Revised March 2005
Osteoporosis: Coping With Chronic Pain
Osteoporosis often causes very painful fractures, which
can take many months to heal. In many cases, the pain starts to go away
as the fracture heals. Most new fractures heal in approximately 3
months. Pain that continues after that is generally considered chronic
pain. One cause of chronic pain is vertebral fractures. When a vertebra
breaks, some people have no pain, while others have intense pain and
muscle spasms that last long after the fracture has healed.
Pain is the body’s way of responding to an injury. When
a bone breaks, nerves send pain messages through the spinal cord to the
brain, where they are interpreted. Your response to pain is determined
by many factors, including your emotional outlook. For example,
depression seems to increase a person’s perception of pain and decrease
her or his ability to cope with it. Often, treating the depression
treats the pain as well.
Chronic pain is pain that lasts beyond the expected
time for healing and interferes with normal life. The injury has
healed, but the pain continues. The pain message may be triggered by
muscle tension, stiffness, weakness, or spasms. Whatever the cause of
chronic pain, feelings of frustration, anger, and fear can make the
pain more intense. Chronic pain can affect all areas of your life and
should be taken seriously.
The following information provides those who have
chronic pain with an overview of different options for pain management.
If you have chronic pain and need help managing it, you may wish to
discuss these options with your doctor.
Coping Strategies: Physical Methods of Pain Management
Heat and ice: Heat, in the form of
warm showers or hot packs, can relieve chronic pain or stiff muscles.
Cold packs or ice packs provide pain relief by numbing the pain-sensing
nerves in the affected area. Cold also helps reduce swelling and
inflammation. Depending on which feels better, apply heat or cold for
15 to 20 minutes at a time to the area where you feel the pain. To
protect your skin, place a towel between your skin and the source of
the cold or heat. Some simple ways to make heat and ice packs are
- Warm towels or hot packs in the microwave for a quick source of heat. (Handle carefully.)
- Make instant cold packs from frozen juice cans or bags of frozen vegetables.
- Freeze a plastic, resealable bag filled with water to make a good ice bag.
Transcutaneous Electrical Nerve Stimulation (TENS):
A TENS machine is a small device that sends electrical impulses to
certain parts of the body to block pain signals. Two electrodes are
placed on the body where you are experiencing pain. The electrical
current that is produced is very mild, but it can prevent pain messages
from being transmitted to the brain. Pain relief can last for several
hours. Some people may use a small, portable TENS unit that hooks onto
a belt for more continuous relief. TENS machines should only be used
under the supervision of a physician or physical therapist. They can be
purchased or rented from hospital supply or surgical supply houses;
however, a prescription is necessary for insurance reimbursement.
Braces and supports: Spinal supports
or braces reduce pain and inflammation by restricting movement.
Following a vertebral fracture, a back brace or support will relieve
pain and allow you to resume normal activities while the fracture
heals. However, continuous use of a back support can weaken back
muscles. For this reason, exercises to strengthen the muscles in the
back should be started as soon as possible.
Exercise and physical therapy:
Prolonged inactivity increases weakness and causes loss of muscle mass
and strength. A regular exercise program and physical therapy can help
you regain strength, energy, and a more positive outlook on life.
Because exercise raises the body’s level of endorphins – or natural
pain killers produced by the brain – it will relieve pain somewhat.
Exercise also relieves tension, increases flexibility, strengthens
muscles, and reduces fatigue.
A physical therapist can help you reorganize
your home or work environment to avoid further injuries. Physical
therapists also teach proper posture and exercises to strengthen the
back and abdominal muscles without injuring a weakened spine. Water
therapy in a pool, for example, is one of the best exercise techniques
for gently improving back muscle strength and reducing pain.
Acupuncture and acupressure: Acupuncture
is the use of special needles that are inserted into the body at
certain points. These needles stimulate nerve endings and cause the
brain to release endorphins. It may take several acupuncture sessions
before the pain is relieved. Acupuncture has been used for centuries in
China and other parts of Asia to treat many types of pain.
Acupressure is direct pressure applied to
areas that trigger pain. This technique can be self-administered after
training with an instructor.
Massage therapy: Massage therapy can
be a light, slow, circular motion with the fingertips or a deep,
kneading motion that moves from the center of the body outward toward
the fingers or toes. Massage relieves pain, relaxes stiff muscles, and
smoothes out muscle knots by increasing the blood supply to the
affected area and warming it. The person doing the massage uses oil or
powder so that her or his hands slide smoothly over the skin. Massage
can also include gentle pressure over the affected areas or hard
pressure over trigger points in muscle knots. Note: Deep muscle
massage should not be done near the spine of a person who has spinal
osteoporosis. Light, circular massage with fingers or the palm of the
hand is best in this case.
