Living with Chronic Pain: Relief is much more than a tablet away
“Living with a degenerative disease [a medical condition that causes a tissue or organ to deteriorate over time] is like living next door to a bully. You never know when he is going to come over and ring your bell and knock you on your keister,” says Karen Duffy, 57, in her just-released book, Backbone: An Inspirational Manual for Coping With Chronic Pain (Arcade Publishing, 2020.) The author, a former actress and model, writes that it took seven years of chemo drugs and long hospital visits to get her disease to a manageable and chronic condition. She now lives with excruciating daily pain.
We all have aches and pains as we inch up the age food chain. We no longer jump out of bed in the morning but ease out gingerly since many may have a slight ache here or a tinge of pain there. Perhaps, you’ve broken a wrist, as Barbara did three years ago, are in acute pain initially but wait for it to heal. Hopefully, at some point, the pain goes away or is minimal, or at least doesn’t stop you from doing things.
And then there are those—about 40 million adults—who suffer severe chronic or constant pain every day, according to a 2012 National Health Interview Survey (NHIS). For chronic pain suffers like Duffy, she never knows what level of pain she’ll have when she first awakens. “Some days I am high functioning, other days I’m cooped up at home because air hurts my skin.”
Chronic pain, which comes in various guises: rheumatoid arthritis, shingles, the after-effects of surgery, illness or an injury, back problems, knee and hip issues, to name a few, costs hundreds of billions of dollars in medical treatments and lost productivity. Sherry McAllister M.S (Ed)., D.C., CCSP, executive vice president, Foundation for Chiropractic Progress, headquartered in Georgetown, Calif., says that lower back pain (LBP), the most common problem a doctor of chiropractic (DC) treats, also happens to be the World Health Organization’s top health condition in terms of years lost to disability around the world. It affects the vast majority of people at some point in their lives and has the highest cost impact, as much as $135 billion a year (source: Journal of the American Medical Association. March 3, 2020. Volume 323, Number 9).
Treatment: Customized and Interdisciplinary Approach
Keith Rafal, MD, MPH (Master of Public Health), believes in treating chronic pain with a combination of strategies, fully understanding the circumstances that triggered the pain, tailoring treatment and taking into consideration the mind/body/social components of each person’s life and making sure the diagnosis is correct. He is founder of Our Heart Speaks https://ourheartspeaks.org a non profit supporting an international patient stories project and Healing Choices, P,C. in Massachusetts at www.healing-choices.net; Medical Director, Rehabilitation Hospital of Rhode Island, and clinical faculty at Brown and Tufts.
Relief is so much more than just a pill away, a fast fix but not always the most prudent. Dr. Rafal reviews any prescription medication the patient may be taking, but the effects of taking prescription pain pills a long time can wear off and both tolerance and dependency issues are a problem for many. If going the medication route, he said, “We need to determine the nature of the pain, if there is a neuropathic (nerve involvement) component to the pain. If so, then certain antidepressants, gabapentin, Lyrica are some options.” He considers opioids a last resort, however for some it may be the only option for quality of life but has to be properly managed. “If opioids are prescribed,” he says, “it’s important to use them with other treatments to minimize their use.” It is also critical to objectively assess clinical benefits vs risk and measures that can be tracked that assess function and quality of life. Goals are best developed in partnership with the patient and not dictated by the medical provider without personal buy-in.
Non-pharmacological options are his preference. This includes physical therapy in conjunction with occupational therapy and other disciplines and equipment to maintain optimum level of function; evaluation of lifestyle and diet; acupuncture; if appropriate manual therapy-chiropractic/osteopathic medicine/massage, and collaboration with cognitive behavioral therapist with expertise in general counselling, chronic pain and PTSD. For some the other tool in the toolbox is clinical hypnosis by a licensed experienced provider. He also suggests gentle yoga with a focus on breathing by a sensitive experienced teacher, or biofeedback and TENS. Specific supplements, topical treatments and in some cases herbal/homeopathic options, can offer with proper guidance a more benign and in some cases inexpensive option. However, this is best done in the context of a well thought out coordinated treatment plan.
Other therapies that are recommended less frequently, he says, include low-dose naltrexone, CBD/medical cannabinoids. “The later, I would refer to a physician who has the expertise and certification in my state, since that is not my primary focus. However, recognize it does have its place,” says Dr. Rafal. At the same time, it’s important to know when to refer a patient to a colleague for either a further evaluation or for an epidural, potential surgery or another intervention. We must get out of the silo mentality in health care. Although the patient is clearly the center of the team, this approach includes all practitioners providing excellent communication which is key to success.
Some of these treatments are covered by insurance like physical therapy. Others, like acupuncture, massage therapy and some of the mind/body approaches may not be. It depends on a person’s insurance policy, notes Dr Rafal, who suggests that an out of pocket low-cost option is community acupuncture which employs more of a clinic setting. “For many this is the only way that acupuncture is accessible and could provide a good option”
Dr. McAllister adds that most insurance companies, including Medicare, will reimburse for a chiropractic adjustment (aka: Spinal Manipulative Therapy). However, Medicare will not cover adjunct care such as a massage or electrical stimulation. Some chiropractors are also licensed acupuncturists and can bill for both services, she says. “More and more payers are supporting progressive policies that embrace chiropractic care and other safer, nonpharmacological methods. For example, in October 2019, UnitedHealthcare announced that health plan participants enrolled in certain employer-sponsored medical plans will have zero out-of-pocket spending, including their deductible, if they select chiropractic care for the treatment of low back pain. UnitedHealthcare estimates that by 2021 this benefit design has the potential to reduce the number of spinal imaging tests by 22 %, spinal surgeries by 21 %, opioid use by 19 %, and lower the total cost of care for members and employers.”
