ACUTE VERSUS CHRONIC PAIN

CHRONIC PAIN

Chronic pain one is of the most costly health problems in North America. Estimated costs, including direct medical expenses, lost income, lost productivity, compensation payments, and legal charges, are approximately $90 billion a year. The following statistics are startling:

• 48 million Americans suffer from chronic pain.

• Over 21 million Americans routinely take prescription painkillers and also spend $3 billion on over-the-counter analgesics.
• Over 13 million Americans cannot perform routine activities because of pain.
• Fourteen percent of employees take time off from work because of pain.
• As many as 45 million Americans have chronic, severe headaches that can be disabling.
• Arthritis pain affects more than 40 million Ameri­cans each year.
• The majority of patients in intermediate or advanced stages of cancer suffer moderate to severe pain. (More than 1.2 million new cases of cancer are diagnosed each year in the United States, and more than 550,000 people die from the disease.)

Lower back pain is one of the most significant health problems in the United States, with back pain being the most frequent cause of activity limitation in people younger than 45 years of age: 65-80% of all people have back pain at some time in their life.

Although pain is a major problem in this country, it is not treated compassionately or efficiently, and it is not just pain that is the problem. The side effects of chronic pain illnesses caused by a sedentary lifestyle, seclusion and depression, and, in some cases, addic­tion to pain killers can be just as devastating as the pain itself.

All pain, whether chronic or acute, physical or emotional, is recognized, interpreted, and acted on by the brain. We may feel the pain in our toes when we stub them, but the recognition, interpretation, and reaction to the pain occur in the brain.

This is how it happens: sensory neurons (special nerves throughout the body) react to pressure, mechanical trauma, heat, cold, and other stimuli. They also respond to prostaglandins, histamine, and other chemicals released by injured or inflamed body tissue. Whether sensory neurons are stimulated depends on how powerful, prolonged, and widespread the heat, pressure, or other stimulus is. When sensory neurons are stimulated, the nerves fire, sending off messages that travel along the nervous system to the brain. In the brain, the pain information is rapidly evaluated, and orders are issued: "Yank your hand away from the hot stove!" or "Stop hitting your thumb with the hammer!"

ACUTE PAIN VERSUS CHRONIC PAIN

As a rule of thumb, physicians know how to treat acute pain quite well, but are not as skilled at helping people who suffer from chronic pain, because the cause of acute pain is often clear and easy to find, although the cause of chronic pain can baffle even teams of specialists.

Acute pain is the type of pain that tells you that something is harming or about to harm your body. Acute pain lets out a three-alarm warning when you accidentally put your hand on a hot stove; it makes you rush to the hospital when your appendix is about to rupture; or it forces you to leap to your feet when you sit on a thumbtack. Frequently, traumatic pain of this nature will respond to rest, ice, elevation of the affected part, and the judicious use of over-the-counter preparations or more natural agents such as homeopathic Arnica for tissue damage. Sometimes more potent medications are required, but only for a short period of time.

On the other hand, chronic pain may be a dull ache that never goes away like a vise squeezing our heads, a sword piercing our abdomens every time we move a certain way, a sharp knife stabbing our backs, or a hammer smashing our hips with every step. Chronic pain seems to have no reason to exist other than to vex us. Sometimes we can determine the causes of chronic pain: for example, cancer of the pancreas that has spread to the back, but often we are puzzled because the original con­dition has healed, and the pain should have vanished.

Modern medicine has devised many methods of attacking pain. Doctors have pain-killing medicines, sedatives, antidepressants, muscle relaxants, and anticonvulsants. They can inject substances into the body to "block" the nerves and prevent transmission of pain signals to the brain, and they often perform surgery—especially on persons with back pain, but none of these approaches is 100% successful and safe.

