Friend or Foe?
Everyone has experienced some type of pain in their lives. Although a rather unpleasant sensation, in many instances, experiencing pain can be of benefit. Take for example, touching a hot stove with your bare hand. Your instinctual response would be to pull away and hold the area of injury with your hand. This knee-jerk reflex is what protects your body from getting further burned and experiencing higher levels of pain. Or perhaps, you bump your leg or foot into a piece of furniture and automatically start bearing more weight on the opposite leg. Doing so limits any unnecessary extraneous load on that leg, allowing it to heal faster. These are some examples of acute pain and the benefits are clear.
But what happens when the pain lasts longer than it should— unexplained by the stimulus that caused it? When the symptom of pain lasts longer than a 6-month period, it is referred to as Chronic Pain. This is the stage at which pain no longer proves to have any evolutionary benefit. Rather, it can become a hinderance that effects many other facets of your life – including your hobbies, job, and relationships. Chronic pain can even compromise your mental health, presenting in the form of depression, anxiety, and insomnia. If not properly treated, chronic pain can drastically alter your quality of life.
So how can we treat chronic pain? There are a variety of different classifications of medications that can be utilized to address this. However, this is not the only treatment option; non-pharmacological approaches should be utilized as well. But before we go down that route, it is important to be able to identify the different types of pain and how each patients’ presentation of pain can vary.
Diagnosing the difference between acute and chronic pain is broadly based on the length of time the pain is experienced and its correlation to stimulus. Typically, acute pain lasts less than six months in duration and a likely direct cause is identifiable (i.e. trauma, infection, surgery, labor). It is important to note that acute pain is self-limiting. This means that the pain usually decreases in intensity and severity over time. There will be identifying signs of the pain itself on physical exam, including redness and swelling of the surrounding areas, discrete tenderness within a well-defined region, and possible decrease in function of that isolated extremity/region. And as mentioned earlier, acute pain serves an evolutionary benefit.
On the other hand, chronic pain typically lasts greater than a 6-month period, may not have a direct correlation with injury, and often times lasts much longer than the original stimulus. Because of the unrelenting nature of chronic pain, it can become a disease process in and of itself, sometimes lasting months to years with little to no relief. But make no mistake, the sensation of pain is very real to the patient. The signs of chronic pain on physical exam might be much less obvious to the physician.
Four types of chronic pain exist, and it is important to identify them in order to find the right type of treatment with the best patient outcomes. They are as follows:
- Nociceptive Pain – usually as a result of tissue injury or damage – examples include cancer/tumors
- Inflammatory Pain – excessive inflammation caused by the body’s inappropriate response to pain – examples include different types of arthritis, back pain
- Neuropathic Pain – pain caused by nerve irritation – examples include complications of uncontrolled diabetes, alcoholism, HIV
- Functional Pain – pain without an obvious origin – examples include fibromyalgia
In regard to pharmacological interventions, non-nerve related chronic pain can be treated with many categories of medications, including anti-inflammatories, and non-opioid and opioid classes of drugs. Nerve related pain has shown to be more likely to respond to other classes of drugs, including antidepressants and antiseizure. This is why it is imperative for the patient and the physician to identify the exact type of pain their patients are experiencing in order to treat it in a more precise manner.
Non-drug related interventions to address pain are varied and finding the right one can be a trial and error process for each patient. However, it is always best to treat the sensation of pain itself with these interventions before turning directly to medications first. Where appropriate, the following can be utilized: Osteopathic Manipulative Medicine, Physical Therapy, Chiropractic Medicine, Acupuncture, Regular Exercise (possibly with a Personal Trainer), Massage Therapy, Yoga, Tai Chi, Meditation, Pranayama (yogic breathing), Psychotherapy and Journaling. A majority of these modalities are readily available at Strive Total Wellness. Here we will formulate a unique plan for each patient suffering from acute or chronic symptoms and lead them to a pain free life.
