Persistent back pain and headaches. Achy bones, especially feet or hands. Gnawing, cramping guts. Whole-body soreness. Many people suffer from chronic pain in many forms. They often have to live with it for months or even years before they find relief.
According to the Centers for Disease and Prevention, 20 percent of Americans suffer from chronic pain. This makes it one of the top reasons adults seek medical attention. Chronic pain can result from fibromyalgia and rheumatoid arthritis, as well as persistent injuries. Untreated pain can cause mobility problems, limit daily activities, and reduce quality of life, often leading to anxiety or depression.
Acute pain is not the same as chronic pain. The pain that follows tissue damage or inflammatory processes is chronic. Chronic pain can be seen as part of healing. Steven P. Cohen MD, chief of pain medicine at Johns Hopkins School of Medicine, Baltimore wrote about chronic pain in a review published in The Lancet in May 2021.
After the initial and intense period of pain has passed, which is generally three to six months, any pain that continues to hurt is considered a burden and increasingly a sign of a serious condition.
Doctors have been prescribing opioid medication for years in an effort to manage chronic pain. However, opioids proved addictive and are now decreasing in prescriptions. This drastic decline left many chronic pain patients who were considered “legacy” without the medication they depended on. Sometimes, this led to devastating consequences. In February 2022, the CDC released a draft document that included more detailed guidelines and a reduction in dose caps.
Are Pain Treatment Recommendations changing?
The draft pain treatment guidelines of the CDC recommend that people who have not used opioids try nonopioid treatments first. This includes medications such as ibuprofen or acetaminophen and also other non-drug therapies like cognitive behavioral therapy (CBT), physical therapy, massage, and other supported modalities.
There are effective alternatives to pain meds, but are they available?
These holistic methods may be beneficial for certain types of pain but society still has a lot to do before everyone can have them. Shravani Durbhakula MD is an interventional pain physician at Johns Hopkins School of Medicine, and host of Pain Matters, the podcast of the American Academy of Pain Management. She says that insurance coverage, access problems, and social barriers can be limiting factors. Some people may not be able to afford pain relief that is non-drug.
Dr. Cohen said that people suffering from chronic pain shouldn’t feel isolated or despair. Research continues to explore various methods of treating pain. Doctors are becoming more aware of the importance. He says that there are many resources for chronic sufferers.
Chronic pain falls into 3 categories
The most common type of pain is chronic pain that results from tissue injury. This “nociceptive” pain, as it is called by medical professionals is quite common. This includes all types musculoskeletal pain. It refers to pain that affects bones, muscles and joints.
Experts classify a second type chronic pain as “neuropathic,” which refers to pain that results from nerve injury, such as carpal tunnel syndrome, diabetes and Parkinson’s disease.
The final category is “nociplastic pain,” where the pain-sensory pathways become affected. This group includes irritable bowel syndrome (IBS), chronic pelvic pain (CPP), and tension headaches. Cohen and his colleagues pointed out in a separate article published in The Lancet May 2021 that this type of pain is just as real as any other. Brain-imaging scans show that this pain is as real as any other. There has been evidence of pain-processing brain areas being activated in patients who suffer from this type of pain.
Chronic pain can be caused by many conditions, including but not limited to sensory pathway alterations. Patients suffering from these conditions complain that doctors don’t treat their pain as seriously as they should. In some cases, their discomfort is dismissed as a figment of their imagination. A study published in December 2021 by the Journal of Psoriasis & Psoriatic Arthritis found that people suffering from psoriasis used words like “being on fire” as a description of their condition. However, doctors focused on their symptoms, such as itching. This led to poor pain management and unneeded emotional strain.
Studies have shown that undertreating pain is a major problem for Black and Brown patients. This can be due to implicit biases held in the medical profession. For example, a research study published in the Proceedings of the National Academy of Sciences found that 135 first-year and second-year white medical students rated the pain of mock Black patients lower than the pain of comparable mock white patients. This led to inadequate pain management.
Even after completing their training, these biases can still persist. JAMA Pediatrics published a review that found that children with appendicitis were less likely than children of other races to be prescribed medication for moderate to severe pain.
There are many treatments available for chronic pain, especially early on.
Robert Bonakdar MD, a pain management expert at Scripps Center for Integrative Medicine, La Jolla, California, stated that chronic pain must be treated as soon as possible to prevent it from becoming intractable and complicated. This was according to Bonakdar’s remarks at the 2021 conference of Academy of Integrative Health and Medicine. He said that it is best to explore as many modalities as possible as soon as possible.
RELATED: 8 Great Pain Reliefs You Don’t Need
One option is medication, which may be necessary in certain cases. Experts point out that they are often ineffective. According to The Lancet, “Drugs only provide significant relief for a small number of people.” The most likely to respond to medication is pain-sensory pathway dysfunction.
Due to this ineffectiveness and concern about opioids, doctors are turning more to non-drug treatments, particularly those that have a lot of research backing them.
