I f you suffer from arthritis, you probably already know that medication provides only partial relief. Fortunately, arthritis, as well as headaches, back pain and most other forms of chronic pain, can be managed via a set of mind-body techniques. These techniques cost nothing and can be self-administered. They are effective whether your pain is caused by a clearly identifiable disease or is of mysterious origin.

ACUTE VS. CHRONIC PAIN

Acute pain is the body's way of warning us that something is wrong. When we get this "warning signal," we take immediate action to protect ourselves.

Example: We drop a plate that's too hot to hold. Doing so helps us avoid additional injury and gives the injury time to heal.

With chronic pain, there is no hot plate to drop. With no obvious way to protect ourselves, we respond emotionally. We may slip into depression, become unable to work and experience trouble with our relationships, etc.

The key to coping with chronic pain is to live well despite the pain.

KEEP A PAIN DIARY

Keeping a pain diary will help you look at your pain objectively.

What to do: Three times a day, rate the intensity of your pain, from zero (no pain) to 10 (the worst pain ever). Also describe the sensation. Is it an ache? Burning sensation? Tightness?

Note what you are doing when pain strikes. Rate your distress, the frustration, anger, anxiety or sadness you feel in response to the pain.

Record what you did to alleviate the pain. Maybe you took an aspirin, went for a walk, applied heat or cold, etc.

Your diary will help you pinpoint things that ease or exacerbate your pain and clearly show the difference between the pain itself and your emotional response to it.

USE THE RELAXATION RESPONSE

In many cases, the psychological stress caused by pain is worse than the pain itself.

Stress causes muscular tension that can lead to new ills, including headache or upset stomach. Stress also aggravates the fatigue that often comes with chronic pain.

By eliciting your natural Relaxation Response, you can alleviate this emotional stress.

Technique: Pick a time when your pain is relatively mild, and find a peaceful place where you won't be disturbed. Sit comfortably or lie down. Use a heating pad, ice pack or pillows to make yourself comfortable, if necessary.

Focus on your breathing. With each exhalation, silently repeat a word or phrase of your own choosing. This can be something neutral, like one or something uplifting, such as God.

Or, count each inhalation and exhalation, and start over when you reach 10. When your mind wanders, gently bring it back to your focus word or phrase. Elicit the Relaxation Response for at least 20 minutes a day.

If you like, elicit the Relaxation Response while exercising. Just make sure your breathing and thoughts are synchronized with your movements.

PERFORM SELF-HYPNOSIS

Once you have mastered the Relaxation Response, add self-hypnosis. While deeply relaxed, close your eyes and imagine that your right hand is becoming pleasantly warm and heavy. Each time you exhale, imagine the pleasant sensation intensifying.

Now imagine a pleasant numbness that begins in your thumb, then moves to each finger with each exhalation. Feel it spread to your palm and the back of your hand, stopping at the wrist.

Place that numb hand on the painful area of your body, or imagine the numbness moving to that spot. When all the numbness has been "absorbed" by the painful area, return to your focus word.

End each session by returning the numbness to your right hand. Feel the normal sensations return to that hand, breath by breath.

PACE YOURSELF

Some chronic pain sufferers try to ignore their bodies, pushing on until the pain becomes unbearable. Others simply shut down, withdrawing from social and/or professional activities.

Better: Pace yourself. Learn to complete your daily activities and live as normally as possible. To do this, you must...

Tune in to your body. Use your pain diary and the Relaxation Response to become aware of subtle sensations that signal a flare-up.

Switch to a less demanding activity when you feel pain building. If you're washing dishes when your pain worsens, sit down and use the time to pay bills. Go back to the dishes later.

CHANGE YOUR SELF-TALK

The meaning you ascribe to your pain makes an enormous difference in its effect on your life and your mood.

What does your pain mean to you? To find out, listen to your self-talk. That's the voice in your head that continually comments on and interprets your pain.

In individuals with chronic pain, self-talk is quite distorted. They tend to catastrophize, making a bad situation worse by engaging in exaggerated self-talk.

Example I: Instead of telling yourself you can bear a flare-up, you think, This pain is unbearable.

Example II: Instead of acknowledging the many things you can still do despite your pain, you say, My whole life is ruined.

Don't give in to such negative self-talk. Make a conscious choice to change it. Say your pain is too severe to keep a lunch date. You think, My whole day is ruined.

Substitute a realistic interpretation. This is unfortunate, but I can make other arrangements. I'll invite my friend to come here, and we'll send out for pizza.

PLAN FOR FLARE-UPS

No matter how well you manage your pain, there will be times when it becomes intense. To be ready for these episodes, keep a written list of strategies that make you feel better, things you can do to reduce the pain and ease your emotional distress.

Examples: Lying down, applying heat or ice, performing self-hypnosis, calling a friend or distracting yourself with a funny video.

HIGH-TECH HELP

Though medication can't stop chronic pain entirely, it can make your self-help program more effective. Four drugs are especially effective...

Gabapentin (Neurontin). It seems effective for nerve pain caused by diabetes and post-herpetic neuropathy.

Mexiletine (Mexitil). This is an oral form of the anesthetic lidocaine.

Fentanyl (Duragesic). A new skin-patch system delivers this potent painkiller continuously for three days.

Morphine (Duramorph). The intrathecal pump constantly delivers morphine to the area around the spinal cord.