Chronic Pain

CHRONIC PAIN: Remedies for physical and/or mental pain

Pain has the capacity to rule our life. Chronic physical or emotional pain is very common. It has clear and devastating consequences for many, making the daily tasks of life sometimes insurmountable. Relief from pain plays an essential role in the healing process. There are many possible causes for any pain and yours should be evaluated and treated by your own health care professionals.

Regardless of the cause though, much can be done to alleviate the pain itself, whether it is physical or mental pain. The choice of many doctors often involves drugs but there are other less invasive solutions that can be used either instead of or along with drug therapy. That is the subject of this article.

The high cost of pain: Chronic pain is common.

Physical pain: Of those who experience chronic pain, 27% suffer from lower back problems, 15% have severe headache or migraine pain and 15% undergo neck pain. Over 100 million people in the United States suffer from chronic physical pain. It's estimated that pain disrupts the sleep of 20% of Americans a few nights a week or more.

Emotional pain: When speaking of pain we often think only of physical pain. But emotional pain is often felt more deeply and more debilitatingly. One way emotional pain displays is with depression: Globally, 350 million people suffer from depression. Approximately 10% of Americans suffer from depressive disorders. Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. Twice as many women are affected by depression as men.
How pain can affect us: Adults with low back pain are often in worse physical and mental health than people who do not have low back pain: 28% of adults with low back pain report limited activity due to a chronic condition, as compared to 10% of adults who do not have low back pain. Also, adults reporting low back pain were three times as likely to be in fair or poor health and more than four times as likely to experience serious psychological distress as people without low back pain. (National Centers for Health Statistics). Those with lower back pain also experience a higher fall risk.

How gender, race and age affects pain experience: In general,
women, those white and those older are more likely to be given pain medication.

In regard to gender, according to the National Institutes of Health, women are more sensitive to pain (65% of women, 46% of men). Men's pain endurance is higher (60% of men, 55% of women). But the telling statistic is that women are far more likely to report pain and therefore receive treatment (70% of women, 40% of men). According to the FDA, women are more likely to be prescribed pain medication, be given higher doses and use them for longer periods of time.
In regard to race, white people are more sensitive to pain (56% of white people, 46% of black people, 48% of Hispanic people). White people are also more likely to report pain (62% of white people, 44% of black people, 45% of Hispanic people). From PhysiciansWeekly.com, black people are 40% less likely to receive medication to ease acute pain and Hispanic patients were 25% less likely than white people.
In regard to age, older adult's are more sensitive to pain and also more willing to report pain with approximately 60% affected compared to 50% affected at younger ages.

Types of pain: The more we can define the circumstances of our pain the more we can find relief.

Pain differs based on underlying condition. In addition, pain symptoms vary greatly from person to person.

Arthritis exhibits often as dull aching stiffness when you move, particularly in the morning. But arthritis can also cause searing constant or intermittent pain.
Peripheral neuropathy pain is often described as a shooting or burning pain. It can go away on its own but is often chronic. Sometimes it is unrelenting and severe, and sometimes it comes and goes. It often is the result of nerve damage caused by excess sugar in the blood stream of those who suffer from diabetes.
Spinal impingement that causes conditions like sciatica and stenosis generates one of the worst kinds of pain. Intense and unrelenting nerve pain that is unrelieved through no matter what you do. Those who do not respond to drug therapy are often considered subjects for surgery.

Dermatomes are very helpful in isolating what may be the cause of your pain. Dermatomes are nerve root maps which define which areas of the body are controlled by which spinal root nerves. See Anatomy of the Spine for more information.

It is important to detail the type of pain you experience when you see your physician:

Does the pain come and go or is it constant?
Does it occur when you are lying down, sitting or standing?
Are you in pain when you are moving or staying still?

How do we respond to chronic pain, whether physical or emotional?

