An integrative approach to chronic pain

September 2nd, 2020
A gentleman rubs his neck due to chronic pain.
Consistent pain that lasts longer than three to six months is usually considered to be chronic pain. Photo: Getty Images.

Pain is a normal response to an injury or illness: it’s your body’s way of letting you know that something is wrong. But sometimes, even after the injury or illness heals, the pain continues, becoming chronic pain.

To effectively treat chronic pain, it’s important to tap into a wide variety of tools with an integrative approach. An integrative approach that involves both physical and behavioral health treatments, people can find relief.

Below, Dr. Brian Siegel, a pain management physician at UCHealth Pain Management Clinic in Steamboat Springs, outlines what you need to know about chronic pain, and how intervention techniques can help.

What is chronic pain?

Consistent pain that lasts longer than three to six months is usually considered to be chronic pain. This pain can be experienced even after the original injury or illness has healed, and there’s no longer evidence of tissue damage. Sometimes, a patient will have chronic pain without a specific injury or illness.

What can cause chronic pain?

Almost anything.

“It can happen to anybody,” Siegel said. “It can be set off by an insignificant accident, or a significant accident, or it can be a post-surgical syndrome in which someone’s pain continues beyond the surgical procedure.”

Why does someone experience chronic pain?

The nervous system, which helps detect and communicate sensations such as pain to the brain, can sometimes go awry, interpreting pain when it shouldn’t.

“There’s plasticity in the nervous system, and it can get turned on to process non-painful events as being painful,” Siegel said.

The condition can be excruciating and can affect all aspects of a patient’s life, but it can be managed or treated.

“What we want to do is turn those processes off and re-set the nervous system,” Siegel said. “Then we add in the physical therapy and cognitive therapy that’s needed to make the person whole again.”

What’s the role of pain medication?

While there is a role for pain medications in addressing chronic pain, the goal is to provide other treatments so that eventually, pain medications are not needed.

“We need interventions that deal with psychological aspects, such as the interpretation of what’s going on in someone’s body, to help them relearn what’s going on with their pain,” Siegel said. “There is a role for pain medications in chronic pain, but they need to be used wisely.”

How can interventional treatments help?

If a nerve gets “stuck” in a pattern of messaging pain, it needs to be “unstuck.”

“Intervention techniques can quiet nerves so people can get into physical therapy, and reach a more functional place,” Siegel said. “It’s like hitting the reset button.”

A doctor first identifies the specific nerves causing the chronic pain, then determines which treatments will be most helpful. For instance, a problem nerve can be turned off for 12 to 18 months through a needling procedure. And through neural stimulation with electrodes, complex pain from the arm or leg can be blocked.

For patients who have been prescribed larger doses of opiates for longer periods of time, and who will likely need opiate medications to manage their pain long-term, an internal medication delivery system may help.

“A dose in the spinal space is three-hundredths of the dose taken orally,” Siegel said. “We can use a lot less medication and get the same positive results. And it’s a lot safer for the patient, as there’s no potential for abuse or overdose.”

Why is an integrative approach important?

Once a nerve is quieted, it’s important for a patient to work through other treatments, including behavioral health.

“These treatments work together,” Siegel said. “And the message should be that people should come in earlier rather than later. When people are struggling, they should know there’s a multi-modal, integrated way to address pain.”

Behavioral health

Sometimes, people can find relief from chronic pain through an integrative approach that involves physical and behavioral health treatments.

Amy Goodwin, a licensed professional counselor and behavioral health specialist with UCHealth Yampa Valley Medical Center, describes how behavioral health is an important part of treating chronic pain.

First steps first

When treating chronic pain, it’s important to first calm down overactive nerves that continually message there’s pain, even after the injury or illness has healed.

“There’s a physical issue, in that the nerves are on and hyper-firing, but the off-switch is still in the brain,” Goodwin said.

Interventional procedures can help disrupt the hyperactive nerve, so that further treatments – such as physical therapy, meditation, massage and acupuncture – can help.

After problem nerves are quieted

When the brain is no longer receiving constant signals of pain, behavioral health treatments come into play.

“It’s my job to take advantage of that so people can enhance their physical functioning by quieting their mind and their central nervous system,” Goodwin said.

Patients are invited to choose behaviors that help their overall health and functioning: for instance, following a healthy diet, and committing to regular exercise.

“The more people are building muscle and maintaining a certain level of health, the better their body can recover,” Goodwin said.

And, Goodwin helps patients identify how their pain affects their overall thoughts.

“When we have a pain response that’s turned on in our body, we increase our brain’s focus on other worrisome issues and ideas,” Goodwin said.

The importance of thought patterns

Slowly, patients are able to think about their situation in a more positive or accepting way.

For instance, if someone is struggling with wanting to be at the same physical level they were before their injury or illness, they can learn to accept their functional level at that moment.

“We have to accept where we are and be mindful of that, instead of being in a rush to get back to where things were before the accident or surgery,” Goodwin said.

Goodwin can also help patients identify and address beliefs that may actually be preventing healing and recovery. That includes ‘all or nothing’ thinking such as, ‘If I can’t be a top athlete, then it’s not worth it to do anything,’ which can create a sense of defeat or helplessness and undermine recovery.

Dispelling pain myths

Though we feel pain in our physical bodies, pain itself isn’t just a physical issue. “Pain is always an interplay between the injury and the body and brain’s interpretation of the injury,” Goodwin said. “It’s like a dialogue between the brain and body. It’s not just in your head, but it’s not just in your body.”

And even with treatment, chronic pain may not simply go away.

“Our pain awareness is not like an on/off switch – it’s like a dimmer dial,” Goodwin said. “We might not ever be able to turn pain off entirely, but we can definitely teach people strategies to dim it.”

When to seek help

A lot of healing can take place within three to six months of an injury or illness. But if there isn’t substantial change after that, people should get help.

“If people are starting to experience chronic pain, the quicker they respond by getting the support and information they need, the better their outcomes,” Goodwin said.

And remember that the stress and isolation that are resulting from efforts to reduce the spread of COVID-19 can make this time especially challenging for people dealing with chronic pain.

“Anxiety can escalate pain. Social isolation can escalate pain. Lack of opportunities to exercise and recreate can escalate pain,” Goodwin said. “It’s more important than ever for people to seek help when they need it.”

 

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About the author

Susan Cunningham lives in the Colorado Rocky Mountains with her husband and two daughters. She enjoys science nearly as much as writing: she’s traveled to the bottom of the ocean via submarine to observe life at hydrothermal vents, camped out on an island of birds to study tern behavior, and now spends time in an office writing and analyzing data. She blogs about writing and science at susancunninghambooks.com.