Chronic pain is a worldwide epidemic with more than 1.5 billion people living with this relentless condition. In the U.S., chronic pain affects more Americans than diabetes, heart disease and cancer combined. The American Academy of Pain Medicine reports that more than 100 million Americans suffer with chronic pain, compared to 25.8 million who have diabetes, 16.3 million who have coronary heart disease, 7 million who have had a stroke, and 11.9 million who have been diagnosed with cancer.
According to research data published in Americans in Pain study, nearly 25 percent of chronic pain sufferers surveyed have had to take a leave of absence from work; 20 percent had to change jobs; and 15 percent needed help with daily living activities and had to move into a different home that was easier to manage. Additionally, more than half say they have little or no control over their pain, and nearly two-thirds say their pain impacts their quality of life.
Pain medicine specialist, Michelle Boyer, PA-C., has nearly 17 years of combine experience caring for people who suffer with pain, from surgical to non-surgical approaches. Boyer, who is part of Northern Arizona Orthopaedics’ Pain Wellness Clinic explains chronic pain and treatment options.
Q: What is the difference between pain and chronic pain?
A: Everyone experiences acute pain, which is a normal and healthy response triggered by the nervous system to alert the body of an injury or illness. Acute pain can often be eliminated by treating the cause of the pain, such as fixing the broken bone, for example.
Chronic pain is considered beyond 6 months of symptoms. Chronic pain is the result of pain signals in the nervous system that keep firing for months and even years after an initial injury or illness. The pain can be continuous or off-and-on, and is difficult to alleviate.
Q: What are the most common chronic pain conditions?
A: Low back pain is the most reported chronic pain condition, followed by severe headaches or migraines; neck pain; joint pain such as arthritis; neurogenic or nerve pain such as neuropathy or sciatica; widespread diffuse pain such as fibromyalgia; and muscular aches/pains. Some chronic pain is caused by diseases such as multiple sclerosis, auto-immune disorders, cancer or end-stages of life.
Q: Can chronic pain be treated or alleviated?
A: Treatment options have increased over the years. Pain management specialists and centers are bringing relief to millions of pain sufferers. Those living with pain have access to new medications, advancements in technology, minimally invasive surgical procedures and alternative therapies. However, patients must understand that coping with and managing the pain is a necessary part of their life in order to have a high quality of life.
Q: What non-surgical treatments are available?
A: There are a host of treatment options and medications that can alleviate or help control pain, such as:
- Adjunct meds: This includes anti-inflammatories, muscle relaxers, nerve pain medications, topical compounded creams, or non-narcotic patches. Often any or all of these medications can affect the cause of the problem, not just to “cover” up the pain.
- Opioids: These powerful medications act on receptors within the nervous system to relieve pain. Medications in this class include hydrocodone, oxycodone, morphine, codeine and other related drugs, all of which require a prescription for use. These drugs are very effective in fighting acute pain but certainly have risks associated with their use. Tolerance, dependence, addiction, brain atrophy, cognitive changes, lowered bone density and hormone imbalances are the main concerning risks, not to mention many side effects, as with any medication. Many people use them for chronic pain as well, but literature will support that opioids are not effective in non-cancer long term pain. They should be prescribed and utilized with great respect.
- Steroids and local anesthetics (numbing agents) are often administered together, most often via an injection, but oral steroids can also be prescribed. Steroids ease inflammation, which lowers pain. Trigger-point injections are injected into spasms or “knotted” muscles.
- Epidural steroid injections: These can help with spinal problems such as herniated discs, degenerative disc disease or discogenic pain (pain from the disc. Medication is injected around/ into the affected area of the spine. The benefits can last from weeks to a year.
- Facet injections: These steroid injections target the arthritic joints in neck or back.
- Radiofrequency Ablation: A special needle is heated and inserted near the nerve that is sending pain signals. These are small nerves on the spinal joints, not the nerve roots that make your legs or arms function. The intense heat interrupts the nerve signal, which stops the pain associated with that nerve for approximately eight months to a year. A patient can repeat this treatment if symptoms return, once or twice a year, depending on insurance. The treatment is primarily for neck, mid back or lower back pain. It can also be done for knee pain.
- Physical Therapy: One of the best conservative approaches to help improve and manage pain is to work with a PT. Muscles in the area(s) of pain are targeted, with the goal of increasing strength and mobility, which allows the joints and muscles to work better; therefore, reducing pain. PTs identify weaknesses, imbalances and alignment issues. Patients must recognize that daily stretching/ exercises must continue beyond the therapy visits or acute/chronic conditions may not improve or maintain.
- Alternative therapies: There is more recent research to support the effectiveness of alternative therapies on positively impacting pain. Therapies such as chiropractic, yoga, massage, meditation, sound, acupuncture, acupressure and aromatherapy can also help decrease the stress associated with chronic pain, positively increase sleep patterns, and help create a sense of control. I highly encourage patients to be open to complementary treatments, if appropriate.
- Behavioral Counseling: Pain affects every aspect of life. It affects quality. It impacts relationships. Coping and managing skills are necessary to function in a healthy manner. Anxiety and looped thinking can manifest in the life of a person living with chronic pain. There are many in the community that work with pain patients to help them achieve a better quality of life. Cognitive Behavior Therapy, Biofeedback, EFT, Mindfulness Based Stress Reduction are some therapies as well that can be utilized with the therapists help.
These two options are more invasive and performed by subspecialists:
- Medication pump: For longer-lasting relief, a medication pump is implanted, where it delivers a slow drip of medication. The pump is programmed to automatically release the medication as prescribed.
- Spinal Cord Implant: This option is often for failed back syndrome (chronic pain despite surgery) or patients who have pathology but may not be able to undergo or recommended to have spine surgery. Leads are guided into the spinal canal under x-ray guidance and for 5 days or so, you can determine if there is positive impact on your pain. These leads are removed in the office without pain. If you desire to proceed, the implant can be done outpatient surgery or more invasive and overnight stay.
“I have come to appreciate the uniqueness that each patient presents with. Their injuries, illnesses, response to them, coping mechanisms, treatments they have responded to and not, as well as their unique social, biologic and psychologic makeup has made me fully comprehend that no two pain patients are alike. Their treatment plans don’t have to be either.” – Michelle Boyer, PA-C
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