The body tenses: When we are in pain, our muscles tighten around the area hurting but our entire body also tenses up in response. With depression, the muscles surrounding the rib cage tighten strongly. This increase in tension makes the physical or mental pain worse.
Inflammation causes pain: There is a strong relationship between pain and inflammation. Reducing inflammation is key to lowering the level of chronic pain.

Fear exacerbates pain: We become more fearful of further pain. Fear is a destructive factor that increases pain.

Depression makes it worse: There is a high correlation between chronic pain and depression. Depression adds to the experience of pain while cutting off avenues that can help. The immobility that comes with depression places our self and our body under much more duress, both emotional and physical. Depression compounds pain present for other reasons.

The Western medical approach to pain: drugs and surgery.

Unfortunately pain treatment has become synonymous with use of prescribed medications resulting in severe overuse of some dangerous and addictive substances. In the United States pain and depression are both usually treated using drugs. Pain medications are very addictive. Anti depressants have a number of unpleasant side effects. Nonetheless both are extensively prescribed. However, for some, these medications are lifesavers even though there are significant potential side effects:

Opioid side effects: Constipation, drowsiness, nausea, vomiting, physical dependence.
Antidepressant side effects: Nausea, weight gain, loss of sexual desire, erectile dysfunction, decreased orgasm, fatigue and drowsiness, insomnia, dry mouth, blurred vision, constipation.

Another treatment for pain involves surgery. Fusion of the vertebrae is a severe treatment which may be recommended for those with intense and constant pain due to deterioration or injury of the spine. It is a dangerous treatment in that it is not always successful and it can actually make the condition worse. Second opinions are recommended. Lumbar laminectomy, a different common spine surgery is a less invasive microdecompression technique used to treat spinal stenosis.

The mistake that medical professionals make is to resort to drug or surgical treatment too early in the process. They should be used as a last resort after other alternatives are tried, including weight loss.

Opioids reduce pain symptoms not by reducing pain but by making you care less about it. Opioids actually increase the pain itself.

Here are the results of a recent study on the use of pain killers in the treatment of osteoarthritis of the knee. Despite longstanding recommendations for physical therapy and lifestyle changes first, prescriptions for pain relief continue rising. Data for this study was analyzed from the National Ambulatory Medical Care Survey database, which conducts an annual survey of office-based physicians on patient characteristics.

The prevalence of knee OA in the U.S. has risen dramatically in recent years, from 9 million in 2005 to 15 million in 2012. (Currently knee OA affects 27 million people in the US.)
Unlike with orthopedic specialists, referrals for PT in primary care were low and did not significantly change from 2009 to 2015. Lifestyle recommendations (to loose weight and exercise) actually diminished.
Prescriptions for NSAIDs went from 221 per 1,000 in 2009 to 498 per 1,000 in 2015. Increases in prescriptions for narcotics went from 233 per 1,000 to 316 per 1,000. In other words more than 80% of patients were given pain pills for OA treatment in 2015, an increase from 45% in 2009.
Those in rural settings and in the South were more likely to rely on pain medications than elsewhere.

Use of narcotic medications for arthritis are by their nature ill advised. Arthritis typically gets worse over time. Managing pain long term is most definitely not the recommended use of opioids. Narcotic medications should be for short term use only, primarily because of the significant addiction possibilities. That 30% of patients with knee osteoarthritis are still given narcotics for the pain knowing that the drugs are extremely addictive is alarming.

