Remember in Rocky III when the TV reporter asked Clubber Lang (Mr. T) what he predicted for the fight against Rocky Balboa? He looked right into the camera and said, “Pain”. What kind of pain are we talking about Mr. T? Physical pain from the fight? Mental pain from training and worrying about losing the title? Emotional pain from possibly losing?
“Pain” is a pretty general term that gets thrown around frequently on the internet and television these days. It seems that everywhere you look there is some new pain disorder, or some term being used to attribute pain or being painful to activities, beliefs, perceptions, medical procedures, and even food. No wonder our medical system is SO expensive and rife with hucksters that exploit pain.
In medical terms the word pain can be broken up into two categories.
- Acute pain: which is a sensation created by the nervous system to alert the individual of potential tissue damage and injury. Acute pain typically last less than 3 months and gradually resolves as healing progresses.
- Chronic pain: pain that has been experienced for over 12 weeks.
If you have acute pain, have been injured, or are the victim of trauma; GO SEEK MEDICAL ATTENTION.
In this post I’m going to be breaking down Chronic pain relief and treatment. What you can expect. What are your options for dealing with it.
Note to reader: I am not a medical doctor, and this post is based purely on opinions from having worked in medicine for the last 27 years and my experience as a Certified Rolfer® and Certified Personal Trainer.
What is chronic pain and it’s affect on society?
Chronic pain can be vague in its creation. That’s why it’s so hard to treat. The causes can be anything from previous injury, repetitive use injuries, ongoing illness, incomplete post surgical rehabilitation, stress from environmental toxins, emotional stress, physiologic stress, allergies, and the list goes on.
In normal situations, tissues begin healing immediately after injury, with complete healing accomplished in 6 weeks of time(reference). In people with chronic pain the nervous system takes over and continues to send “warning” signals to the brain, triggering the pain response even after the injury has healed.
Biomedical vs. Biopsychosocial model of chronic pain
Our current medical system primarily uses the Biomedical model of pain to treat and diagnose chronic pain. What this means is that pain and disease are caused by external factors that affect the function of our organ systems and thus our bodies (5).
Injury, infection, toxicity, etc> Tissue Damage> Pain.
Simplified- You have a threat of tissue damage from an injury and the nervous system goes into protection mode. It serves to protect and warn you from further injury. Hand on hot surface > Pain > remove hand from surface. Unfortunately, this model is still used even after the tissues have healed, creating a situation of recurring pain that is often not resolved with medications, therapies, and surgeries. With the Biomedical Model, if you have pain, then there has to be a physical reason. Thus, we get the over use of medical imaging, medications, surgeries, and therapies.
Make no mistake, pain is real. There is no dispute about that. The cause of the chronic pain is up for debate.
Contrary to the Biomedical Model of pain. Fascinating new research is showing is that these warning signals or threats can be triggered by literally “anything”. The Biopsychosocial model; which is used by pain researchers and some medical practitioners to study and treat pain; theorizes that pain can be triggered by relevant physical, psychological, or socially based factors, thereby then eliciting responses from the nervous system and creating pain.
Instead of just focusing on the physical aspect of the creation of pain. While not discounting the physical aspects of pain, The Biopsychosocial model also delves into the physical and psychological reactions and behavior stemming from the creation of pain and how previous experiences and possible anticipated consequences might affect that person in dealing with their pain. MRI studies have even been used to correlate the pain response of these triggers. When the patient is exposed to certain pain triggers: such as smell, color, or pictures; different parts of the brain light up correlating to pain. (6)
Some hypothetical examples:
- You were attacked by a person in a red jacket and injured your shoulder, now whenever you see a person with a similar red jacket your shoulder starts hurting. Just seeing something similar brings back the pain.
- You fall at work and injure your back. You get treatment, your back heals, and then you go for your annual review. Your boss mentions your attendance history and brings up your missed days due to injury and you don’t quite get the raise you were expecting. This is very emotional and your back starts giving you problems again. Why? Because there are physical changes that take place with emotional responses. Hormones are released, muscular guarding happens. This previous triggering of your nervous system lowers the warning system “threshold” and getting out of your chair illicit a pain response.
- You injure your knee skiing. You go thru PT and rehab and things seem to be good. Then mid summer comes and you’re partying a lot, drinking too much, and your diet is really off. You still get in your workouts, but your knee starts to swell and hurt a lot. You go see a doctor and everything seems normal. What’s going on? Systemic inflammation possibly? Inflammation can cause chronic pain(reference) Could your diet and alcohol consumption be causing it? Quite possibly.
So as you can see, chronic pain can be triggered by lots of hypothetical situations. That’s why it’s so hard to treat.
That’s also why it is so expensive to deal with.
Western Medicine model treatment
Treating the symptom is the at root of the western medical model also known as allopathic medicine. If you have pain, it’s going to be treated. If it’s acute pain, that means getting rid of that pain through medical intervention like visits to the emergency room, pain medications, and surgeries. In other words “the western model of treatment” could also be called disease, or injury management; typically through the use of pharmacology and imaging.
Unfortunately, chronic pain relief treatment can be tricky and the pharmacological approach often fails. As we mentioned above, certain triggers can cause re occurrence of pain. Sometimes lasting days, months or even years. Rarely is the root cause of pain searched for or found. Patients suffering from chronic pain typically run the gamut of medical doctors, repeated imaging procedures, and medications without getting rid of their pain.
The 15-Minute Doctors Visit for the chronic pain patient
By now we’ve all been to the doctor at one point in our life, and by now you known the “old school doctor” is a thing of the past. Doctors don’t make house calls unless you pay a for an expensive concierge medical service. Additionally, in lot of cases you don’t even get to pick your doctor anymore, your insurance company dictates what group or groups of physicians you can use.