Mind-Body Medicine: It’s crucial to work with the mind
Psychological therapies are an important part of pain management. Experts say that while people suffering from pain may assume that referring them to a therapist or other behavioral therapies means they think the pain is imaginary, the truth is that mental health therapies can reduce pain. According to a Cochrane Database review, these techniques “change how people manage pain [and] minimize disability or distress.”
According to The Lancet, cognitive behavioral therapy (CBT) is the most popular psychological treatment for pain. This involves replacing negative beliefs, attitudes and behaviors that make pain worse, such as the belief that your pain will never end or is too unbearable.
These unhelpful reactions are called “catastrophizing” and can physiologically increase pain intensity. Eve Kennedy-Spaien is the clinical supervisor for the Pain and Functional Restoration Program at Spaulding Rehabilitation Hospital, Medford, MA. According to Eve Kennedy-Spaien: “The brain responds with shifting pain levels higher and increasing inflammation markers in the body.”
A study of people suffering from rheumatoid (RA) was presented at the European Alliance of Associations for Rheumatology’s annual conference in June 2021. It found that those who describe their pain the most strongly are less likely to be in remission than those who don’t (34% versus 70%).
There are some factors that can worsen pain.
These reactions to pain aren’t always predictable. “We need to show the brain that chronic pain is an alarm that keeps on going. Kennedy-Spaien explains that chronic pain doesn’t always signal danger. Calm your mind, the alarm will go away and you’ll feel less anxious.
Cochrane reviewed confirmed that CBT, a method to learn to reduce catastrophizing in the short-term, has some benefits. According to a February 2022 study that examined data from 32,000 Americans, less than 4 percent of Americans experiencing prolonged pain used this approach.
Kennedy-Spaien suggests that patients might also benefit from biofeedback or mindfulness-based stress relief (MBSR), which are techniques that train the mind to reframe. The American College of Physicians recommends MBSR for chronic low back pain.
Pain reprocessing therapy and pain neuroscience education have also been proven to reduce brain activity in some chronic pain types. These modalities use psychological and educational techniques to retrain brains to respond better to bodily signals, and promote positive feelings and sensations. In a study published in JAMA Psychiatry December 2021, PRT was found to have almost eliminated chronic low-back pain in two thirds of participants.
Lifestyle Interventions Can Help With Chronic Pain
Cohen states that most people suffering from chronic pain are aware of the potential for sleep problems, depression, and other psychological distress. These associations are bidirectional, meaning that the distress and insomnia can also make the pain worse.
Cohen states that improving your daily health habits is crucial for pain experts. Cohen says that a patient suffering from pain should prioritize getting enough sleep, eating healthy, being active, and quitting smoking.
It is particularly important to exercise. While pain patients used to be told to lie down in agony, doctors now recognize that moving is an important component of healing the body as well as the mind. Cohen states that there is a general consensus that exercise can be beneficial for all musculoskeletal conditions as well as nociplastic pain.
Although no one exercise is better than another, working with an occupational therapist or physical therapist can help you to choose safer exercises or modify your routine. Physical therapy is a form of physical therapy that helps people exercise more. This can be beneficial for a variety of mental and physical health conditions. Catastrophizing can be reduced by learning to move more comfortably. Physical therapy is recommended by the CDC in its draft guidelines for pain treatment.
Yoga is a great way to relieve pain. It soothes the body and mind. The benefits of yoga for pain relief are largely due to the fact that it’s an exercise form, according to The Lancet review. If yoga isn’t appealing, you can still do any other activity.
It is possible to make a change in your diet that can be quite effective. Research has shown that changes in diet have pain relieving properties. For example, a 2020 Journal of Clinical Medicine review found that plant-based diets reduce musculoskeletal and other pains. According to the same review, reducing sugar and fat can help osteoarthritis sufferers “wear and tear”.
Several Healing Techniques Help Chronic Pain
Alternative and complementary medicine can be used to help some chronic pain conditions, but there is no single right method. These therapies are supported by science.
- Acupuncture is one of the most widely used integrative medicine methods in America. This ancient Chinese method of inserting thin needles along energy pathways, is known as acupuncture. This modality is recommended by the American College of Physicians in their guidelines for chronic back pain. They cite moderate-quality evidence. Agency for Healthcare Research and Quality, the federal government, calls acupuncture an effective treatment for pain. It notes that although researchers are still not able to fully understand how it works, preliminary research suggests that it may activate the body’s pain-killing chemical. Research suggests that acupuncture may be able to reduce the intensity of pain in patients with cancer. It also has potential to treat psoriatic arthritis symptoms (PsA). According to a JAMA Network Open study, acupuncture is now covered by more insurers. Nevertheless, only half of patients can afford it.
- Chiropractic Therapy is another approach. Chiropractic Therapy is another method of manual therapy. This involves pressure and stretching applied by a credentialed chiropractic practitioner. It usually involves quick and gentle thrusts on the spine and other joints. According to a 2018 Spine Journal review, chiropractic therapy was shown to be effective for low-back pain that is not specific. Preliminary research indicates that it might help with chronic pain in multiple sclerosis patients (MS).