Alternative Remedies

Exercise: One of the very best pain relievers is to stretch out the tension that the pain has caused. A guide to this is explained below. Proper joint warm ups also help a great deal.
Increase core strength: Pain is often greatly alleviated when the abdominals are in use. Lower back pain in particular is a red flag to the body that the lower spine may be taking too much stress because the abs aren't taking enough.
Loose weight: Over 40% of chronic pain is spine related. One of the heaviest stressors on the spine is carrying extra weight. Another common source of pain is knee pain where weight is even more of a factor. If you are overweight or obese, weight loss is by far the most effective pain reduction strategy regardless of the specific cause of your pain.
Lower the level of inflammation in the body: This can be done through diet in particular. I have experienced an almost complete reduction in pain caused by arthritis of the fingers since I gave up eating refined sugars and processed foods. It is not difficult to lower inflammation in your body through diet and it should be considered before other more onerous solutions. Read Inflammation, a BALANCE NEWS article, to learn how.
Use the breath to reduce tension and anxiety. This is especially effective in reducing the experience of fear, a negative emotion that exacerbates underlying conditions.
Mindfulness Meditation and other forms of structured meditation are very effective at reducing the trauma of the pain experience and therefore reducing the pain itself.
Physical therapy: There are many reasons to request a prescription for physical therapy and chronic pain experience is certainly one of them.
Massage is also helpful for relieving muscle tension.
Keep moving physically to reduce the effects of depression.

Learn from your pain.

Pain experience is greatly affected by our own perception. There is a difference between the actual pain and how our brain receives pain messaging. We have a choice in how to experience those signals. It is possible to train the mind to not accept the pain cues. In fact, structured meditation, a wonderful mental health technique, has been successfully used to significantly reduce pain.

A dancer's point of view: Pain or discomfort is the body telling us that something is askew that needs to be attended to. In my dance practice I find that pain is a signal that my underlying technique is ignoring something important. Often that something important is to use the core more. Pull in the abdominals and the pain frequently disappears. Other times the scourge will be alignment. When my foot hurts after practicing a particular dance I will practice again, keeping good foot alignment in my consciousness as I move. With the right alignment and proper use of the feet the pain again often disappears.

In general if something hurts stop. Discontinue whatever you are doing. Ideally, find a safer way to do the same thing. Try pulling your belly in when something hurts and often the pain will disappear. Nonetheless err on the safe side. If something hurts, stop.

A student of mine experienced intense discomfort in her knee from the deterioration of its cartilage from arthritis. It took her 40 seconds of excruciating pain to straighten it each morning. I taught her one of the fantastic exercises for the knees that is included in all the Building Better Balance DVDs. After doing it in the morning before standing up she was able to straighten her knee without any pain, illustrating how movement can be just as effective at drugs at reducing pain. Perhaps even more effective since side effects are minimal.

Which muscles should you stretch if you are in pain? In general, stretch the muscles that your pain has tightened.

Lower Back

Joint Pain

Knees

Neck

Headaches

Emotional Pain

Stretch the hips, a technique so important that it is taught in each of the Building Better Balance DVDs.

Stretch the muscles surrounding the joint after first releasing the joint itself. Also stretch and release the joints on either side of the injured area.

Stretch the back of the legs (the calves and hamstrings). Circle the knee gently in its joint. Release tension in nearby joints (the ankle and hip).

Stretch the trapezius (back of the shoulders) and the muscles on the sides and back of the neck.

Stretch the muscles of the face, eyes and jaw.

Stretch the face, tongue and especially the front of the rib cage and concentrate on improving breathing. Our natural response to sadness and despair is to tighten the rib cage as a way of protecting a hurting heart. Reversing that physical reaction by instead lifting the heart and stretching the front of the chest helps to interrupt the pain/tension cycle.

Stretch the "stress muscles": Regardless of cause, it is useful to stretch the muscles that always tighten when we are under duress, the shoulders, neck and front of the chest.

When in pain, think of improving your posture. This will automatically stretch the muscles that tighten with pain.

After teaching simple Building Better Balance lower back exercises at a luncheon presentation, one of the attendees came up to me to say that the exercises had caused his lower back pain to disappear! The other 7 gents at his table experienced the same thing!

The Building Better Balance DVDs show you how to reduce pain and inflammation in any area affected by deterioration or injury. For example, the DVD Developing Spine Health, incorporates effective movements that reduce tension in the lower spine as well as in the neck and shoulders resulting in significant reduction of back pain.

How to Reduce Symptoms of Depression