To Your Health: Pain Management Without Addiction

By Erika Anderson, Harvard Chan School of Public Health, and Ann Backus

Temporary aches and pains are very common, especially among people with labor-intensive careers, such as fishermen. Pain is our body’s way of telling us that something is not right and that we should proceed with caution before continuing our usual activities.

Minor joint pains lasting a day or two will often resolve on their own. These shorter-term aches can often be caused by strains, sprains, or bruises that the body will heal without intervention. However, what do we do when the pain continues?

Minor aches can be treated with over-the-counter Tylenol or Ibuprofen, provided your doctor approves their use. These medications help with pain and inflammation, and while generally considered safe, should not be taken every single day. Ice and heat packs can also be used if they provide some relief. If the pain persists longer than one to two weeks without improvement, however, it may be an indication of something more serious occurring; a visit to your doctor may be necessary.

Beginning in the 1990s, prescription opioid pain medications were routinely over-prescribed. This resulted in many patients becoming addicted to these medications and even overdosing.

It is a common misconception that visiting your doctor for musculoskeletal pain will result in the doctor simply prescribing these medications to you. In fact, quite the contrary is true. There are many other pain control alternatives available, including referrals to physical therapy or a chiropractor, joint injections, acupuncture, or other non-addictive prescription pain medications. A crucial component of any treatment plan is addressing the underlying cause of the pain.

A multitude of actions or diseases can cause chronic joint pain, such as arthritis, overuse injuries, inflammation of joints or tendons, or, more rarely, more severe injuries, such as torn ligaments, that require medical intervention. Lobstermen are at particular risk for joint pain because their daily job poses ergonomic challenges. Actions such as hauling traps repetitively, reaching out over the rail to gaff a buoy, and placing the rope on the davit all place stress on the workers’ joints. Frequently kicking the rope on the deck often causes knee and hip pain which in later years may require surgical intervention. The process of squeezing the banding tool to place a band on lobsters’ claws is a repetitive task that requires a heavy squeeze, potentially leading to an overuse injury.

Fishermen are innovative and many have devised “fixes” to address these ergonomic problems. The late Louis Romer, of Vinalhaven, carved a semi-circle out of his starboard rail to shorten the distance he had to reach to gaff the trap buoy and place the rope on the davit. Many other lobstermen experiment with davit height, angle, and adjustable angles to find positions that work best for them. Research at Harvard led to lobstermen and the Maine Marine Patrol incorporating rope lockers into their boats that allow the rope to fall below the deck out of the way. Wherever able, adjustments should be made to equipment to minimize the strain on the body’s joints while fishing.

Although many different changes can be made to prevent joint issues, occasionally pain still creeps up when we least expect it. Several different factors go into how we interpret the pain that we feel, including personal variation in pain tolerance, as some individuals may be more sensitive to pain than others.

Psychological factors also affect a person’s interpretation of pain, with depression and anxiety potentially exacerbating an individual’s pain response. Social factors may also effect a person’s perception of pain --- strong social support is a protective factor for chronic pain. It is important to consider all of these factors so that pain can be controlled through as many mechanisms as possible.

Treatments like cognitive behavioral therapy (CBT) or counseling can help with the psychological component of pain. Massage and meditation may decrease stress and improve relaxation, also improving musculoskeletal pain.

The best treatment for joint pains, however, is to prevent the pain from occurring in the first place. Maintaining regular physical activity can help prevent injuries. Weight training assists in strengthening the muscles around a joint to enable the joint to function properly. Cardiovascular training can help the body better prepare for the vigorous demands of the job and helps maintain a healthy weight. Adequate nutrition is also essential, ensuring that you consume a balanced combination of fruits, vegetables, grains, and protein.

There are many avenues for controlling pain that do not involve strong or addictive drugs. Think of it as a holistic approach: adjust your work environment so that your gear and boat suit you ergonomically; consider aspects of your life such as nutrition, exercise, sleep, and social contacts that may prepare you better for your work; and/or reach out to coaches or counselors for additional help. You may find some resources through the Northeast Center for Occupational Health and Safety at https://necenter.org/what-we-do/fishing.