Effective Strategies for Managing Chronic Pain in Multiple Joints

Shoulder blade, wrist joint, knee joint, ankle joint, lumbar intervertebral disc, sternum?

The trapezius muscle has been in a forward-leaning position for a period of time while using a laptop about 8.9 years ago, resulting in long-term stiffness and soreness in the deeper areas of the trapezius muscle between the right shoulder blade and the spine.
After examination at a public hospital, the only treatment provided was relaxation and heat therapy.
I later sought help from a traditional Chinese medicine clinic, where I received bloodletting, cupping, and electrotherapy, but these treatments were almost ineffective.

Two years ago, I twisted my left wrist while practicing self-defense techniques.
The public hospital only recommended rehabilitation, and the traditional Chinese medicine clinic also provided bloodletting, cupping, and electrotherapy.
Although there was no impact on the range of motion, I occasionally experience dull pain near the joint disc.

Six years ago, I injured my left knee while performing a twisting motion.
The public hospital suggested strengthening the leg muscles, but I still experience long-term dull pain in the deeper areas below the patellar ligament, especially during activities like going down stairs and squatting.

Regarding my right ankle, I am uncertain about the exact location of the pain, but I know that I experience pain from the middle of my middle and ring fingers down to near the ankle joint, especially when the joint feels like it dislocates and then relocates.
Walking causes continuous pain, making it difficult to walk far.
The public hospital only advised strengthening the foot muscles.

For the lumbar intervertebral disc on the right side, around L2-L3, an X-ray taken in high school indicated slight protrusion and compression.
Today, a different physician at the same public hospital said there was nothing wrong, and the only recommendations were rehabilitation, stretching, and pain medication.
However, I regularly perform exercises like hanging from a pull-up bar and table supports, but I experience sharp pain when bending to the left and prolonged soreness and weakness when sitting for long periods while driving.
Upon waking, I feel a persistent sharp pain and weakness on the right side, as if under long-term pressure.

Three years ago, I accidentally strained the area between the sternum and the pectoralis major on the right side while performing a bench press.
After resting for one to two years, I still experience pain when exerting myself.
When I lie with my head on my left shoulder, the affected area feels excruciatingly painful.
The public hospital only advised me to apply ointment and self-massage, while the traditional Chinese medicine clinic provided bloodletting, cupping, and electrotherapy, but none of these methods have been effective.

I enjoy deep squats and core strengthening exercises, and my medical records mostly indicate visits to orthopedic and rehabilitation departments.
I have undergone rehabilitation at the hospital several times, but over the long term, aside from increased muscle size and strength, the painful areas remain painful.
I wonder if the doctors assume that students have no money, as their responses always suggest relying on self-care.

What should I do to heal and avoid further discomfort in middle age?

Chen JJ, 20~29 year old female. Ask Date: 2014/11/06

Dr. Shi Guozheng reply Orthopedics

Shoulder and neck pain is usually caused by overuse, and reducing activity in this area along with moderate heat therapy or some rehabilitation treatments may lead to improvement.
If the right wrist joint continues to be problematic, it may be necessary to check for ligament issues or injuries to the distal radioulnar joint.
Pain in the left knee joint may be related to the position of the patella, and tendonitis cannot be ruled out.
The issue with the right ankle is also related to ligaments; a stress test X-ray can be performed to investigate this further.
Chronic lower back pain is likely associated with posture or prolonged sitting.
Cases of intervertebral disc herniation at the L2-3 level are rare.
Chest pain is also categorized as myofascial pain syndrome, and reducing exercise-related injuries is the best approach.
Physical training should be moderate; excessive activity can lead to injuries, and recovery can sometimes be very challenging.
It is relatively uncommon for a young person to have widespread issues.

Reply Date: 2014/11/06

More Info

Managing chronic pain, especially when it affects multiple joints, can be a complex and challenging process. Your situation, involving long-standing issues with various joints and muscle groups, requires a comprehensive approach that combines medical, physical, and lifestyle strategies. Here are some effective strategies that may help you manage your chronic pain more effectively:

1. Comprehensive Assessment
Before embarking on any treatment plan, it’s crucial to have a thorough assessment by a healthcare professional. This should include imaging studies (like MRI or X-rays) and a detailed physical examination to understand the underlying causes of your pain. Given your history of injuries and chronic pain, a multidisciplinary approach involving orthopedic specialists, physical therapists, and possibly pain management specialists may be beneficial.

2. Physical Therapy
Physical therapy is often a cornerstone of managing chronic pain. A physical therapist can design a personalized exercise program that focuses on strengthening the muscles around the affected joints, improving flexibility, and enhancing overall function. Techniques such as manual therapy, ultrasound, and electrical stimulation may also be employed to alleviate pain and improve mobility.

3. Exercise and Strength Training
While you mentioned that you enjoy deep squats and core strengthening exercises, it’s essential to ensure that these activities are performed with proper form and technique to avoid exacerbating your pain. Low-impact exercises, such as swimming or cycling, can also be beneficial. Incorporating flexibility and stretching exercises can help reduce muscle tightness and improve range of motion.

4. Pain Management Techniques
Consider exploring various pain management techniques, including:
- Medication: Over-the-counter pain relievers (like NSAIDs) or prescription medications may be necessary. Discuss with your doctor the potential benefits and risks of medications, including muscle relaxants or topical analgesics.

- Injections: Corticosteroid injections or hyaluronic acid injections may provide relief for specific joint pain.

- Alternative Therapies: Acupuncture, chiropractic care, or massage therapy may offer additional relief. While you’ve tried some of these, it may be worth exploring different practitioners or techniques.

5. Lifestyle Modifications
Making certain lifestyle changes can significantly impact your pain levels:
- Weight Management: Maintaining a healthy weight can reduce stress on your joints, especially weight-bearing joints like the knees and hips.

- Ergonomics: Adjust your workspace to promote better posture and reduce strain on your neck and back. Consider using ergonomic chairs, desks, and tools.

- Sleep Hygiene: Ensure you are getting adequate rest, as poor sleep can exacerbate pain. Establish a calming bedtime routine and create a comfortable sleep environment.

6. Mind-Body Techniques
Chronic pain can often be exacerbated by stress and anxiety. Techniques such as mindfulness meditation, yoga, and cognitive-behavioral therapy (CBT) can help manage the psychological aspects of chronic pain. These practices can improve your coping strategies and reduce the perception of pain.

7. Regular Follow-Up
Chronic pain management is an ongoing process. Regular follow-up appointments with your healthcare providers are essential to monitor your progress, adjust treatment plans, and address any new concerns. Keeping a pain diary can help track your symptoms and identify triggers, which can be valuable information for your healthcare team.

Conclusion
It’s understandable to feel frustrated when treatments seem ineffective. However, managing chronic pain often requires a combination of approaches tailored to your specific needs. Engaging with a multidisciplinary team and being proactive about your treatment can lead to improved outcomes. Remember, healing is a journey, and persistence is key. Don’t hesitate to seek a second opinion or explore new treatment options if your current plan isn’t yielding results. Your health and well-being are worth the effort.

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