The Treatment of Chronic Pain

Many of my previous articles have primarily centered about the treatment of acute and repetitive strain injuries, primarily brought on by work or recreational activities. With a large segment of our population reaching “maturity”, quite a number of the individuals that I see also deal with chronic pain. The pain is usually initially described with the generic default term “arthritis”, but there are many other causes and contributing factors, which make it imperative to assess the patient, and not just the pain. The American public has been emotionally and physically traumatized due to announcements by the FDA concerning the devastating long term health effects discovered in a number of prescription pain medications, including of the COX-2 inhibitors (i.e. Aleve and Naprosyn) - some of the most popular pain drugs on the market. Many are now wondering what their future holds, where they can go, and what they can do to ease their chronic pain.

Chronic pain is in fact it is a distinct neurological condition, most often involving the brain and it is often poorly understood, poorly treated, and often stigmatized. It is like a broken alarm; it's permanently stuck in the “on” position. Chronic pain can make employment or recreational activities difficult or impossible. At the same time, one of the worst effects of chronic pain is isolation – which in turn can increase the pain itself. The complexity of chronic pain includes a multidimensional input.

First, the biological component. Within this area, unresolved acute strain-sprain injuries and, often, years of over-use and repetitive strains have caused a breakdown in one or more tissues in the body (bone, muscle, fascial, etc.), so physically, something is not working, or broken. Initially, the acute pains are mainly felt due to the signals by the nervous system’s nerve endings, making you respond accordingly to put a stop to the stimulus. The action typically involves taking a few days off from the painful activity(ies), using some ice or heat and downing some meds to numb the pain. However, the longer that the unwanted signals remain or persist, the more “sensitized” the nervous system becomes; the pain remains even after the stimulus is long gone. One’s pain threshold is lowered to where activities or stimuli, that normally would not have hurt, now do. This manifestation can then be aggravated by the aberrant or abnormal mechanical behavior of individual joints. For example, if an injury occurs to one’s ankle (a very flexible joint), the knee, (a hinge joint, that is limited in its motion), will then be called upon to ante up more than its designed mobility and thus be compromised for easier and, or, compounded injuries. This has chronic implications, as we are able to compensate for weaknesses, up to a point; eventually, something within the tissues is going to fail, and when tissues fail, injuries occur. There is the need to address the specific injured tissues.

Secondly, there is the metabolic and endocrine component. This involves the correct or adequate processing of nutrients (and hydration!) as well as the functional behavior of hormonal activity and adequate sleep. Some individuals are very sensitive to acidity within their body and can become more inflamed; the body desires to be at a slightly alkaline pH. Foods that include dairy, refined carbohydrates (processed) and meats all tend to make one more acidic, or lowered pH, whereas, vegetables and most fruits lead the body to respond oppositely. Thankfully, most of us can balance that plate of manicotti with a nice mixed green salad! Also, thyroid imbalances can masquerade as pain and parathyroid imbalance can influence muscle activity via calcium shortages. When this physiological breaking down occurs, even one’s immune system may be affected. Fibromyalgia is a condition where “allodynia”, which is defined as a painful response to a non- painful stimulus (i.e. touch), or “hyperalgesia”, which is a heightened degree of pain to a normally painful stimulus, constantly plague the individual, sometimes even to a debilitating degree. Pain is their focus, at least to some degree on a daily basis, initially at trigger points and the referred pattern areas ( i.e. the quadratus lumborum, a deep muscle between the last rib and the pelvis has trigger points that can refer pain sensations down the buttock and posterior thigh); the chronic cascading of this is where stress now increases one’s misery and sleep is interrupted, headaches are frequent, mood swings and phobias are apparent and even irritable bowel syndrome or gastric reflux become unwanted physiological guests. Herein lies the term “psychosomatic” in which the brain (psyco) affects the body (somatic) as the chronic picture unfolds. While this term has often meant that “it’s all in your head” (meaning that the symptoms were not real), it is actually true, reflecting the Central Nervous System’s involvement , but, it could get you a verbal, if not worse, beating if you even inadvertently make the casual inference to someone!  

Lastly, there is the psyco-emotional component. This area dove-tails with the above, as it refers to the individual’s internal emotional response to certain experiences (work, child raising, parental care giving, personal, family crises, or being told that your pain is just in your head!), as well as a triggering by our thoughts (grandmothers of European and Asian descent seem most prone to these unsubstantiated and often unnecessary worries, in my non-scientific experience and observation). We can worry about things that do not have a snowball’s chance of materializing and become quite adept at it, only to bring us to our symptom expressive demise! Hopefully, you begin to see how integrated these components are and that the longer that they persist, the broader, or more multidimensional one’s issues become.

So many have been emotionally and physically traumatized due to the influences of these factors and this makes it unsurprising when we observe the habitual abuse of strong meds, alcohol and illegal drugs! So, what’s the solution? One will probably be able to get a litany of suggestions over the internet, but, I will offer my own based on my personal research and clinical experience.

1. Balance your diet to become more alkaline. You can Google “alkaline diet” and see the food selection. Also, you can purchase pH test strips at your local health store or pharmacy, or, even online to monitor your daily balancing (7-7.5 is optimal); also, limit total calories and HYDRATE well!
2. Beginner yoga to stretch, strengthen the core muscles and deep breathe, engaging your diaphragm (lie on your back, put your fingers over your tummy and breathe; you should see your fingers rise, and not your chest). Activity (walking, eliptical machine, water aerobics) will help to divert your brain away from your symptoms, as well as promote the release of endorphins, your “happy hormones”.
3. Get a good night’s sleep (avoiding sugar, caffeine and electronic devices that may not allow you to relax, i.e. the news, action movies, business calls). Behavior modification is paramount and exercising to tissue tolerance is always advised. Also, try to smile as much as possible. If nothing else, you will be a joy to those around you and they, in turn, to you.
4. Chiropractic adjustments for joint mobility and stiffness.
5. Acupuncture (including needleless laser and Piezo-electric), which generally reduces stress, benefits sleep, lifts and stabilizes moods, and improves energy. All of these effects might be helpful to someone who is pursuing a multi-pronged approach to managing chronic pain. Therefore, we encourage everyone who wants to try acupuncture for pain to do so. I generally recommend that patients get 8-10 treatments as close together as possible in order to initially decide if acupuncture would be helpful for them. After the initial 10 visits, it's a good idea to have a conversation about what a maintenance schedule might look like. By that time, most patients have a good idea of what acupuncture can do for them. Interestingly, the fascial tissue below the skin, which contains an abundant nerve supply, is unavoidably involved and the meridians involved are often within fascial separations. This is why addressing soft tissue restrictions works so well in combination with acupuncture. An important fact to remember is that the more chronic your pain, your pain threshold decreases, meaning that it will take less and less to trigger a flare-up. 

So, if you are the victim of chronic pain, please call for an appointment, and, if someone even innocently says that it may be in your head, just smile and say “Thank you for noticing!”

Have a blessed month!

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