Managing Pain: Entire Lesson

Many patients with hepatitis C experience pain. You may be one of them. The specific pain you feel may or may not be directly related to hepatitis C. However, if the pain is affecting your life, it is important to seek help.

There are many types of pain, and different people experience pain in different ways. Pain can be brief, it can come and go, or it can be long-lasting. The cause of pain may be from an obvious source, such as an injury, or the cause of a pain may never be found. Because everyone experiences pain from time to time, it is not always clear whether a pain is related to hepatitis C.

Some diseases regularly cause pain, and the pain is a warning sign that the disease is worsening. For example, coronary artery disease (having blocked arteries in your heart) can cause "angina," which is chest pain. In these cases, chest pain is usually a sign that the coronary artery disease is progressing and it may be a symptom of a heart attack.

Other conditions that often cause pain include: arthritis, herniated discs, migraine headaches, prostatitis, urinary tract infection, pancreatitis, stomach ulcers, and acid reflux (heartburn).

Conditions that usually do not cause pain include: diabetes mellitus, hypertension (high blood pressure), high cholesterol, hypothyroidism, stroke, and liver diseases (alcoholic liver disease, hepatitis B, hepatitis C and others).

In the case of hepatitis C, some patients do experience pain, but most do not. For those who experience pain, the level of pain does not indicate the severity of the hepatitis C disease. In other words, if a patient with coronary artery disease has chest pains, it could be a signal that the heart disease is worsening and that there could be a risk of heart attack. But if a patient with hepatitis C has pain, even in the area of the liver, it does not mean that the liver is in danger or that the hepatitis C is worsening.

Some patients with hepatitis C feel discomfort in the abdomen or in the area of the liver. This may be a dull ache or a sharp pain. Sometimes the pain can be mild, and occasionally it can be severe. The pain may come and go, or, for a few patients, it may persist. This sort of pain may be caused by a stretching of the outer edge of the liver, but it does not mean the hepatitis C is worsening.

Some people with hepatitis C experience sore joints--often in the small joints of the hands or ankles or wrists, but occasionally in other areas. Once in a while, hepatitis C causes the body to produce small proteins called "cryoglobulins," which can cause joint pain. If you develop joint pain, you should see your doctor and ask about cryoglobulins. Of course, most people who have hand pain or joint pain do not have hepatitis C, such as hand pain caused by arthritis, tendonitis orcarpal tunnel syndrome.

If there is abdominal pain due to hepatitis C, treating the hepatitis C with pegylated interferon and ribavirin will not necessarily change any abdominal pain which is experienced. The treatment of hepatitis C is not expected to better, worsen or have any effect on abdominal pain.

If there is pain due to hepatitis C related cryoglobulinemia, the treatment with pegylated interferon and ribavirin can (but not always) eliminate the cryoglobulins and improve the associated joint pains. If you have hepatitis C and cryoglobulins are detected, then treatment of hepatitis C may be a particularly good idea in order to improve this condition.

To summarize: Many people with hepatitis C experience pain. But pain does not mean that the hepatitis C is "getting worse." and may not be at all related to the hepatitis C. Most importantly, no matter where the pain is felt, it is important for you to discuss any sort of pain and any concerns with your health care provider.

Patients often experience discomfort from the interferon medication they take to treat hepatitis C. These are side effects of the medication, not pains from the hepatitis C itself. The side effects can be similar to symptoms of the flu, and may include:

• Nausea
• Muscle and joint aches
• Headache
• Fatigue and weakness
• Feeling depressed or down
• Soreness at the site of needle injection
• Sore throat

These symptoms may last throughout pegylated interferon and ribavirin treatment, but they usually are most intense during the first month. When the interferon treatment is stopped, these symptoms go away.

If you have hepatitis C and persistent (chronic) pain, it may or may not be possible to make the pain go away completely. You can work with your doctor to use medications or find other ways to relieve your pain. The keys to reducing pain are:

• Improving physical functioning
• Reducing stress and depression
• Improving quality of life

What follows are some useful techniques for reducing pain. Any one of these approaches used alone may improve your pain somewhat. However, when multiple techniques are used together, they can make a big difference.

Sometimes, working with a physical therapist to learn good muscle stretching techniques will be the best way to develop good routines for life.

You can develop specific relaxation skills, such as:

• deep breathing--breathing from the abdomen
• progressive muscle relaxation--tensing and relaxing muscles in a coordinated way, which helps reduce muscle tension
• guided imagery--using visualization techniques to change your focus from pain to something else
• self-hypnosis--a way of teaching your body to relax
• biofeedback--using a machine to measure how much certain muscles are tensed, and teaching your body to relax those muscles

If you are depressed or anxious, coping with chronic or intermittent pain is very difficult. What's more, chronic pain often makes people feel more depressed. Treating depression can improve the pain, because pain often feels less difficult to tolerate and easier to relieve when depression is under control. By working to reduce symptoms of depression, you can make a big impact on your pain.

Your health care provider may make a variety of recommendations to help with pain. These could include:

• Pain medications
• A transcutaneous electrical nerve stimulation (TENS) unit--a device placed on the skin around the painful area that sends electrical impulses, which causes a buzzing or tingling sensation, rather than pain
• Surgery--recommended only if there is something that can be fixed

Be involved in your treatment.

Treating any kind of chronic pain requires active, daily involvement from you. Only you know how bad your pain is, and only you know what makes it feel better. Your involvement in your treatment will help your providers better understand your pain and be better able to help you manage it.

Remember to always keep your medical appointments.

Keeping regular appointments with all providers will be most helpful in treating your pain.

Understand the recommendations of your health care provider.

If you think you can't follow one or more of the recommendations, talk with your provider. There may be another way to do what is needed. Recommendations may include exercising, stretching, using a TENS unit, attending classes, having a mental health evaluation, taking medications, and using self-management strategies. Talk with your health care provider whenever you have a question or concern.

Tipsheets

Hepatitis C Side Effects Chart
A one-page printable sheet of tips for coping with common side effects of hepatitis C treatment

Suggested Reading

• The Chronic Pain Control Workbook, 2nd Edition; by Ellen Catalano and Kimeron Hardin
• Managing Pain Before It Manages You, Revised Edition; by Margaret A. Caudill, MD, PhD

Websites

• American Academy of Pain Management: Resources
  
• American Pain Foundation
  

The VA librarians are available to help.