This protocol examines individual treatments, supplements, and other methods of pain relief on an individual basis. Indeed, most research involves taking one single, potentially therapeutic item and testing for its efficacy. However, particularly in the area of natural treatments, it is not a single item that does the job, but rather a synergy between different treatment modalities. This is true of all disease, but it is particularly true of chronic pain that can have so many precipitating factors and changing features.

The nature of pain is subjective and each person will perceive pain in his or her own particular way, sometimes as a result of prior experience and exposure to pain. To assume that one method will help your pain is probably naive. A combination of factors is much more likely to help. Pains that are muscular or skeletal in origin tend to respond well to treatments that relax muscles. These would include diverse modalities such as acupuncture, trans-electrical nerve stimulation (TENS), Reiki, therapeutic touch, all types of massage, hydrotherapy, self-hypnosis, yoga, Feldenkrais, and so forth. However, pains that are neurogenic in origin (when nerves have been damaged or cut) may respond less well to soft tissue techniques such as Reiki, therapeutic touch, and massage and more positively to acupuncture, nerve blocks, or treat­ment with opioid medications.

How should a person with a chronic pain condition approach healing using alternative or conventional methods? Many people with chronic pain conditions will be less than optimally nourished as a result of eating the standard American diet—consisting mostly of excess sugar, fat, and salt. Improving the diet would be a very good beginning. If chronic pain is due to an underlying condition of inflammation (such as in arthritis), then the supplements listed in this protocol that are anti-inflammatory will probably be beneficial. This is where essential fatty acids, ginger, borage oil, green tea, curcumin, and other anti-inflammatory mediators will be successful. These natural anti­inflammatories work best when combined with a healthy, natural-based diet.

If your pain is musculoskeletal in origin, it is essential to consider therapies such as biofeedback, massage, hypnosis, physiotherapy, acupuncture, magnetic therapy, and others. Exercise is an important part of any therapeutic regime, but in some cases it may exacerbate a pain condition. Over-the-counter preparations may be helpful in acute pain, but may not be strong enough for pain that is chronic. Prescription medications may be required in addition to other approaches. Whatever therapy you decide to use to help your pain condition, you must first discuss it with your primary healthcare provider.

Some people will opt to try one thing at a time, so that they can decide what impact each therapy is hav­ing on the condition. Other people will decide to use many modalities at once and are unconcerned with which particular one is beneficial. If your primary health­care provider is supportive of alternative therapies, he or she will be able to advise you whether different modalities will be compatible with your current ther­apy. If, as is often the case, your primary provider is unaware of alternative therapies, then you may need to elect a complementary care provider to assist with your future plan for healing. This could be anyone from a knowledgeable friend to a therapeutic complementary care provider such as a massage therapist. Above all, you need someone who can support you in your journey toward wellness and relief from pain.

During the past few years, it has been recognized that despite extensive progress in the scientific understand­ing of pain in humans, serious mismanagement and under-medication in treating acute and chronic pain is a continuing problem. Physicians are strongly influenced by their percep­tions of drug regulatory agencies, fearing censure or delicensure for over prescribing opioids. In this survey, over 50% of respondents believed, incorrectly, that addiction is a common result of legitimate prescrip­tions. They also believed that requests for increased prescriptions were a result of increasing tolerance or addiction to the analgesic rather than a result of unrelieved pain. A disturbingly high percentage of physi­cians showed negative psychological traits such as authoritarianism, intolerance of ambiguity, and reliance on technology regarding patients with chronic pain.

80% of new products approved for clinical use each year in developed countries provide no advantage over existing treatments. Only 2% of new drug treatments offer a real advance to patients and 5% provide minor benefits.

The perception of pain is a very individualized experience. No one person can have the experience of another person's pain. As a result, mind/body approaches are an integral part of any pain relief program. These approaches may include, but are not limited to, hypnosis, biofeedback, guided imagery, meditation, and yoga. Because of its very personal nature, the spiritual aspects of pain relief play an important role as well. Beliefs about oneself and maintenance of hope are very important in the production of any effective pain management process.