Pain is a fact of life, and oftentimes a useful one at that. While it’s a partner we generally tend to loathe, pain is a partner that saves lives. It’s often through pain that people first become aware that something is wrong in their bodies, and it’s through following the pain that many physicians diagnose countless patients and often catch diseases that would otherwise end their lives. Pain gives us the natural apprehension and caution necessary for injuries to resolve themselves and heal.
But pain can be misleading, superfluous, or unnecessary. By far the most patients who come into a doctor’s office are those worried about the pain they’re experiencing. And more and more Americans are finding themselves struggling and complaining about chronic back pain, problems with the knees and hip, and neck injuries. Meanwhile, thousands of Americans struggle with pain due to genetics and various diseases, from disc degeneration to fibromyalgia, and everything in between.
To tackle these challenges head-on, the medical community needs to build an encompassing understanding of the nature of pain, the many shapes and forms it takes on, and the various methods through which pain can be diagnosed and treated.
The Challenges of Approaching Pain
Pain is a sense, much like our other senses, and it is typically triggered when nociceptors in the body react to physical stimuli. For example, if you fall over and break a bone, the damage done to the body will send a severe pain signal to the brain, letting you know that something has gone terribly wrong and requires your immediate attention. This may be dulled at first by a sudden rush of endorphins and adrenaline, which numb the pain somewhat.
Nociceptive pain can be somatic and visceral, with somatic pain being either superficial or deep. Superficial somatic pain is main in the outer “layers” of the body, mostly our skin and membranes (such as the inside of the mouth). Deep somatic pain is pain in the muscle tissues, bones, tendons, and so on. Visceral pain, on the other hand, is organ pain – such as a stabbing feeling in the heart, searing lungs, pain in the bowels, etc.
Pain can also be neuropathic. Neuropathic pain is caused either by damage to the brain and central nervous system, or by damaged nerves and nerve endings. While neuropathic pain is often accompanied by an underlying tissue injury at the root of it all, or some other source, it can sometimes arise without the presence of painful stimuli, or long after an injury has healed.
Pain is treated pharmacologically, psychologically, physically, and socially. Approaches have to take into account the fact that pain is a complex issue that changes very quickly and determining the exact cause of pain can be difficult in certain cases. Modern pain management specialists don’t lean immediately towards the narcotic option, because of the adverse risks associated with skipping straight to opioid medication. Over-the-counter medication can help with certain forms of pain, but most of the time, it takes more than an anti-inflammatory to help a patient feel better. Interventions, both the surgical kind as well as different non-invasive interventions, are key. Active interventions call for patients to participate directly in the treatment process (including alternative and complementary medicines like physical therapy, yoga, and stretching), while passive interventions require no input from the patient (injections, acupuncture, massage therapy, and surgery).
Patient care, as well as psychotherapy, play a part in reducing pain through the psychological aspect. The way a patient is treated can have an impact on their pain. A low mood and depressive symptoms can often arise from long-term and chronic pain and can further complicate a patient’s case as these moods are also linked to increased perception of pain.
Every Case Is Unique
When patients experience pain, their personal perception of pain is unique. Some patients feel pain very differently from others, and pain tolerance is bound to a very long list of factors that may determine how a person perceives and manages their pain, including mood, culture, overall physical health, and more. Furthermore, the effects of pain, as well as the duration of the pain, can differ from case to case. And finally, patients respond differently to different types of treatment to pain. While everyone responds positively to treatments that tackle and resolve the root cause of the pain, recovery time is individual, and not every pain has an immediate and obvious root cause that can be fixed within a short period of time.
This ultimately highlights the most challenging problem when tackling pain as a medical issue: it’s very individual. This is why collaborative pain strategies are necessary, working with experts throughout different medical professions to develop a plan of action that considers a patient’s history, as well as all biopsychosocial factors. Most importantly, pain management needs to incorporate the wishes and thoughts of the patient. Working with patients is just as important as working with other medical professionals, especially when the issue at hand is something as individual as pain.
Working with Pain Management Patients
The only way to accurately determine whether a course of treatment is effective is to consult with the patient directly. Patients need to communicate to their doctors how they feel, and whether they feel better or worse, as well as how their condition has changed. Clear and effective communication between a patient and their physician is crucial for the management and elimination of pain over the long-term.
By interacting with patients, pain management specialists can also discuss treatment options and determine what course of action works best in the patient’s favor. Pain management is not a matter of getting a formulaic checklist of treatments and working your way down from A to Z – it’s important to organize treatments in such a way that time and resources are spent efficiently and effectively to help the patient find relief, without wasting their time, energy, or financial resources.
Integrating Contemporary Medicine with Complementary & Alternative Medicine
Integrative pain management requires the collaboration between specialists from different practices to come together in benefit of a patient’s healthcare. While the modern approach includes a variety of pharmacological and non-pharmacological options, it may be wise to incorporate or consider other forms of pain management including chiropractic medicine, acupuncture, yoga, spiritual guidance, journaling, and psychotherapy among others.
While some studies seem to suggest there are benefits to prescribing acupuncture in lieu of massage therapy, others contradict these findings. Yet even while alternative medicine seems to be backed on limited data or anecdotal findings, it may benefit some patients to take a collaborative approach on pain management, taking into account what a patient feels and wishes for, and communicating clearly and effectively with patients to choose treatment options, follow-up appropriately, and determine the best path forward.