Navigating the New Landscape of Chronic Pain Management


*Originally published on on March 12, 2024. 

Strategies for chronic pain beyond medication

Key points

  • The misuse of narcotic pain medications for chronic pain has led to an addiction epidemic.
  • Chronic pain affects an estimated 20 percent of adults in the U.S.
  • Physical therapy can help rewire the brain and increase pain tolerance.
  • A holistic approach to chronic pain management includes addressing sleep and emotional well-being.

We’re in big trouble in this country when it comes to pain medications. For many years, due to a lack of knowledge and unscrupulous tactics by some pharmaceutical companies, we relied on narcotic pain medications, like Vicodin and Oxycontin, to help with chronic pain. What we ended up with is an epidemic of addiction. Even worse, we found that narcotics not only don’t work well for most chronic pain but also may make your pain worse if used for too long. Sadly, rather than helping people in pain, we created a mess.

Fortunately, we finally have recognized this problem and have made great strides in limiting narcotic use nationwide. But now, what are people in pain supposed to do?

First, let me review “pain” in general. Pain is a survival tactic that our bodies developed over millions of years. Pain is your signal to stop doing something that may cause damage to your tissue, and it’s really effective. If you touch a hot stove, pain makes you pull away so you don’t barbecue your hand. It’s so crucial to survival that your body fights very hard to keep your pain signals surging no matter what, which makes fighting these signals very difficult.

We have some good medications for acute pain, such as ibuprofen and acetaminophen, and, for more severe cases, narcotics. But when it comes to chronic pain, we don’t have great treatments available. This is a big deal since an estimated 20 percent of U.S. adults suffer from chronic pain, which can bring with it depression, poor sleep, and an inability to work.

Chronic pain differs significantly from acute pain. An excellent way to understand chronic pain is by viewing it as an overexcited pain system. Instead of the pain fibers firing when there’s the risk of tissue damage, they may fire after even a mild stimulus, such as a gentle touch. This often develops after a physical or emotional trauma, so your pain threshold drops dramatically to protect you from that event happening again. This physiological mechanism can work well for survival, however, it makes the sufferer miserable. A lower pain threshold can spread to the entire body rather than remaining just at the site of trauma.

While we don’t have great medications for chronic pain, some can dull the pain somewhat, such as gabapentin, or that can treat the resulting depression, but there’s no magic bullet. Some new research shows that physical therapy can help, even if there’s no mechanical problem to cause your pain. In chronic pain, the brain’s wiring is malfunctioning—the “pain trigger” gauge is set too low. A physical therapy regimen, implemented by someone trained in treating chronic pain, can help rewire the brain to get you back to normal functioning and reduce pain.

The basic concept is practice. If you push yourself a little bit, to the point of feeling a little bit of pain each day, you can eventually increase your pain threshold. It’s sort of like eating spicy foods. You wouldn’t sit down and eat a jalapeno pepper after years of a bland diet, but if you start with a banana pepper and work your way up, eventually you can handle any spice your local Indian restaurant can dish out. It’s the same with pain. Your body can slowly learn to adapt to higher and higher amounts of pain.

This is not necessarily an easy or quick process, and should only be done with a specialist. But the evidence is encouraging and gives us a good, long-term treatment option that is not a pill. It can help patients move and exercise in a controlled setting to help them get over the fear of pain, which greatly exacerbates the underlying problem. The first step is getting the sufferer to realize the pain is merely an illusion caused by an abnormal process in the brain, and not related to tissue damage.

There are many other treatment options for chronic pain, such as acupuncture, electrical stimulation, psychotherapy, biofeedback, massage, and a myriad of alternative medications. Nothing works for everyone, but almost every approach can work for some people. If you’ve tried multiple treatments without success, keep at it because there’s a good chance something will work, at least partially.

I would be remiss if I didn’t discuss my favorite subject—sleep. There is a one-to-one inverse relationship between sleep and pain. The less sleep you get, the more pain you will feel, and vice-versa. Any reasonable pain control regimen needs to address sleep aggressively.

Finally, treating depression and anxiety is important. Chronic pain can, understandably, lead to depression. However, it can also cause anxiety since patients can get anxious about doing an activity that may worsen their pain. Antidepressants and counseling have been shown to significantly reduce or even resolve a patient’s suffering in many cases.

If you are a chronic pain sufferer, there is hope for relief. The evolving landscape of pain management is moving away from a reliance on narcotics and towards a more holistic and multifaceted approach that addresses the root causes of pain, your lifestyle, and your emotional well-being. With advancements in physical therapy, alternative treatments, and a deeper understanding of the brain’s role in chronic pain, we now have more tools than ever to help you regain control over your life. Remember, the path to managing chronic pain is often a journey rather than a sprint, requiring patience, persistence, and a willingness to explore various treatment options. But with the proper support and a tailored approach, finding relief and improving your quality of life is an achievable goal.

Dr. Ken Zweig

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