By James N. Campbell, MD, Special to Everyday Health
Think about the last time you experienced pain. Was it a headache or backache, or maybe a twisted ankle or pulled muscle? Regardless of its source or location, for most of us, pain is short-lived and easily curtailed with Tylenol (acetaminophen) orAdvil (ibuprofen), a heating pad, or the passage of time.
For a third of the U.S. population, however, pain is something they live with on a daily basis.
What Is Chronic Pain?
According to the American Chronic Pain Association (ACPA), “Chronic pain or persistent pain can be described as ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury healing, more than 3 to 6 months, and which adversely affects the individual’s well-being.”
A simpler definition for chronic pain is pain that continues when it should not. Pain can be a useful signal that something is wrong, but too often, pain outlives its usefulness and becomes the problem itself.
Chronic pain can occur in a variety of locations in the body and for a variety of reasons. In some cases, chronic pain starts following an injury, such as whiplash after a car accident or a back sprain. In other cases, an underlying illness could be an ongoing cause.
Treatment is aimed at addressing the root cause or source of pain (if that can be identified) and at reducing the pain and improving function so a person can resume day-to-day activities.
Self-Treating Chronic Pain
Commonly, when people first experience pain that doesn’t subside as quickly as they expect, they turn to home remedies or to over-the-counter (OTC) pain relievers such as Tylenol or Advil. Then, if the recommended dose of OTC medication doesn’t adequately eliminate the pain, they take increasing amounts, or they combine two or more OTC pain medications.
While OTC pain relievers are generally safe, they can cause such serious side effects as acute liver failure (in the case of Tylenol) or gastrointestinal bleeding and cardiovascular side effects (in the case of a non-steroidal anti-inflammatory drugs [NSAIDs] such as Advil, or Celebrex [celecoxib]) when used in large doses or on a long-term basis.
Seeking Help for Chronic Pain
When self-medicating fails, which it does in most cases, the person with chronic pain seeks professional medical help and becomes the patient with chronic pain. This is a critical point in the continuum of chronic pain management.
Medical schools traditionally spend little time teaching the principles of pain medicine and, as a result, primary care physicians are ill-equipped to evaluate and treat pain — even though it is one of the most common complaints patients have.
Too often, a primary care physician addresses a complaint of pain with a prescription for an opioid, a dangerous practice that has contributed to this country’s current prescription opioid abuse epidemic.
Initially, opioids can be highly effective for some patients, but they are seldom a long-term, sustainable solution for any patient. Both short- and long-term opioid use is associated with moderate to severe side effects and risks, and physicians are charged with the difficult task of weighing benefits versus harm of using or continuing an opioid pain medication.
In recent years, physicians have come under fire for liberally resorting to opioids without mitigating risk or adequately exploring alternative options.
In March 2016, the Centers for Disease Control and Prevention issued guidelinesaimed at helping primary care providers make better decisions about prescribing opioids while optimizing the management of chronic pain and curbing prescription opioid abuse.
The heightened awareness of the dangers of opioids has spurred a public backlash against opioids and the physicians who prescribe them, and a corresponding outcry from the chronic pain community who feel victimized and penalized by the regulators and legislators who strive to limit access to medications that some patients considers to be their only lifeline.
Finding a Collaborative Partner for Pain Management
If you have chronic pain and are seeking treatment for it, it’s important to find a physician who can be a collaborative partner in what is likely to be a long relationship. Since there is no objective test that can measure or locate pain, during the initial visit, a physician should invest a great deal of time taking your “pain history” to characterize the type, location, and timing of the pain.
A patient’s description of what the pain feels like can provide important clues to the cause of the pain and help inform the appropriate treatment.
Your pain physician should also know that there are many treatment approaches to chronic pain, with medication being just one of them. For long-term pain management, a treatment plan that combines traditional medicine with complementary therapies may be the best option.
The ACPA organizes nonmedication and nonsurgical therapies under the umbrella of complementary and alternative medicine, defined as “a diverse group of healing systems, practices, and products.”
Some of the more common complementary and alternative treatments that can help to alleviate pain include the following:
- Light therapy
- Paraffin (wax) treatment
- Hyperbaric oxygen (HBO) therapy
- Spinal Manipulative Therapy (SMT)
- Transcutaneous Electrotherapy
- Trigger Point Injections
- Exercise (active therapy)
- Functional training
- Tai chi
- Graded Motor Imagery
Psychological and Behavioral Approaches
- Pain psychology
- General behavioral medicine and mental health counseling
Fear Avoidance Training
- Relaxation and biofeedback
I encourage patients to visit the ACPA website for more information on complementary and alternative treatments so they can discuss these options with their doctor. Education is a critical aspect of chronic pain management, and an informed patient can form a stronger partnership with a physician and as a result, improve the overall treatment outcome.