Treating Chronic Pain to Improve Function

The following article written by Mel Pohl M.D. in A Day Without Pain is particularly relevant to my practice because many of my clients suffer from chronic pain as a result of a physical injury that they have suffered.  When one suffers from pain the instinct is to reduce activity and cease behavior that causes pain.  With many severe injuries however leading a pain free life is simply not possible, and maintaining muscle and activity is extremely important.

While narcotic pain medication can be effective in reducing the experience of acute pain it is not an effective treatment for chronic pain and frequently creates dependency both emotionally and physically.  Building motivation, hopefulness and a realistic understanding of chronic pain is essential for chronic pain patients to regain control of their lives:

Unlike other injuries, chronic pain is unrelenting, lasts longer than six months, and is characterized by decreased function. The desire to avoid feeling more pain or aggravating the pain one does feel leads patients to avoid movement, which, over time, erodes function. The old “use it or lose it” mantra is definitely applicable here.

It’s understandable that patients with chronic pain fear worsening their pain by moving, but what most people don’t realize is that maintaining mobility is essential if function is to be preserved for the present and the future. Body parts that go unmoved for any length of time eventually become “frozen.” This can happen with the back, the abdomen, the joints (e.g., knees and shoulders), etc. Furthermore, with decreased movement, circulation decreases, scar tissue eventually forms, and pain increases.

The consequences of this are not merely limited to decreased mobility and lingering pain. Avoidance of movement ultimately leads to complete non-function. When people are limited, they may become ashamed of their disability and want to hide, want to do nothing. If I can’t get my shirt on by myself in the morning, why would I want to go out in public and expose any other problems I have to friends and strangers alike? This response to pain, this avoidance, leads to feelings of depression and helplessness that only feed into the cycle of immobility and worsening pain until the patient is entirely non-functioning. This is called the Fear Avoidance Cycle

Now, some people will try to function around all of this by taking drugs. If I go to a physician or a prescriber and I say that my shoulder or back hurts, what will I be prescribed? Painkillers in the form of opioids (narcotics). Many people who take these medications and as a result feel less pain assume that their treatment is working for them. Successful treatment of chronic pain must include improvement of function as well as reduction of the level of pain.

When people whose only treatment has been medication to reduce the pain come to treatment at my center, I notice that their function is deceased and they are sleepy, less active, and cognitively impaired. This lethargy affects all aspects of their life, from digestion to social interactions. We see people medicated for pain, but their function overall has suffered as a consequence. This is not the proper treatment of chronic pain.

The root of this problem is fear. People need to be supported to walk through their fear of pain. Numerous studies that have proven that if someone is afraid of a certain activity, he or she will avoid that activity, and as a consequence won’t progress in his or her treatment. If we expose the person to the activity with support and gentle movement, the fear slowly diminishes. If fear diminishes, pain does as well, and the person regains mobility and confidence. There is a direct correlation between fear, anxiety, and pain. The solution for Fear Avoidance is increased movement, which will cause some discomfort initially. But it is on a temporary basis because at first patients are breaking up the fibrous tissue that has built up as a result of their inactivity. But with increased mobility we get increased function, and improved self-esteem and lower social isolation. The person overall becomes healthier.

When using medications, it is essential to make sure that the function of the patient improves. Simply taking the pain away and putting someone to bed for 20-plus hours a day is bad pain treatment. Unfortunately that is the cycle that people get into. They can’t sleep because of their pain meds, and then they are given sleeping pills. This makes them anxious during the day, so they are given anti-anxiety pills, and then pills to wake up. The result is that they are over-medicated and they are not living life to the fullest. Their quality of life is diminished. The solution is to decrease or eliminate the use of these medications until overall function improves and life gets better even though there is pain present. It is this delicate balance that defines pain recovery.

One Reply to “Treating Chronic Pain to Improve Function”

  1. I agree with your theory of movement and function, unless it is impossible or unlikely, and other factors must be weighed on a case by case basis including what the patient values and their desired lifestyle. Are they elderly and single/married? Are they still raising children? Are physical challenges, travel, exploration etc. important to them? Do they have a flexible schedule, do they prefer a steady schedule?

    With pain, it is SO individual and such a wide range of feeling and intensity that one size for all is never appropriate.

    Doctors may give options to deaden nerves, take medication and other treatments that do cause sleepiness, reduce or eliminate limb function etc. However, a patient may decide to take options only that allow full use of body and senses and that allow them to function with their conditions. There is a chronic pain that flares with intense acute pain in several conditions. This may be appropriately handled with some plants, now pills via pharma, and yes that may reasonably and safely (compared to new, unknown meds) be used in a plan.

    Take for example a patient in excruciating pain needing acute relief, with daily chronic pain as well. The pain saps strength and energy, as well as focus. The treatment of pain via receptors, allows your body to start healing, patients to work their bodies correctly (therapy, physical) and also engage the reward center by having positive experiences and being more self-reliant and even support others, leading the way for the family or loved ones they mentor. Neurological conditions are especially prone to this method.
    types of med depend on patient history, makeup etc. Pharmacogenomics

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