Editor’s note: This is the third part of a three-part series on managing and treating chronic pain. Part one focused on understanding chronic pain. Part two focused on how injections can provide relief.

A patient seeking relief from chronic pain may feel relief from physical therapy, massage therapy and acupuncture as stand-alone treatments or in conjunction with each other.

When treating a patient with chronic pain, “the patient and their providers ideally work as a team to figure out what will be the most successful approach, and that will look different for every person,” said Devra Reiman, a physical therapist at UCHealth SportsMed Clinic in Steamboat Springs.

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Chronic pain is typically defined as ongoing pain lasting for more than three months as opposed to acute pain from an injury or an accident that resolves more quickly. What is important to know is that chronic pain does not mean that the injury has not healed properly.

Physical therapy

Reiman and other physical therapists work with patients to create an individualized program starting with education and then exercise, functional movements and hands-on therapy as ancillary treatments.

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Education and movement are vital to teach patients how “to tap into their naturally occurring positive chemicals,” said Reiman. Physical therapy has extensive evidence to support its use in resolving chronic pain.

Ultimately, pain is created in the brain based on threat and because of this, “as long as you think something is wrong, it’s going to hurt,” she said. Education is foundational to help demystify pain to help reduce threat and therefore reduce pain.

Massage therapy

“If a body can’t relax and engage the parasympathetic nervous system, it can’t fully heal,” said Monica Schwaller, certified massage therapist at UCHealth Integrative Medicine Clinic in Steamboat Springs. “When people have chronic pain, it’s almost like their body is their enemy; they don’t trust it anymore, and they don’t feel comfortable in their body.”

That’s when massage therapy can help.

When patients arrive saying, “everything hurts,” Schwaller can use massage therapy to help track the source, such as a knotted muscle or tissue that creates a sort of spider web or pain referral pattern that transfers the pain throughout the body.

By applying direct pressure on the “trigger point” and through massage, the pain can be eased, she said.

“To have a therapist and a modality that provides comfort in the moment is so important for patients in a lot of pain,” said Schwaller, adding that she sees people with spinal injuries and knee and joint injuries as well as those who have scar tissue and nerve damage from prior surgeries.

“Offering people a window of time where they can just ‘be’ while receiving caring, empathetic touch can offer physical, mental and emotional relief from their pain,” she said.

Acupuncture

Acupuncture entails the use of tiny needles that are inserted at specific spots in the body. Stimulating these points increases circulation of lymph, blood and body fluids and can reduce inflammation.

It also sends signals to the brain to release endorphins, which act as natural pain relievers, as well as neurotransmitters including serotonin and dopamine. This all contributes to a feeling of wellbeing, said Lisa Thornhill, a licensed acupuncturist at UCHealth Yampa Valley Medical Center.

“Acupuncture can treat a multitude of conditions, but it’s most famous for treating pain,” she said. “It is especially useful for patients with chronic pain who are often stressed because of their diagnosis. Stress can aggravate their pain because it causes their muscles to tense and triggers the release of cortisol, which can cause more inflammation. Acupuncture stimulates the vagus nerve, which activates their parasympathetic nervous system to help shift them from a state of ‘fight or flight’ to one of ‘rest and digest.'”

Thornhill said it can take up to three sessions before patients notice a difference. Since it’s a natural approach, you won’t get instant results as if you had taken pain medication. She urges people to be patient and to keep an open mind.

“As part of a pain management treatment plan, it can really make a difference and be another tool in your kit to fight pain,” she said.

Mary Gay Broderick writes for UCHealth. She can be reached at marygaybroderick@comcast.net.