- Tai Chi and Qigong are centuries-old Chinese methods that combine gentle movements and different postures with mental focus, breathing, relaxation, and mental focus. In 2020, a review in Complementary Therapies in Medicine examined more than 800 studies. It concluded that qigong can often reduce pain and improve physical function and quality life for people suffering from chronic obstructive lung disease (COPD), or other conditions.
The Best of All Worlds combines pain therapies
Patients should visit one place that offers several of these options. This is called an “interdisciplinary pain program”, or IPP. This usually includes a team that includes doctors, psychiatrists and occupational therapists as well as physical therapists and exercise therapists. They create and oversee an individual plan for each patient.
Although only a handful of such programs are currently available in the United States they have proven to be extremely effective. Outpatient programs are offered by the Spaulding Outpatient Center, Medford, Massachusetts; the Pain Treatment Program at Johns Hopkins University, Baltimore; and the Chronic Pain Neurorehabilitation Program, Cleveland Clinic.
People who don’t have access to these programs may be able to create their own multi-pronged approach and seek out different providers. Experts say it can be beneficial if your primary doctor communicates with outside therapists to ensure everyone is working towards the same goal. The draft guidelines of the CDC encourage such team-based care.
If you’re interested in an integrative approach but are not able to find one, it may be worth looking for a specialist who is more focused on this approach. Some doctors may have additional training in integrative medicine, such as the University of Arizona’s Andrew Weil Center for Integrative Medical or lifestyle medicine. These doctors might take longer to discuss non-pharmacological pain management options.
RELATED: How do I find an integrative medicine doctor to help chronic pain?
Virtual reality (VR), has the potential to reduce pain and stress levels. Ziga Plahutar/Getty Images
There are promising new pain treatment techniques on the horizon
Scientists continue to search for new options for chronic pain sufferers. These newer methods are not yet well-researched and proven to be effective. However, doctors and patients agree that some of these methods are worth looking into.
However, it is important to talk to your doctor before you use any newer tools. Online or social media cures can cause people to lose their time and money.
- Prescription Digital Therapeutics. Prescription digital therapies (PDT) can be virtual programs that are prescribed by a doctor and may be reimbursed by insurance. Pear Therapeutics, in partnership with Cincinnati Children’s Hospital Medical Center, offers a product that combines cognitive behavioral therapy and patient education. Somryst, a product similar to Somryst for chronic insomnia patients, is also offered by the company.
- Kennedy-Spaien states that specialized apps Graded Motor Imagery (GMI), smartphone apps that engage the brain to assist with complex pain, are also interesting. Apps such as Recognise use explicit motor imagery, which allows the brain to think about moving but not actually do it.
- Cranial Eletrotherapy Stimulation Using clips on the earlobes to deliver a microcurrent through your brain to stimulate nerve cells, may sound odd, but some pain specialists are paying attention to the Alpha-stim cranial electrodetherapy stimulation (CES). The current price of $1,300 makes it prohibitive, but it is hoped that the cost will drop over time.
- Telemedicine and Virtual Reality are two new tools that can provide great relief. Virtual reality can be used to immerse patients into an alternate world that can help with both pain and stress. Firsthand Technology. Telemedicine was also quickly adopted by healthcare providers during the COVID-19 epidemic. Telemedicine allows people to have access to pain programs in areas they may not be able to before. Spaulding, for example, recently started using telemedicine to manage its interprofessional pain program.
RELATED: Here’s what happened when I tried virtual reality telehealth for chronic arthritis pain.
Integrative Approaches Make Access a Major Issue
Despite the promise of various methods, many Americans are unable to take advantage of accepted non-drug approaches.
Experts say insurance is the greatest limitation. Dr. Durbhakula states that if Medicare or other insurance doesn’t cover a particular technique, it is not available for most people. For example, she notes that not one of her pain patients’ insurances has covered virtual reality treatments.
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In its draft guidance on pain management, the CDC acknowledges this issue. The draft document states that these therapies are not always fully or completely covered by insurance and that patients may face barriers to accessing them.
Durbhakula also says that there is a shortage of practitioners, particularly in rural areas. She says that although CBT is an amazing therapy, it can be difficult to find a provider for a patient, especially in rural areas, where there are few therapists.
Telemedicine Isn’t a Solution — Yet
Telehealth is often promoted as a solution to access problems. However, one still requires trained therapists who are available for appointments and reliable Wi-Fi. The COVID-19 pandemic has shown that Americans are far too dependent on reliable internet access. Experts point out that many doctors are prohibited from seeing patients outside their states because of licensing rules. Durbhakula believes that relaxing these regulations and increasing government funding would make it easier for psychiatrists and other rural practitioners to locate in rural areas.
She says that Congress must ensure Wi-Fi access throughout the country so that people can log into telehealth appointments or apps to help with pain.
She also says that transportation must be improved for in-person treatment. There will not be any help if someone is unable to get to a doctor, a physical therapist, or another alternative practitioner (or a pain physician).
