Monday Medical: An integrative approach to chronic pain
For Steamboat Pilot & Today
Editor’s Note: This is first part of a two-part series on an integrative approach to treating chronic pain. Part 2 covers the role of behavioral health in addressing chronic pain.
Pain is a normal response to an injury or illness: it’s your body’s way of letting you know that something is wrong.
But sometimes, even after the injury or illness heals, the pain continues, becoming chronic pain.
To effectively treat chronic pain, it’s important to tap into a wide variety of tools with an integrative approach.
Below, Dr. Brian Siegel, a pain management physician at UCHealth Pain Management Clinic in Steamboat Springs, outlines what you need to know about chronic pain and how intervention techniques can help.
Consistent pain that lasts longer than three to six months is usually considered to be chronic pain. This pain can be experienced even after the original injury or illness has healed, and there’s no longer evidence of tissue damage. Sometimes, a patient will have chronic pain without a specific injury or illness.
What can cause chronic pain?
“It can happen to anybody,” Siegel said. “It can be set off by an insignificant accident or a significant accident, or it can be a post-surgical syndrome in which someone’s pain continues beyond the surgical procedure.”
The nervous system, which helps detect and communicate sensations such as pain to the brain, can sometimes go awry, interpreting pain when it shouldn’t.
“There’s plasticity in the nervous system, and it can get turned on to process nonpainful events as being painful,” Siegel said.
The condition can be excruciating and can affect all aspects of a patient’s life, but it can be managed or treated.
“What we want to do is turn those processes off and reset the nervous system,” Siegel said. “Then we add in the physical therapy and cognitive therapy that’s needed to make the person whole again.”
While there is a role for pain medications in addressing chronic pain, the goal is to provide other treatments, so that, eventually, pain medications are not needed.
“We need interventions that deal with psychological aspects, such as the interpretation of what’s going on in someone’s body, to help them relearn what’s going on with their pain,” Siegel said. “There is a role for pain medications in chronic pain, but they need to be used wisely.”
If a nerve gets stuck in a pattern of messaging pain, it needs to be unstuck.
“Intervention techniques can quiet nerves so people can get into physical therapy and reach a more functional place,” Siegel said. “It’s like hitting the reset button.”
A doctor first identifies the specific nerves causing the chronic pain, then determines which treatments will be most helpful. For instance, a problem nerve can be turned off for 12 to 18 months through a needling procedure. And through neural stimulation with electrodes, complex pain from the arm or leg can be blocked.
For patients who have been prescribed larger doses of opiates for longer periods of time and who will likely need opiate medications to manage their pain long-term, an internal medication delivery system may help.
“A dose in the spinal space is three-hundredths of the dose taken orally,” Siegel said. “We can use a lot less medication and get the same positive results. And it’s a lot safer for the patient, as there’s no potential for abuse or overdose.”
Once a nerve is quieted, it’s important for a patient to work through other treatments, including behavioral health.
“These treatments work together,” Siegel said. “And the message should be that people should come in earlier rather than later. When people are struggling, they should know there’s a multi-modal, integrated way to address pain.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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