Non-Medication Approaches to Help Manage Nerve Pain

Non-Medication Approaches to Help Manage Nerve Pain

Authors

• Jackie Walumbe, BSc (Hons) Physiotherapy, MSc, MSc, DPhil, Pain Management, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Health and Care Innovation Research (CHIR), City St George’s, University of London, London, UK.
• Mayumi Oguchi, MPsych (Clin), Michael J. Cousins Pain Management & Research Centre, Royal North Shore Hospital, Sydney, Australia.
• Whitney Scott, PhD (Clinical Psychology), INPUT Pain Unit, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom; Health Psychology Section, King’s College London, London, United Kingdom.
• Keith M Smart, BSc (Hons) Physio, MSc, PhD: UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.

Introduction

Neuropathic pain can have significant physical, emotional, financial, and social impacts on a person’s life. It can be managed through medication and/or medical procedures or through non-pharmacological treatment from healthcare professionals such as psychologists, physiotherapists, occupational therapists, and art therapists. Community services and support may also be available depending on where you live.

While there are several non-pharmacological treatments for neuropathic pain that don’t involve medication (hands-on manual therapies (like massage and nerve mobilization), electrical nerve stimulation, acupuncture, and mindfulness meditation), we don’t really have clear evidence to measure exactly how helpful they may be in reducing pain ^[2-4].

The approaches we describe here focus on managing symptoms and improving quality of life. Healthcare professionals can help people living with neuropathic pain to improve movement through physical activity, reduce the impact of pain by using psychological approaches, and by encouraging greater involvement in everyday life through community connections.

Identify what matters to you as a person living with neuropathic pain

Healthcare professionals can help you to identify what is most important to you in managing your pain so that they can personalize your treatment. Together, you can then set specific, manageable, and meaningful goals to help you with activities alongside your pain ^[6].

• If your goal is to walk to work or play with children, you might fo­cus on our tips for improving movement and physical activity.
• If you are more concerned with the emotional impact of pain, focus on the psychological approaches and resources.
• If you want to spend more time socializing with other people who also have pain and learning from them, see the section on connection with the community.

It is important to have a range of strategies to help you to cope better with pain and enjoy your life.

Movement-based approaches

There is strong evidence that physical activity and exercise benefit people with neuropathic pain conditions ^[8-10]. Physical activity here means anything that increases the amount of energy used above resting levels, including activities of daily living, work-related tasks, or activities done for enjoyment. Exercise is planned physical activity, which is structured and repetitive, performed to improve or maintain physical fitness or to achieve a specific health benefit.

Exercise does not just mean going to the gym. Walking, household chores, driving, cooking, working, and hobbies can all be helpful. Sudden flare-ups or increases in pain do not necessarily mean that more damage is being done to your body, so finding ways to keep moving is crucial. You can try shorter sessions or different approaches – there are some good examples in online videos. Complete rest is not a good idea, as it can make it more difficult to start moving again.

Psychological approaches

Cognitive-behavioural therapies (CBT) are types of psychological treatment that help people to notice the links between the bodily sensations of pain and thoughts, feelings, and actions. CBT treat­ments suggest new ways of dealing with pain-related thoughts, feelings, and bodily sensations. For example, gradually facing situations and activities you avoid because of pain. This type of treatment can help people think about what really matters to them, identifying “values” that can then help guide day-to-day choices. These could include working toward physical activities, spending more time with friends, or adjusting to different work situations. This can help keep you motivated despite pain-related challenges.

Cognitive-behavioural therapies can therefore help some people with chronic or persistent pain to reduce the impact of their pain and distress ^[11]. More recently, researchers looked at psychological approaches in people with neuropathic pain and found that these treatments may help some people to feel a bit less pain and dis­tress and improve their ability to carry out day-to-day activities ^[5].

Not everyone has access to psychological support, but your health­care professional should be able to let you know what is available locally. If you can’t access psychological support in your area, look for online resources.

Community and connection

Family, friends, and colleagues may not understand pain or how it affects day-to-day living, so people living with pain can find it helpful to meet and talk to others with similar experiences ^[1,7] either in their local area or online. If you want to find out about pain sup­port communities near you, ask your local healthcare provider, look online, or start something yourself.

Resources

The following links provide lots of practical strategies and resourc­es for managing thoughts, feelings, activity, and movement when living with persistent pain:

• https://livewellwithpain.co.uk/resources-for-people-with-pain/
• https://psyche.co/guides/how-to-use-tools-from-act-to-live-with-persistent-pain
• https://ppa.csp.org.uk/content/links-people-pain

Disclosures

JW is a clinical academic physiotherapist at UCLH NHS Trust, a publicly funded healthcare provider; holds current research funding from the Race and Health Observatory; is a knowledge mobilization fellow funded by the National Institute for Health and Social Care (NIHR), North Thames Applied Research Collaboration and hosted by City StGeorge’s University.

MO has no interests to declare.

WS has received research grant funding from the Medical Research Council and Versus Arthritis related to the PAINSTORM neuropathic pain consortium (MR/W002388/1) as part of the Advanced Pain Discovery Platform. WS has also previously received conference travel reimbursement from the British Pain Society and the Neuro­pathic Pain Special Interest Group of the International Association for the Study of Pain.

KMS holds research funding from Pain Alliance Europe and PPI Ignite Network @ UCD; has received financial support from the European Pain Federation (EFIC) to attend congresses; maintains a small clinical caseload as a Clinical Specialist Physiotherapist at Blackrock Health, Blackrock Clinic, Dublin, Ireland, a for-profit healthcare provider.

References

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