Monday Medical: Understanding chronic pain
Editor’s note: This is the first part in a three-part series on managing and treating chronic pain. Part two will focus on how injections can provide relief, and part three will look at how complementary therapies such as acupuncture, physical therapy and massage therapy can also help.
While many people feel occasional physical pain, some people experience such a level of super-charged discomfort that it impacts their ability to work and perform daily tasks. It can also negatively affect their relationships, and mental and emotional health.
However, finding the correct treatment for chronic pain is possible and can greatly improve the quality of your life, pain experts say.
“If chronic pain is a constant in your life, it’s all you think about,” said Heather Hack, a board-certified family nurse practitioner at the UCHealth Pain Management Clinic in Steamboat Springs. “It interferes with everyday actions, work and social life. People with chronic pain can develop depression, anxiety and lack of sleep. They can start to feel hopeless about ever getting better.”
Frequent chronic pain diagnosis
Chronic pain is typically defined as unresolved pain lasting for more than three months despite medication and treatment. If you are suffering from chronic pain, a good first step is to be seen by a primary care physician to determine the cause of the pain. A treatment plan can then be developed that includes appropriate referrals, if needed, and pain management techniques.
Nearly one of every five Americans suffer from chronic pain. The causes of chronic pain are varied, and can originate from a number of sources, such as:
- Injury or accident.
- Bone cancer or cancer pressing on nerves or organs.
- Complex regional pain syndrome.
- Nerve damage from diabetes.
- Prior surgery.
- Arthritis in the spine or joints.
- Fibromyalgia, a chronic condition characterized by muscle tenderness.
Hack said she also sees a fair number of patients who have developed chronic pain from work-related duties that include repetitive tasks, lifting, bending and dealing with heavy machinery.
Chronic pain treatment options
These days, pain specialists rely much less on prescribing opioids, using them only in a limited capacity and in conjunction with other treatment options. Rather, Hack and her colleagues favor a holistic approach that encompasses other types of medications, targeted injections, physical therapy, acupuncture and massage therapy.
Reducing a reliance on opioids is important, as in addition to their addictive quality, they can cause opioid-induced hyperalgesia which increases the level of pain that a person experiences.
“Your body then thinks it needs more opioids to manage the pain, and it becomes a vicious cycle,” Hack said.
Long-term use of opioids is also associated with hormone dysfunction, abnormal heart rhythms and increased risk of bone fractures.
“We prefer to use other alternatives that are more curative, actually treating the pain rather than just covering up the pain.”
Hack said the goal for patients is to reduce pain by 70% to 80%.
“While we may not be able to completely eliminate pain, we can reduce it so people can be functional and have better quality of life,” said Hack, adding that some people “graduate” from the pain clinic and never return, while others need to come back periodically. For instance, someone may need to come back for steroid injections that might last six months.
Hack said it’s important for the pain management team to collaborate and develop an individual treatment plan for each patient to maximize success. It is key to review a patient’s medical history, do an exam, ask about previous treatments and determine overall commitment to therapy when determining a treatment route.
An integral element for some patients is addressing the psychological element of pain. That might include a patient working with a behavioral health specialist to explore the connection between emotion and pain, with treatment ranging from relaxation techniques to goal setting and education.
“Chronic pain affects the whole person,” said Hack. “There are many options and treatments that can really diminish the level of pain a patient may be experiencing and make a big difference. We want to give people back their lives.”
Mary Gay Broderick writes for UCHealth. She can be reached at firstname.lastname@example.org.
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