Even more frustrating is that insurance companies now have control over what procedures and modes of treatment you can have based on your insurance plan. Creating even more distrust and anxiety over the medical process, which we known can affect the pain response. Finally, most doctors visits are typically 15 minutes long and very compressed. This leaves patients feeling like they have NO control over their situation, they don’t understand what’s going on, and feel that no one listens to them.
Some interesting studies on doctor/interactions:
- In a study of 300 medical encounters: doctors averaged only 1.3 minutes explaining or giving medical information(7).
- In another study of 264 visits to family physicians: patients were interrupted after an average of 23 seconds into telling the doctor about their problem (8)
- Average of 50% of patients leave appointments without understanding what their doctor said(9)
These 15 minute Doctor’s visits quite often leave the chronic pain patient feeling like they got nothing out of the appointment except medications and possibly another order for another set of imaging studies. Nothing was done to find the root cause of the problem. The chronic pain cycle keeps turning.
Holistic Medical Model treatment
Also called the natural approach, the holistic medical approach aims to treat the whole individual, not just the presenting symptoms. Typically practiced by Naturopaths and Functional Medicine M.D’s; holistic medicine emphasizes health optimization through diet, exercise, stress management, and elimination of inflammatory/toxic materials in the body.
Aimed at finding the root cause of pain; Holistic Medicine utilizes the Biopsychosocial model; stressing whole body health in chronic pain relief and treatment. By evaluating more than just physical symptoms the practitioner can examine all aspects of the persons’ health relating to pain. Kind of like a detective, the practitioner utilizes verbal and physical assessments and histories to dive into the clients past and current state of being to find clues to what might be causing their pain.
You most likely will be advised to make lifestyle changes and these professionals will be able to support you in the changes that you need to make. Don’t take lifestyle counseling for granted. There will be modifications that will have to take place to help you get rid of your pain.
Assessments might include:
- Diet assessment
- Functional Movement Screen
- Looking at stress markers(possibly labs)
- Medical/Injury history
- Physical fitness evaluations
- Physical Therapy history
- Psychological Screening
- Lifestyle counseling
Quite often Naturopaths and Functional Medicine Doctors partner with personal trainers, nutritionists, functional dietitians, Rolfers®, massage therapists, physical therapists, yoga instructors, mental health counselors, chiropractors, and other like-minded physicians. Unfortunately a lot of these types of practitioners DO NOT take insurance and you will have to pay out-of-pocket. But.. It’s worth it. What they do isn’t dictated by the insurance company. Also.. Check to see if they take Flexible Spending Cards, HSA cards. Most payment options allow the use of FSA or HSA cards to be used for medical reasons.
Pain is real
Pain is real! Make no mistake about it. If someone tells you that your chronic pain is all in your head, they are indeed correct. Pain is produced in the brain, but it’s much more detailed than that; and as we mentioned above; lots of other factors are involved. Chronic pain is created by your neuromuscular system incorrectly decoding pain signaling in your body. It’s too hypersensitive and perceiving every bit of input as a danger signal, thus creating more and more pain signals.
If you are told to just deal with your pain, find another doctor who will listen and refer you to the right people. IF your doctor just sends you to get imaging and appointment follow-ups with surgeons, demand a referral to a functional medicine doctor. You have to take control of your health decisions.
Chronic pain. It doesn’t have to ruin your life
Chronic pain is real, but it doesn’t have ruin your life. It needs to be managed daily!
Here’s what you need for Chronic Pain Relief Therapy
- Dedication- It’s going to take work and trial and error. Don’t expect instant results. Stick to it!
- Openness to change – Lifestyle change will need to happen. Whether it’s giving up certain foods, starting up and exercise program, or seeing a counselor; you will have to make changes. Embrace the change!
- Support – Talk to your family and friends about the changes you need to take. For you to be successful you need people pulling for you and not getting in your way.
- Goal Oriented – A goal is just a dream unless it’s written down. Maybe it’s to get 30 minutes of walking in a day, or to work out 3 days/ week. Maybe it’s cutting out TV and screen time before you go to be. Write it out, and stick with it. You can do this!
If your someone that suffers from chronic pain and are not getting anywhere with your efforts to get out of pain, I hope this post has enlightened you take control of your health. Use your options. Talk to your doctor, get referred to the people who can help you. Try things. If what you’re doing isn’t working try something else.
Feel free to comment. I’m interested in opening this up for discussion.
All the best
- MedlinePlus (2011) Chronic Pain: Symptoms, Diagnosis, & Treatment. [Online] Available from: https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg5-6.html .
- National Academy of Sciences (2011Relieving PAIN in America. [Online] Available from: https://www.nap.edu/read/13172/chapter/2.
- National Academy of Sciences (2011)Relieving PAIN in America. [Online] Available from: https://www.nap.edu/read/13172/chapter/2 .
- National Center for Health Statistics (2006) Health, United States, 2006. [Online] Available from: https://www.cdc.gov/nchs/data/hus/hus06.pdf .
- Virtual Mentor. May 2013, Volume 15, Number 5: 455-459.
- Peyron R., B Laurent, and L.Garcia-Larrea, Functional imaging for brain responses to pain. A review and meta-analysis. Neurophysiol Clin, 2000 30:263-88
- Roter and Hall. Ann Rev Public Health 1989:10:163.
- Waitzkin. JAMA 1984;252:2441
- Braddock et al. JAMA 1999;282;2313