Living with Chronic Pain: Pain Management Techniques to Try

Chronic pain patients need pain management that treats not only physically but also mentally. From therapy to acupuncture, find out some methods to try here.

A woman holding her shoulder with one hand; a painful facial expression

Whether it’s a paper cut or twisted ankle, everyone has felt pain one way or another at some point in their lives. Now imagine if that aching feeling wouldn’t disappear no matter how many pain management techniques you try. That’s pretty much what chronic pain patients must endure every single day. 

Since people living with the condition don’t show any apparent signs of illness, some of them have been brushed off by doctors who consider their pain a mere psychological issue. Thus, many dubs chronic pain an “invisible’ disability” that hinders a person from receiving treatments. 

Fortunately, there has been some progress as well. Studies have been made to figure out the cause of chronic pain. Western doctors have also worked together with Traditional Chinese Medicine (TCM) practitioners to develop better pain management. Read along as we discuss chronic pain and its treatment options. 

The Definition of Pain 

According to the International Association for the Study of Pain (IASP), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. At times, the pain stays for a long time, developing into chronic pain. 

Chronic pain is pain that persists or recurs for longer than three months. You shouldn’t confuse it with acute pain, which duration is less than three months. Unfortunately, chronic pain can affect any part of the body. Many have reported feeling pain in their back, hip, knees, and foot — even periodic headaches — from time to time. The Centers for Disease Control and Prevention reports 50.2 million people live with chronic pain in the U.S. 

Causes of Chronic Pain 

Chronic pain can be divided into two. When chronic pain is a symptom of another disease, like cancer, it’s called “chronic secondary pain.”  

However, there is a kind of pain that seems to surface out of nowhere, becoming a disease on its own. Or sometimes, it comes from an old injury, yet when the wound heals, the pain remains. When this happens, it’s called “chronic primary pain.” Both types can co-exist. 

Studies have been conducted to discover the reason chronic primary pain occurs. The answer seems to lie in the brain, although differing opinions exist. A 2021 study claims there are chemical imbalances in the brains of chronic pain patients. They have reduced levels of two neurotransmitters, namely y-aminobutyric acid (GABA+) and glutamate, in the medial prefrontal cortex or the part of the brain involved in emotional processing (limbic system). 

Another 2021 study reveals chronic pain has neuroplastic nature. Neuroplasticity is defined as the ability of neurons to alter their structure and function in response to internal and external stimuli. In other words, the brain can learn how to react. By stating that chronic pain is neuroplastic, the study believes the condition is caused by the brain’s misfired attempt to protect against danger. 

Whatever the actual underlying cause is, it must be borne in mind that chronic pain is a real disease. When it goes untreated for a certain period, chronic pain can trigger substance abuse and mental disorders (depression, anxiety, post-traumatic stress disorder, somatoform disorders). 

Pain Management 

A woman smiling while lying face down and getting acupuncture treatment on her back
Acupuncture is part important to stop patients from suffering mentally too.

Chronic pain is not curable but manageable. Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders, Substance Abuse and Mental Health Services Administration (SAMHSA) notes treatments should focus on reducing pain, maximizing function and improving quality of life. 

Here are some pain management methods: 

Painkillers 

National Health Service (NHS) recommends using over-the-counter painkillers considered relatively safe such as paracetamol and ibuprofen. 

SAMHSA also lists some other non-addictive painkillers. They are: 

  1. Serotonin-norepinephrine Reuptake Inhibitor (SNRI), a kind of antidepressant.
  2. Tricyclic antidepressant. May have anticholinergic side effects (dry mouth, constipation, eye-related symptoms, increased heart rate and urinary retention) and orthostatic hypotension (a form of low blood pressure).
  3. Anticonvulsant or antiseizure medication.
  4. Topical pain relief, like herbal plasters.
  5. Antipsychotic, mostly to eliminate migraine or headaches. Side effects are tremors and metabolic syndrome. 

Therapies 

Suggested therapies for chronic pain include: 

1. Physical Therapy 

NHS says that physical therapy can help patients move better, relieve their pain and make daily tasks easier. This physical therapy can be delivered by a physiotherapist, chiropractor, osteopath or occupational therapist. 

2. Cognitive Behavioural Therapy (CBT) 

SAMHSA writes that CBT or talking therapy can improve chronic pain and its psychological implications such as distress, depression, anxiety, etc. It also helps patients with coping, functioning and sleep. 