Coping Strategies: Psychological Methods of Pain Management
Relaxation training: Relaxation
involves concentration and slow, deep breathing to release tension from
muscles and relieve pain. Learning to relax takes practice, but
relaxation training can focus attention away from pain and release
tension from all muscles. Relaxation tapes are widely available to help
you learn these skills.
Biofeedback: Biofeedback is taught by
a professional who uses special machines to help you learn to control
bodily functions, such as heart rate and muscle tension. As you learn
to release muscle tension, the machine immediately indicates success.
Biofeedback can be used to reinforce relaxation training. Once the
technique is mastered, it can be practiced without the use of the
Visual imagery and distraction: Imagery
involves concentrating on mental pictures of pleasant scenes or events
or mentally repeating positive words or phrases to reduce pain. Tapes
are also available to help you learn visual imagery skills.
Distraction techniques focus your attention
away from negative or painful images to positive mental thoughts. This
may include activities as simple as watching television or a favorite
movie, reading a book or listening to a book on tape, listening to
music, or talking to a friend.
Hypnosis: Hypnosis can be used in two
ways to reduce your perception of pain. Some people are hypnotized by a
therapist and given a post-hypnotic suggestion that reduces the pain
they feel. Others are taught self-hypnosis and can hypnotize themselves
when pain interrupts their ability to function. Self-hypnosis is a form
of relaxation training.
Individual, group, or family therapy:
These forms of psychotherapy may be useful for those whose pain has not
responded to physical methods. People who suffer from chronic pain
often experience emotional stress and depression. Therapy can help you
cope with these feelings, making it easier to manage your pain.
Coping Strategies: Medication for Pain Management
Medications are the most popular way to manage pain.
Commonly used medications include aspirin, acetaminophen, and
ibuprofen. Although these are probably the safest pain relievers
available, they sometimes cause stomach irritation and bleeding.
Narcotic drugs may be prescribed for short-term acute
pain. These drugs should not be used for long periods because they are
addictive and can affect your ability to think clearly. They also have
other side effects, such as constipation.
Many people with persistent pain that has not responded
to other forms of pain relief are treated with antidepressant
medication. These drugs may work in a different way when used for
treatment of unyielding pain. The body’s internal pain suppression
system may depend upon the concentrations of various chemicals in the
brain. These concentrations are increased by the use of antidepressants.
The above-mentioned methods of pain management are used
in various hospitals and clinics across the country. If you have
chronic pain that has not responded to treatment, you should consult
your physician for a referral to a physical therapist or a clinic
specializing in pain management.
Pain Management Resources
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 877-22-NIAMS (226-4267) (free of charge) or 301-495-4484
The National Institute of Arthritis and Musculoskeletal and Skin Diseases publishes Pain Research: An Overview. This publication is available at: http://www.niams.nih.gov/hi/topics/pain/pain.htm.
National Institute of Dental and Craniofacial Research
National Institutes of Health
Bethesda, MD 20892-2190
The National Institute of Dental and Craniofacial Research is the primary NIH organization for research on pain.
National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Phone: 800-352-9424 (free of charge) or 301-496-5751
The National Institute of Neurological Disorders and Stroke has
developed a Chronic Pain Information Page. This resource is available
American Pain Society
4700 West Lake Avenue
Glenview, IL 60025-1485
Fax: 877-734-8758 (free of charge)
This society provides general information to the public and maintains a
directory of resources, including referrals to pain centers.
American Chronic Pain Association
P.O. Box 850
Rocklin, CA 95677-0850
Phone: 800-533-3231 (free of charge) or 919-632-0922
This association provides information on positive ways to deal with
chronic pain and can provide guidelines on selecting a pain management
NIH Pain Consortium
National Institutes of Health
9000 Rockville Pike
Bethesda, Maryland 20892
The NIH Pain Consortium was established to enhance pain research and
promote collaboration among researchers across the many NIH Institutes
and Centers that have programs and activities addressing pain.
For Your Information
This publication contains information about medications
used to treat the health condition discussed here. When this fact sheet
was printed, we included the most up-to-date (accurate) information
available. Occasionally, new information on medication is released.
For updates and for any questions about any medications
you are taking, please contact the U.S. Food and Drug Administration at
1-888-INFO-FDA (1-888-463-6332, a toll-free call) or visit their Web
site at www.fda.gov
The National Resource Center acknowledges the assistance of the
National Osteoporosis Foundation in the preparation of this publication.