Gaining better physical function and reducing pain through various therapies is vital. Moving is important and that includes the benefits of walking, touted by Duffy. In addition, Duffy recommends sedentary strategies during down time to improve mental capacity. Also good are writing, journaling and reading—what Duffy calls bibliotherapy or “the practice of reading books with the goal of ameliorating or even resolving emotional issues.” When one experiences chronic unrelenting pain, it can lead to anger and depression. Psychological counseling is encouraged and even the use of emotional support animals helps. Equally important is to maintain engagement in life and relationships.
Real pain or are chronic pain suffers just wimps?
Illness and pain are not character defects or signs of weakness as some might think, Duffy writes. This is corroborated by chronic pain sufferer Lauren W. (not her real name) who says, “It’s hard to explain, but having constant pain makes me feel alienated from people. Many people, if I tell them about it, berate me for not trying to fix it. Not trying hard enough. Having to prove that the problems are valid. Have I tried this or that? Being a wimp?”
What is the mindset of someone who is in constant pain? Those who suffer from it do not think of themselves as an injured person. Chronic pain suffers don’t usually like to talk about their pain. They are what Duffy calls “eccedentesiasts—those who hide their misery behind a big fat smile.”
Katherine S., who lives with the challenges of pain daily, can relate. “I have had a pain specialist for 25 years and I don't know what I would do without my almost weekly visits to my chiropractor. This is not a simple subject with simple answers. My pain varies from day to day.” She smiles and bears it.
She experiences pain in many ways; from headaches to foot pain to muscle pain to joint pain It can be moderate to severe, she says. “I am affected by the weather and/or barometric pressure. I have tried medication, exercise., acupuncture, injections and rest. I feel best when in a swimming pool, in the sun on a beautiful, warm day. I have also tried CBD oil and creams and gummies...with mixed results. I also use Salon Pas, over-the counter pain patches. I often get some relief with those, but I smell of menthol when I use them!! We will try almost anything to get relief!! It takes a sense of humor to live with pain!!” she adds.
Lauren has been living with lower back pain that is usually centered, but over the years has moved around and aggravated and disrupted her daily life for more than 40 years. “There have been times when the discs in the low back have been ruptured. This causes severe sharp pain and hinders walking. Bad times but infrequent. My pain is worse when I first lay down in bed. Often my legs and feet get very cold, which feels like a circulation issue. I use a very firm mattress and sleep aid medication to sleep thru the night.
“There is considerable swelling and arthritis in the SI (sacroiliac) joints, both sides. These joints are just below the tailbone and to either side. Moving hips, waist, and legs is problematic when these joints are swollen. I’ve had all sorts of tests, including MRIs. Results are difficult to see because of the location. No doctor has ever said there would be any relief from surgery, as far as I’m concerned it is not an option.
“For relief I occasionally wear a ‘waist clincher’ when the stabbing leg pain is bad. It is basically a girdle for the waist. Very tight. It keeps my lower discs straighter and more aligned, because it is difficult to bend my waist while wearing it. It helps a great deal if I am on my feet a lot, such as when cooking. Walking, heat and being warm and in warm weather, mild exercise, rest, continual rearranging of position...these techniques help some,” she says. Yet, the pain continues.
When to Turn to a Chiropractor? Interview with Dr. Sherry McAllister
- What are the tools in your toolbox to help alleviate pain?
Doctor of Chiropractic focus their attention on the neuro-musculoskeletal system. Pain, while an indicator to the patient that something is wrong, is not the chiropractor’s chief concern. Our focus is on the cause of the problem which ensures that treatment is geared to function rather than symptoms. We are trained to manipulate the joints (chiropractic adjustment) and work on the muscle tissue to enhance movement and reduce pain. We educate the patient on holistic measures that will complement the care plan, such as topical analgesics, oral supplements, taping, ice/heat and exercises/stretches. Most importantly, we encourage patients to access effective, drug-free pain management methods and to avoid highly addictive opioids as much as possible.
- What is your most effective treatment overall?
The most effective treatment offered by DCs is the chiropractic adjustment often referred to as Spinal Manipulation. It is the single most common treatment given by DCs around the world. Spinal manipulation can be done in a variety of ways and is geared to the needs of the patient. The focus is on restoring function.
- What percentage of patients get better with treatment?
According to the Gallup Palmer College of Chiropractic Survey, three out of four adults who saw a DC in the last year described the treatment they received as “very effective.” Patient satisfaction rates are among the highest among non-pharmacological approaches. And a new nationwide consumer survey from the Foundation for Chiropractic Progress and The Harris Poll found that 81% consider chiropractic effective for professional and amateur athletes.