An Epidemic of Pain

You hit your little toe on the coffee table and your world stops. Agonizing, shooting pain that makes you double over and curse like a sailor. This is a transient pain. You walk it off and you go on. But, what happens when the pain stays? When it’s stuck to you like a shadow?

100 Million Americans suffer from chronic pain according to the American Academy of Pain Management. Compare that to 11.9 million suffering from cancer. According to those numbers, if I know 2 people with cancer I probably know 16 with chronic pain. [1] Those cancer patients could be part of that number, because chronic pain is not an isolated condition. It can be its own disease or be a comorbidity with cancer, diabetes or heart disease. 

 Stats provided by the American Academy of Pain Medicine [ 1 ]

Stats provided by the American Academy of Pain Medicine [1]

When I started at SCNM I was super excited about learning to fix dysbiosis, hypothyroid and autoimmune disease. I was fired up to get people healthy with diet modification, sleep and exercise. But, my supervised clinic shifts exposed me to patients in pain. Forget exercise and clean eating, these patients hurt too much to sleep. And their chronic pain affects them mentally to the point of depression.

We have a specialty within the medical profession that treats pain, and they are not very good at it. They can suppress pain easily with a narcotic drug or even neuron ablation. Is that really removing the obstacle to health?

I know we can’t always wait for nutrition and exercise to eliminate pain. If someone breaks their femur they should be given morphine or if your bones ache because of chemo you should get pain medication. No one deserves to be in pain. Even Pain Centers with the bad reputation for being “Pill Mills” are needed, someone has to manage these patients.

My gut feeling is that standard pain management is only addressing the symptom. For the most part, they never get to treatment plans including restorative exercise, sleep and nutrition. When medical training shuns or shies away from therapies that are not pharmaceutical or surgically based, it creates a system that has limited tools. These tools come with serious consequences. Entire states and whole communities continue to have problems with addiction, and drug monitoring programs are not helping. [2] 

One day while driving to the store, I was listening to “The Diane Rehm Show” and I hear this:

 Diane Rehm Show: Tuesday, July 28th 2015

Diane Rehm Show: Tuesday, July 28th 2015

Stacy is a decorated veteran and addicted to heroin. She says during her call “I am not stupid.” She clearly knows shooting heroin is a bad situation. She’s trapped in a web of failed interventions. When another panelist asked her to go to the nearest detox clinic Stacy said, “I don’t have insurance.” At that point, I pulled over to the side of the road, blood boiling and chills running down my spine. I was upset, and I still am. But I don’t want to stop at upset; I want to do something about it. Do me a favor, go listen to the entire episode.

Most of the people coming to get help at my school’s pain center have some level of “disease of civilization” (stress, insulin resistance, obesity) I have been following the Paleo community for a long time, and I have seen a ton of N=1 subjects transform their lives by quitting wheat, avoiding sugar and ditching seed oils. Paleo can help patients with chronic pain. How do we get a patient in debilitating pain into these major lifestyle changes?

I’ll get flack for looking for answers to this chronic pain stuff outside of what uptodate.com or other Evidence Based Medicine databases recommend as standard practices. But guess what folks, the stuff that is being recommended is not working. The standard treatment for plantar fasciitis starts by prescribing an NSAID for a couple of weeks, and if that doesn't work inject some glucocorticoids. If the patient continues feeling pain then surgery. If surgery doesn't work, what's next opioids? And when the patient depends on opioids to control their pain, and then get labeled as addicts or worse become heroin addicts whats the next step? [4]

Modalities such as physical manipulations [5], acupuncture [6], mind-body medicine [7], injection therapy [8], e-stim [9] and myofascial massage [10] are all effective practices that are looked down on by conventional MDs. Are they panaceas that will cure chronic pain 100% of the time? Sadly, no. Just like Paleo, we need to identify what is applicable to the situation and use a combination of interventions when indicated, and under the supervision of a medical professional. We can use this complementary approach to get a person out of pain and most importantly off of pain medication. In the coming weeks I’ll write more on each of those techniques.

I am not talking about flushing your pain meds and starting CrossFit. I am not talking about going to Whole Foods and pounding down the turmeric or fish oil supplements. I am talking about questioning the status quo and learning about the other options that are available. Treating the pain wheather naturally or with medication buys you time, it can get you back to work it can help with quality of life. This is not the solution. Using the most gentle pain interventions while continuing to  remove obstacles to health is the answer to our chronic pain epidemic.

References: 
1. Available at: http://www.painmed.org/patientcenter/facts_on_pain.aspx#incidence. Accessed April 23, 2016.
2. Maughan BC, Bachhuber MA, Mitra N, Starrels JL. Prescription monitoring programs and emergency department visits involving opioids, 2004-2011. Drug Alcohol Depend. 2015;156:282-8. 
3. Fletcher CE, Mitchinson AR, Trumble EL, Hinshaw DB, Dusek JA. Perceptions of other integrative health therapies by Veterans with pain who are receiving massage. J Rehabil Res Dev. 2016;53(1):117-26. 
4. Rubinstein SM, Leboeuf-yde C, Knol DL, De koekkoek TE, Pfeifle CE, Van tulder MW. The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study. J Manipulative Physiol Ther. 2007;30(6):408-18.
5. Garland EL, Froeliger BE, Passik SD, Howard MO. Attentional bias for prescription opioid cues among opioid dependent chronic pain patients. J Behav Med. 2013;36(6):611-20.
6. Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain. Ann Intern Med. 2005;142(8):651-63.
7. Cherkin DC, Sherman KJ, Balderson BH, et al. Comparison of complementary and alternative medicine with conventional mind-body therapies for chronic back pain: protocol for the Mind-body Approaches to Pain (MAP) randomized controlled trial. Trials. 2014;15:211.
8. Sanderson LM, Bryant A. Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review. J Foot Ankle Res. 2015;8:57. 
9. Jauregui JJ, Cherian JJ, Gwam CU, et al. A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Surg Technol Int. 2016;XXVIII (E-Stim)
10. Kumar S, Beaton K, Hughes T. The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews. Int J Gen Med. 2013;6:733-41.