Chronic pain – kind of pain that is persistent and appears permanent, lasting longer than three to six months.
In my years of practice, I have had to deal with the results of overmedicating for chronic pain more often than I believe is necessary. I have seen patients with pain medication addiction issues, kidney issues and liver issues (hepatitis can occur even with over the counter pain medication if the doses are large enough for long enough.) As someone who has lived with chronic pain her entire life and made a career of helping others with chronic pain, I decided it’s time to address this issue.
In a poll recently released by the American Osteopathic Association, 70% of Americans stated they or someone they care for had experienced pain in the prior 30 days and that more than 76 million Americans live with chronic pain making chronic pain more common than heart disease, diabetes or cancer.
“Chronic pain is a very serious and unaddressed public health issue, and many people are reluctant to speak to their physician for fear of feeling hopeless, or simply not knowing how to initiate the conversation. It is important for physicians and their patients to work together to address the issue of pain,” said Dr. Robert I. Danoff, of Aria Health System in Philadelphia, in an AOA news release.
Here were some of the survey responses that shocked me:
- 48 percent of surveyed respondents did not believe that proper treatment can ease chronic pain.
- 41 percent believe pain is a normal part of aging, and 10 percent simply ignore the pain.
- 31 percent would not speak to a doctor about their pain for fear they could not afford treatment.
Here are some of the responses that I personally agree with having had personal experience with managing my pain in early adulthood with acetaminophen with codeine that I could still be on today had I not decided to do things differently. (While there are some patients I do recommend pain medication care to, I spend more time helping people do better without them than with them.) Long-term pain medication should be the absolute last resort.
- 36 percent would refuse doctor-recommended or doctor-prescribed pain medication for fear of becoming addicted.
- 34 percent believe pain medications that cause side effects are worse than pain itself.
Proper treatment can ease chronic pain.
This is only true if you define what proper treatment is. The problem I find, with regular medicine is that because chronic pain doesn’t fit the acute uncomplicated “got pain, take a pill and let’s hope it resolves” profile that when it doesn’t resolve with medication the patient is often referred for physical therapy, which may help if it is what the patient needs. If medications and physical therapy fail, the physician is generally stymied and the patient becomes, by default, a candidate for long term narcotic pain medication or pain management.
So often these patients come to us not wanting narcotic drugs or pain shots. Proper treatment for these patients may end up involving the changing of their shoes (maybe they have great orthotics in shoes that are so worn they are bound to have back pain or maybe they just need orthotics). We may advocate a new mattress or different sleeping positions, we may have to determine when the pain is worse and what habit behavior they are involved in when it becomes worse (I can’t tell you how many patients with neck or low back pain that is worse at night get out of their recliner or off their favorite couch/chair and do better). Knowing our patients and what they want to do, try to do and the habit patterns involved in their pain means patients who have not responded to conventional treatment can begin to respond.
Pain is a normal part of aging and so it is OK to ignore the pain
YoYo Ma said, “if you live to be 40 and haven’t experienced pain, you haven’t lived.” I think this is a valid statement. That 10 percent who simply ignore pain, however, confounds me.
If you had a smoke detector going off in your house I hope you wouldn’t just pull the battery out of the alarm and say “problem resolved.” When we ignore pain, we do exactly that. Our bodies create the sensation of pain to tell us to slow down or stop this activity. Pain is the body’s way of telling the brain that in this moment the activity we are trying to do should not be done.
Now, I certainly don’t advocate bed rest or lack of motion as an answer to chronic pain, but I also do not recommend the taking of an over the counter or prescription pain medicine to alleviate the annoying or uncomfortable pain so that you can do the very task the pain is telling you not to do . . . . I am firmly convinced this is why so many can’t get better. They turn off the body’s smoke alarm with pain medication and then wonder why the pain consumes us much like fire will consume a home.
I won’t speak to the doctor because I can’t afford treatment
I know that in my practice we will work with anyone who is genuinely trying to work with us, being compliant with their care plan and working out affordable financing and I know that I am not the only physician out there who is like this.
This statement concerns me though when this belief is more of a value issue than a financial issue. I have heard patients say they can’t afford the care and in the next breath they are telling my staff about the trip they are planning, the car they are buying, the extra channels they want on their satellite TV. I am not saying that these patients shouldn’t have these things, but I am saying that if working to reduce their pain had value they would put these items on hold for a while and take care of themselves so they could really enjoy their trip, or get into and out of their new car, or sit to watch that new TV channel on a slightly different timeline. They would put their health first.
The Treatment of Chronic Pain
Chronic pain treatment needs to be as individualized as the patient. In my lifetime, I have experienced things that seemed to help and then as my needs changed so did the treatment. Orthopedic shoes gave me relief for a few years as a child. A heel lift gave me relief as a teen/young adult. Chiropractic and acupuncture have always given relief but not necessarily the same techniques of adjustments or listings for the adjustments and the acupuncture points have changed over time also. Treatment is always tailored to the needs of the body in that moment.
Other factors have become very apparent to me in dealing with my own chronic pain issues and they include:
Dehydration – if you want to feel pain, stay dehydrated. Up to 70% of Americans are dehydrated. They either just don’t consume enough water or they consume enough caffeine, salt, and sugar that the water they consume isn’t enough.
Sugar – the more you eat, the more you challenge your body. To get rid of excess sugar your body has to go into overdrive to remove the extra sugar from your bloodstream. This form of damage control leaves your body with less basic metabolic energy for healing and repair. Ask any diabetic how they feel overall when their sugar is high. They ache all over and they heal more slowly.
Caffeine – is a diuretic and as such will leave you dehydrated elevating your pain levels. Caffeine is also a stimulant and it will raise pain levels much as kerosene thrown on a fire will make the flames bigger and hotter. Want to hurt worse? Use caffeine (the only exceptions here would be certain types of headaches.) I personally love it when I ask how much caffeine a chronic pain patient consumes and hear about the 18-oz coffee and the 32-oz big gulp of caffeinated soda. By eliminating the caffeine altogether we often see a remarkable drop in pain levels. These patients generally have a really bad headache for a day or two also as they come off of the drug we call caffeine. Many who have high blood pressure will see it drop also as a result of removing caffeine from their diet.
Inflammatory foods – American’s love foods that are fully loaded with omega 6 fatty acids. These acids create an inflammatory response making it really hard for the pain to resolve. Nutritional counseling, the addition of omega 3 fatty acids and time for it all to register with the body, make this an important pain management tool for many patients.
Taking care of these four things and being evaluated for manual medicine should be alternatives to living with chronic pain that every American with chronic pain should consider.
Jenny L Crosby DC