There have been significant advances in understanding the physiology that have not equaled improvement in treatments of chronic pain for many patients. Most patients report that their treatments are poor to fair overall. With patients reporting an average around 30% effective in improving pain–which is about what you see with placebo treatment.
Even if a treatment improves pain, it may not provide physical, emotional or functional improvements. We need to look at the patient with chronic pain in a holistic manner. An individual in pain responds as a unit (body, mind, and spirit). In the osteopathic philosophy, prolonged levels of pain over time (≥3 months) upset this unit. That means, slapping a prescription on a chronic pain complaint, and calling it a day does not solve the problem. It puts a Band-Aid on the problem, but does not address the multifactorial causes of chronic pain.
The following is a list of questions to ask yourself about your chronic pain. Talking with your doctor and having an open dialogue about your chronic pain is key, since this is a life long endeavor.
What is your activity level? Has it declined in the past weeks? Months? Years? The activity of a patient should be addressed. This includes their activity level prior to the chronic pain as well as while they have been living with the chronic pain. The activity goals of the patient must be addressed. The activity level with the chronic pain should eventually allow for completion of regular daily tasks that the patient needs to accomplish.
For most patients, fear of damage from pain often leads to less activity leading to tightening of muscles and increased pain. Think of this as a negative feedback cycle. For most chronic pain conditions, exercise programs have been shown beneficial. This, in conjunction with OMT, can be highly beneficial for chronic pain sufferers.
How well do you sleep? Do you have issues falling asleep? Staying asleep? Sleeping habits of the patient should be addressed. The quality and duration of a patient’s sleep can dramatically affect their chronic pain. The “sleep hygiene” of the patient must be explored. Sleep hygiene, which is a whole other topic in itself that needs a separate discussion, includes behaviors that improve and maintain good quality sleep.
Is your BMI at the obese range? Some doctors, or health care practitioners, are notorious for placing the blame game and pointing the finger at the patient about this subject. This is not practicing medicine like a human–it’s not constructive or beneficial.
A thorough discussion of dietary habits and whether or not the patient is obese should be taken into consideration. There are certain foods that may exacerbate the chronic pain of the patient. In addition, being overweight can also contribute to the intensity of the chronic pain.
For many obese patients there is chronic non-resolving inflammation that is occurring. C-reactive protein (CRP) is a sign of chronic inflammation. CRP elevation has shown preliminarily to increase rates of lower back pain and higher elevations of CRP can be found in patients that are obese. This is a simple blood test that can be run. In addition, chronic non-resolving inflammation can be associated with low back pain, rheumatoid arthritis, multiple sclerosis, atherosclerotic disease, and diabetes.
The typical Western diet promotes inflammation because it is low in fruits and vegetables (which act as natural antioxidants) and high in red meat. Therefore, it is a good idea to eat a diet that reduces inflammation such as the “Anti-Inflammatory” lifestyle (which I have covered) or the “Mediterranean Diet”.
What is your mood? What is your emotional state? A distressed emotional state can negatively impact a patient’s chronic pain. Also to note, psychiatric conditions can also have an affect on pain and should be treated to help alleviate physical pain symptoms. Sometimes, the chronic pain that is not validated by a medical professional is exacerbated, can cause anxiety and depression. That is why it is so important to have a collaborative discussion with your doctor!
Do you have medications on board that are helping with your pain? Pharmacologic agents should be evaluated to make sure they are appropriate. (Part of the reason there is an opioid epidemic is that many prescribed opiates are inappropriate—Band-Aids on the solution rather than looking at the root cause!) This includes both prescription medications and over-the-counter supplements. Medications and supplements may play a key role in the alleviation of pain, however there are certain agents that may acutely or chronically exacerbate the chronic pain issue.
What are your social relationships, or lack there of? Social relationships need to be explored. Humans are social animals and a healthy social network can help improve a patient’s chronic pain condition. The reverse is true as well. Lack of a healthy social network can have a negative impact on a patient’s chronic pain condition.
What are your emotional and physical stressors? Stress can have a negative impact on chronic pain. Emotional stressors can in the short term, or acutely, cause pain and lead to a worsening of chronic pain. Physical stress may contribute to new injury and acute pain in addition to heightening a chronic pain condition.
I hope this gives you guidelines to discuss with your doctor about your chronic pain. Or if you want to discuss it with me, that’d be great too!
Resources:
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Cunningham, N. R., & Kashikar-Zuck, S. (2013). Nonpharmacological treatment of pain in rheumatic diseases and other musculoskeletal pain conditions. Curr Rheumatol Rep, 15(2), 306.
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