Chronic Pain Can Be Such A Pain!
As you probably know from repeated news reports over the past decade, we are in big trouble in this country when it comes to pain medications. For many years, due to 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 quite 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?
What is pain?
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 Advil, Tylenol, and, for more severe cases, narcotics. But when it comes to chronic pain, we don’t have very good treatments available. This is a big deal, since an estimated 20% of U.S. adults suffer from chronic pain, which can come with depression, poor sleep, and an inability to work. Chronic pain differs fairly significantly from acute pain. A good way to understand chronic pain is by viewing it as an overexcited pain system. Instead of the pain fibers firing only when there’s risk of tissue damage, they may fire after even a mild stimulus, such as a gentle touch, or they may just fire continuously regardless of the input. This often develops after a physical or emotional trauma, so your pain threshold drops dramatically to protect you from that event happening again. This can work well for survival, but it makes the sufferer miserable. And a lower pain threshold can spread to the entire body, rather than remaining just at the site of trauma.
As I stated, we don’t have great medications for chronic pain. There are medications that can dull the pain somewhat, such as gabapentin or pregabalin, or that can treat the resulting depression, but there’s no magic bullet- not even close. However, there’s some new research showing that physical therapy can help, even if there’s not a 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 function and be pain free.
How do we manage 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. And 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 a multitude of 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. So if you’ve tried multiple treatments without success, keep at it, because there’s a good chance something will work, at least partially.
Don’t forget to sleep!
And I’d be remiss if I didn’t talk about my favorite subject- sleep. There is a one-to-one inverse relationship between sleep and pain. In other words, 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. But 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.
Obviously, pain management is a huge subject, so this just barely touches the surface, but hopefully it gives you a brief overview of the treatment options. The encouraging news is that we are much better at this than we used to be. So, if you are a chronic pain sufferer, there is hope for relief.
Good luck, and good health!
Ken Zweig, M.D.
Northern Virginia Family Practice Associates