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pain journal shows what it takes to self-manage chronic pain


Self-Managing Chronic Pain

“Expert guidelines for non-pharmacologic interventions are backed by strong evidence from randomized trials of the beneficial effects of structured exercise, Cognitive Behavioral Therapy, and complementary / alternative therapies, in contrast to well-known risks of long-term opioid therapy.” From the study being discussed today
Back in February of 2013, Practical Pain Management ran a piece titled Chronic Pain Program in a Primary Care Setting.  Although the article carried an array of interesting statistics, the gist was that we need more pain specialists to manage the catastrophic amount of CHRONIC PAIN here in America.

“There is a shortage of pain specialists with only one for every 21,000 patients. Meanwhile, untreated chronic pain impacts multiple aspects of the patient’s life, leads to depression, anxiety, irritability, emotional frustrations, social avoidance, relationship issues, loss of self esteem and lack of enjoyment of living and, occasionally, leads to suicidal ideation or attempts. Many primary care providers are comfortable treating acute pain due to its short course and usually identifiable cause, however they are much less comfortable treating chronic pain due to the myriad of complexities… such as pain without a clear etiology.”

The article went on to talk about various ways of addressing chronic pain, mostly pertaining to medication — most specifically opioids.  Fast-forward six years, and we are in the throes of an OPIOID EPIDEMIC that is costing our nation over 500 billion dollars and killing nearly 50,000 people each and every year. 

As I showed you (HERE), the pendulum has swung so far back the other way that many doctors are no longer prescribing opioids for fear of government retribution — not having their claims paid, losing their licenses, or even being sent to jail.  Add this to the medical community’s realization that they have no real solutions to most of the chronic health issues they face all day, every day (HERE and HERE), and it’s simple to see why there is a shift taking place in what constitutes the best way to deal with patients struggling with chronic pain.

Google ‘chronic pain self-management,’ and you’ll come up with over 130 million hits.  Today we are going to talk about just one — an article from the new issue of Practical Pain Management titled Self-Management of Chronic Pain in Primary Care.

“Despite the complexity of chronic pain, at least half of all patients receive their healthcare from a primary care clinician. This raises a striking conundrum since primary care practitioners have been found to harbor negative attitudes toward patients with chronic pain, driven by a sense of insufficiency in addressing this patient complaint.  To effectively address the multidimensional effects of chronic pain, patients need self-management training about behaviors, strategies, and activities that may help to control the destructive effects of pain on their quality of life.”

How would you like to have a doctor that harbors “negative attitudes” towards you?  The authors went on to talk about “limited options available to manage common cases of chronic pain,” as well as that fact that both sides of this equation — doctors and their patients — feel “stuck” with their options; both groups typically and unfortunately seeing “increasing medication as the only solution.”  What this has done — which, while not perfect for every person or situation — has forced the medical profession to re-evaluate and abandon many of the practices that got us to this point. 

What this really means for you — the pain patient — is that with doctors increasingly threatened with treatment audits and their careers being taken from them, the burden is increasingly falling on you to step up to the plate and take care of yourself (after all, today’s post is about ‘self care’). Since necessity is the mother of invention (or change), let’s look at some of the self-management tips being promoted by these authors (an MD and clinical psychologist) for people struggling with chronic pain.

  • UNDERSTAND PHYSIOLOGY:  Look; if you don’t have at least a cursory understanding of PHYSIOLOGY, INFLAMMATION, and CHRONIC PAIN (most people think they understand the latter two, but few actually do), getting better is going to prove tough.  Since nothing makes sense, the entire situation, along with everything you try, will seem hopeless.  Knowledge really is power!  The authors also mentioned ‘goal setting‘ under this bullet point.  I would whole-heartedly agree since one of the most important aspects of my protocol is having patients create a PERSONALIZED EXIT STRATEGY for getting out of pain.  And even though it was not mentioned, this is a good time to say something about having a support network of some kind.  Online is great, but I would argue that in most cases, having someone nearby is better.
  • MEDITATION & MINDFULNESS:  While I’m a fan (our family watched a COOL VIDEO on meditation last evening), I have argued that “mindfulness” is all too often an intellectual-sounding, all-encompassing cop-out provided to people in chronic pain.   A recommendation made by practitioners who aren’t really getting to the root of things, or in many cases don’t believe it’s even possible to do so (HERE).
  • BODYWORK:  Although the authors mentioned massage, there are an almost unlimited number of forms of bodywork that can provide amazing results (HERE and HERE are two articles on this topic concerning fibromyalgia).  Although there are people coping with “intractable” chronic pain (CENTRAL SENSITIZATION), I’ve shown you how important it is to work with these folks (HERE, HERE and HERE) because in many cases improvement is possible.  My goal with my patients is not just to manage, but if possible, help provide solutions (THIS is what I’m talking about).
  • STRETCHING, EXERCISE, ADL’S:  I’m a huge fan of using various sorts of physical training to help get people back to performing activities of daily living without suffering every step of the way (these authors specifically mentioned stretching and a STRENGTH / CARDIOVASCULAR COMBO).  Be aware, however, that in many cases, the cart gets put in front of the horse.  Put simply, if people are trying to exercise or stretch areas that are microscopically ‘TETHERED’ by scar tissue, it has the potential to make things worse (HERE, HERE, or HERE).  The more severe the case, the more true this is.
  • HEALTHY EATING PLAN:  Because I would argue that it’s the number one key to solving SYSTEMIC INFLAMMATION (which can greatly help with either local or systemic pain), this bullet should have been number one on the list.  Although I’m not quite sure where to begin since this bullet could encompass several volumes of books, THIS SHORT POST provides a starting point.  It’s important for the chronic pain patient to realize that inflammation always leads to fibrosis (HERE).
  • SLEEP HYGIENE:  Although I’ve talked about this in many posts, probably the most important can be found HERE.
  • COUNSELING:   Several things were mentioned here, including CBT, acceptance therapy, and managing setbacks.  While counseling can be valuable (emphasis on “CAN“), it’s important to have the right kind of counselor.  Many people could benefit from seeing someone who’s mostly Florence Nightingale, with a streak of Sgt Lee “Gunny” Ermey.

The most beautiful part of this plan is that much of it can be done on your own.  Once your FIBROSIS / SCAR TISSUE has been dealt with, even much of the bodywork can be accomplished without professional assistance (HERE or HERE).  For those of you looking to expound on this protocol, HERE it is.  And while there are no fool proof methods for dealing with chronically ill or chronic pain patients, my protocol will at least get you thinking outside the box (which research is starting to show is actually inside the box even though far too many practitioners have not yet come to this realization).  If you like what you’re seeing or feel it deserves to be shared with struggling people, you can reach those you love and value most by liking, sharing, or following on FACEBOOK.


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