3. Pain Reprocessing Therapy (PRT) 

As mentioned above, this psychological therapy is based on the 2021 study that concluded that chronic pain is neuroplastic. The treatment works by making patients reconceptualize their pain as a non-dangerous brain activity rather than a peripheral tissue injury. 

Acupuncture

Evidence shows that TCM, particularly acupuncture, is effective in managing pain. The ancient art of acupuncture works by inserting fine needles into specific acupoints. This is to stimulate de-qi sensation, which will alert the pain matrix in the brain. In doing so, the brain will release endorphins and serotonin to eliminate the pain chemicals. The best part? The pain-relieving effects of acupuncture could also be long-lasting. In fact, a study in 2017 shows that the treatment effects of acupuncture persist over time.

While the aim of TCM and Western treatments in chronic pain is generally the same, the approach is different. Acupuncture focuses on correcting any imbalances in the body to reduce inflammation and nerve dysfunction.

Acupuncture may also work as a supplementary treatment. Physician Wong Si Xuan, from Eu Yan Sang clinic, Singapore, says that patients usually undergo Western medicine first before getting acupuncture. She also explains that acupuncture reduces pain through the stimulation of meridians, thereby improving the flow of qi and blood circulation at the affected area.

A 2016 study discovers that the combination is superior to acupuncture alone and Western medicine alone. Several studies have also examined the immediate analgesic effect, as early as 30 minutes within the first session.

If you choose to undergo acupuncture treatment, seek out a professional TCM physician or acupuncturist.

Lifestyle Changes or Adjustments as Pain Management 

A partial view of a woman burying her face in her hands
Acupuncture is part of the pain management method.

Daily things patients can do to manage pain: 

1. Consume foods that strengthen bones, for example: 

A. Dairy (milk, cheese)

B. Soymilk with added calcium

C. Green leafy vegetables other than spinach

D. Bread

E. Sardines  

F. Chinese herb morinda officinalis root, which possesses anti-osteoporotic activity. 

2. Stay active 

According to NHS, activities like walking, dancing, yoga, Pilates, swimming and using an exercise bike are necessary to reduce pain and make patients feel more in control.

In contrast, lying in bed all day long would make back pain last longer. This is why NHS advises staying active by being at work. Working can distract patients from their pain, and it may also help them fight depression. 

While chronic pain manifests physically on the patients’ body parts, it can also affect them mentally. That’s why SAMHSA opines that the treatments for chronic pain should also address co-occurring mental disorders. Whether through Western medicine alone or its combination with TCM, the best pain management relieves the aching both on the outside and inside. 

This is an adaptation of an article, “Managing Pain: East-West Alliance”, which first appeared on Eu Yan Sang website.

References

  1. Harvard Health Publishing. 2017. Chronic pain: The invisible” disability  [Accessed 9 January 2022]
  2. International Association for the Study of Pain. 2021. Definitions of Chronic Pain Syndromes [Accessed 9 January 2022]
  3. World Health Organization. 2021. ICD-11 for Mortality and Morbidity Statistics [Accessed 9 January 2022] 
  4. Wolters Kluwer. 2021. Prevalence of chronic pain among adults in the United States.
  5. NCBI. 2021. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. [Accessed 9 January 2022] 
  6. JAMA Network. 2021. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain [Accessed 9 January 2022] 
  7. Wiley Online Library. 2021. Disruption to normal excitatory and inhibitory function within the medial prefrontal cortex in people with chronic pain [Accessed 9 January 2022] 
  8. National Center for Biotechnology Information. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. [Accessed 9 January 2022]  
  9. National Health Service. 2018. Ways to manage chronic pain [Accessed 9 January 2022]
  10. National Center for Biotechnology Information. 2019. Acupuncture for chronic pain: update of an individual patient data meta-analysis [Accessed 9 January 2022]
  11. PubMed. Anticholinergic side effects of tricyclic antidepressants and their management [Accessed 10 January 2022]
  12. PubMed. 2016. Acupuncture combined with western medicine for CP/CPPS:a randomized controlled trial [Accessed 10 January 2022]
  13. National Health Service. 2017. Calcium  [Accessed 10 January 2022]
  14. PubMed. 2009. Inhibitory effects of morinda officinalis extract on bone loss in ovariectomized rats [Accessed 10 January 2022]
  15. Journal of Pain. 2017.  Acupuncture for Chronic Pain: Update of Patient Data Meta-Analysis [Accessed 7 February 2022]

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