an ice gel pack that you put in the freezer. Ice was recommended by the nurse, but gel packs dont leave a pool of water behind.
A TENS machine works by passing electrical signals into the body. Firstly this blocks the bodys pain signals that are normally transmitted through the nerve fibres to the brain. Secondly it stimulates the bodys production of endorphins, which are our own bodys painkillers. Sticky pads are attached to the area of pain and electric signals are sent from a portable battery operated device. It uses very low levels of electrical signals that can be controlled at different strengths and types of signal from tapping to vibration. I find it most effective for back pain, stiff shoulders and sore muscles. It does take some getting used to and some people do not enjoy the feeling. They vary a lot in price, but I found a fairly cheap one from my local pharmacy is effective.
For a lot of chronic pain issues physiotherapy can be very effective. I have used it to help with both my hip muscle pain and my posture pains. It has helped me become more flexible, stronger, gain better balance and improved my stance. It can take quite a long time for it to have a noticeable effect on pain, being a gradual process of getting fitter. Most people do not need ongoing appointments with a physiotherapist; three or four is often enough. Then it is up to you to do the exercises at home most days. Occasionally there is a need for more intensive physiotherapy often in a hospital gym setting, but this is usually after some kind of surgery. Some physiotherapy exercises are designed for long term use, such as my posture exercises, because when I stop doing them for a few days my pain becomes worse again. I have been doing some of my leg and hip exercises for years. However some physiotherapy is temporary whilst getting over an injury or sickness. My tennis elbow exercises were daily at first, but now I only have to do them as and when I feel the pain returning. Some people struggle with physiotherapy as at first it can be quite painful to exercise when not having done so in a long time, but it can be worth persevering with.
Hydrotherapy uses water based exercise led by a physiotherapist. The water supports your weight making exercising the joint easier. It can be excellent for those struggling after joint replacement surgery to get fit again or for arthritis. However it can be hard to get as not every hospital has a hydro pool and it can be expensive to pay for privately. Often a few sessions will suffice to learn the exercises and then you can do them for yourself at a regular swimming pool.
Whilst physiotherapy can be helpful with specific issues, more general exercise and fitness can help reduce some kinds of pain. I found physiotherapy good for getting me to a level I can now work on my fitness in other ways. Just walking more has helped me become less stiff. Finding a form of exercise you enjoy is good for both physical and mental health. I have always enjoyed swimming as a good way to stretch my sore joints.
With that said, knowing your limits is also important. Not over doing it and taking a break can also help when you feel pain coming on. Sometimes just a short rest can help to relax the muscles and relieve tension. Occasionally a longer rest maybe required to give the body time to heal such as after surgery or illness. I have found trying to push past my pain and keep going is not a good idea as it can lead to worse pain the next day.
If regular pain medication and other things are not helping you enough with you pain, your doctor may refer you to a pain clinic. They are usually run by a team of doctors and physiotherapists. The clinic programmes vary depending on your needs and what they have on offer. I saw a pain specialist doctor and a physiotherapist. They offer talks about understanding pain, which can help you to understand how to treat yourself for your pain, mentally as well as physically. They offer a series of classes in various things including tai chi, yoga, hydrotherapy and circuit training. They do not claim to totally eliminate your pain, but reduce it and help you cope better with it.
I took the course in tai chi led by the pain clinic physiotherapists. Tai chi uses a series of movements combined with relaxation and deep breathing techniques. I found it helpful for my balance and flexibility. It also helps me to feel somewhat relaxed and less stressed which is turn helps my pain, especially in my shoulders which are often tense. It takes a while to get the hang of it and learn the movements, but with a good instructor it can be worth while.
There are several types of yoga, some more focused on the mental side and some more on the movements. Like tai chi it uses a combination of exercise and relaxation to help with flexibility, balance and mental wellbeing. It is important to find the right yoga instructor because some seem to over do the exercise part to the point that it could make things worse for a chronic pain sufferer. I have not done a whole course in yoga, but have learnt some of the basic moves using Wii Fit. Over time a lot of the moves have become easier and I have defiantly found them beneficial for my fitness and pain issues.
There are many kinds of alternative treatments, but I have chosen to write about acupuncture as it is one of the most commonly used and one of the few I have actually tried. It uses very fine needles inserted into specific points in the body relating to where your pain is. The needles are believed to stimulate activity in areas of pain resulting in the release of endorphins and scientists think it may also promote the release of steroids. I tried it when I had a frozen shoulder and thought there was an element of truth behind it, but it was only mildly helpful. It may have been the relaxed atmosphere and sense of calm that helped me more than the actual needles I am not sure. However the effect it had wore off after only a few hours and I feel that it was not effective enough for the price they wanted to charge me after my first two trail sessions.
A massage can be very helpful for pain the shoulders, neck and back. If done well the effects can last several hours. A huge part of it is how relaxed it makes you feel, helping to relieve tense muscles. It can be done by a partner or close friend, but needs to be done carefully so as to avoid making pain worse. A professional masseur should have some idea about common areas of muscle and joint pain and know how to work them safely to get the best results.
Surgery is usually a last resort, but sometimes necessary. It can help with a lot of types of pain, but is never an easy solution. There is always a risk with any surgery and recovery can take time and effort. My hip replacement surgery for example was a lot of work to recover from and mentally as well as physically exhausting, but worth while long term. Some surgeries may only reduce pain, not totally eliminate it and some types of pain may not benefit from surgery at all. It is definitely an option worth exploring if in a lot of pain for a long time. However surgeons often expect non-surgical options to have been tried first.
As popular as a form of pain relief and now legal in more places I feel I should give a mention to cannabis. However I live in the UK where it is still mostly illegal and have never tried it myself. There is a growing body of scientific evidence that it is an effective pain killer, but the strain and dose should be carefully chosen so as to not experience so many side effects. If legal here I would definitely try it, but I would be careful to use a knowledgeable source who could advise me on using it for pain. In the UK CBD is legal, which is an extract of cannabis without the illegal part called THC. Some people say they get benefits from CBD, but the scientific evidence for it is limited. Some studies suggest it can have a very mild effect on pain and of course there is the placebo effect as well. You can get it in several forms including drops, vape oil, edibles and as patches. It should be noted that CBD products come in various strengths and some in fact contain only a very small amount of it. To get a decent strength dose it can be quite expensive.
If you experience intense pain frequently you should see your doctor. They maybe able to help diagnose your source of pain which can help in finding the right treatments. Pain can be referred pain from elsewhere in the body and have a cause you might not suspect, such as my wrist and arm pain being tennis elbow caused by my shoulder problems. A doctor may have more ideas to try relating to your specific issues.
Recommended reading- The Pain Relief Handbook by Dr Chris Wells and Graham Nown. Although published in 1993 so possibly a little out of date in some areas since a lot more research has been done on pain since then, it still has a lot of worthwhile information. Dr Wells helped establish the first pain management programme in the UK, which became the model for future pain clinics in the NHS.