Vail Daily health feature: Cracking the chronic pain mystery
At times, chronic pain can seem like an unsolved mystery, with few clues leading one toward the cause, or the cure, for this pain. Even those in the medical field are unsure why some people experience chronic pain for weeks, months or years, after an injury, while others heal in the standard amount of time
CHRONIC PAIN AND THE BRAIN
Keith McCarroll, physical therapist and owner of Ascent Physical Therapy in Avon, said in roughly 20 to 25 percent of patients with injuries, acute pain becomes chronic. With acute pain, the nervous system sends signals to your brain alerting you of a possible injury. With chronic pain, these signals keep sending the message that you might be doing harm to your body. McCarroll said the idea that chronic pain may be neurotically based may explain why this pain doesn’t go away, even after our physical selves have healed.
“When we have pain for a long time, our brain starts to change how it perceives pain and how our brain produces pain,” McCarroll said. “It becomes more sensitive to that location in the body, and then that pain is a threat mechanism, a protection mechanism. The brain continues to try and protect an area even if the injury may be healed and not a problem anymore.”
McCarroll said back and neck pain are the most common types of chronic pain. Curiously enough, how we think about pain can influence how we experience it physically.
“Forty percent of the healthy population has a herniated back and has no pain,” McCarroll said. “Just because you have this injury doesn’t mean it’s the cause of your pain. Someone with a (herniated) disc may think they need surgery, they need medication and things like that, but a lot of people are walking around with a herniated disc and they don’t even know it.”
Just because your brain affects how you feel pain doesn’t mean those with chronic pain are exaggerating their experiences.
McCarroll said some patients have been told that their chronic pain is “all in their head,” but for them the pain “is 100 percent real; they’re feeling that pain.”
EASING INTO PAIN TREATMENTS
At Ascent Physical Therapy, McCarroll said they’ve seen success in treating chronic pain by educating patients on how pain works, changing their perception of pain and increasing their pain threshold gradually. If someone can only do a certain activity for 10 minutes before feeling pain, the goal is to get that patient to 15 minutes, building up slowly. McCarroll said some with chronic pain have limiting fears that cause them to become less mobile.
“(They think) ‘If I get pain, I’m going to stop’,” McCarroll said. “Over time they become less and less active. The people who go through the pain … and keep themselves doing it for awhile, (we) teach people how to manage that, and what levels are safe for them, without flaring their pain all the time.”
Avon resident Carmen Blanco, 48, pulled her leg while working in the laundry department at her job seven months ago. Blanco assumed the cramp in her left leg and her lower back pain would go away, but the pain continued. After trying medication and physical therapy at another clinic, Blanco was referred to the chronic pain program at Ascent Physical Therapy.
“I wasn’t even able to bend over and tie my shoes; that’s how much pain I was in when I came to (Ascent Physical Therapy),” Blanco said. “Around the fifth or sixth visit, the pain on my left was able to go away, and I was able to tie my shoes and do all the activities that I wasn’t able to do.”
Blanco said while she’s not yet completely pain-free, she feels “a lot better,” and thinks being educated on how pain works helped her heal.
McCarroll said it isn’t necessarily realistic to expect someone to entirely eliminate their pain, especially if they’ve had chronic pain for a long period of time or have other medical issues.
“If they go from a seven out of 10 (on the pain scale) all the time to being a two out of 10 some of the time, that’s significant for them,” McCarroll said.
USING CHI AND CHINESE MEDICINE
While some with chronic pain have success with physical therapy, others turn to alternative health treatments like acupuncture, which also may influence the nervous system. David Hahn, a licensed acupuncturist at All Mountain Sports Acupuncture in Edwards, said acupuncture needles have a more local affect on where someone has pain, but they also might affect the brain.
“(Acupuncture) affects the tissues around where they’re feeling pain,” Hahn said. “Locally it helps improve circulation, but it also works its way back through the nervous system to the brain and influences how the brain perceives pain.”
A 2012 study published in the Archives of Internal Medicine surveying almost 18,000 participants found that acupuncture was an effective treatment for chronic pain. While admitting that acupuncture works, researchers still called it a “highly controversial therapy,” due to lack of biological evidence on how it reduces pain.
Developed thousands of years ago as a part of Chinese medicine, acupuncture is based on the idea that we have chi (also known as qi), or life energy, which flows through our meridian pathways. When our chi becomes blocked or our blood is not moving, pain occurs. Compared to Western medicine, the idea of chi can be hard to grasp, partly because we have no proof it exists.
“Traditional Chinese medicine has a different framework for pain and how the body works,” Hahn said. “There is no way to anatomically show that there’s these meridians and chi in the body, and (see) that chi flowing through.”
GOING ‘UNDER THE NEEDLE’
Hahn said he doesn’t think the question of whether chi exists or not is that important. The key here is that those who use acupuncture to treat chronic pain often see positive benefits and a reduction in their pain. An estimated three million Americans use acupuncture each year, and the most common reason they do so is for chronic pain.
Hahn said typically the longer someone has chronic pain, the longer it takes to lessen or have it vanish completely. Hahn said unlike surgery, acupuncture is a non-invasive treatment with virtually no side effects.
“What have you got to lose?” Hahn said. “Let’s try this out. Once they do surgery, it becomes a challenge. Before you go under the knife, go under the needle.”
In treating chronic pain, there isn’t a perfect treatment that works for everyone, with some responding better to methods like physical therapy, yet others finding that alternative treatments like acupuncture help them heal. Another important thing to remember when treating chronic pain is the placebo effect.
“With any kind of medical treatment, there’s something like a 30 percent placebo (effect),” McCarroll said. “If you gave 10 people sugar pills, three people would say it helped their back pain.”
We don’t know if chronic pain is more about mind over matter, or if there are other biological factors at play. What we do know is that for many, chronic pain feels real and can prevent us from doing many of the activities we enjoy. We also know that even if there isn’t one miracle cure, chronic pain is treatable, and there are many methods one can try to go from being in pain to feeling good again.
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