Neck pain. Back pain. Joint pain. Nerve pain. Headaches. Pain from an injury yesterday or years ago. Pain from disease. Pain that stops and starts. Pain that never ends. Many people suffer with ongoing pain. In fact, chronic pain is a worldwide epidemic with more than 1.5 billion people living with this relentless condition.
In the U.S., the numbers are staggering and recent data shows that chronic pain affects more Americans than diabetes, heart disease and cancer combined. The American Academy of Pain Medicine reports that more than 100 million Americans suffer with chronic pain, compared to 25.8 million who have diabetes, 16.3 million who have coronary heart disease, 7 million who have had a stroke, and 11.9 million who have been diagnosed with cancer.
And, not only does the ongoing treatment of chronic pain increase medical costs, but it also increases job and living costs — nearly 25 percent of chronic pain sufferers take a leave of absence from work; 20 percent change jobs; and 15 percent need help with daily living and often move into a home that is easier to manage.
Fortunately, there are specialists and treatments options to help ease and/or stop the pain. Below are some common questions and the answers surrounding chronic pain and treatment options.
Everyone experiences acute pain, which is a normal response triggered by the nervous system to alert the body of an injury or illness. Acute pain can be eliminated by treating the cause of the pain, such as fixing the broken bone, allowing the injury to heal or the sickness to resolve. Pain that lasts for more than six months is considered chronic pain. Chronic pain is the result of pain signals that keep firing for months and even years after an initial injury or illness. Some chronic pain is caused by injuries to the nervous system itself. The pain can be continuous or off-and-on, and is difficult to alleviate.
Low back pain is the most reported chronic pain condition. Headaches/migraines, neck pain, joint pain such as arthritis, nerve pain such as neuropathy or sciatica and widespread diffuse pain such as fibromyalgia are also included. Some chronic pain is caused by diseases such as multiple sclerosis, auto-immune disorders, cancer or the end stages of life.
Pain management specialists and centers are bringing relief to millions of pain sufferers. While there are treatments, often pain management involves with coping and living with some degree of pain.
Adjunct medications, the first line for treating pain, include anti-inflammatories, muscle relaxers, nerve pain medications, anti-depressants, topical compounded creams or non-narcotic patches. Generally, these medications can affect the cause of the pain, rather than just cover the pain.
Radiofrequency ablation is used for neck, mid- or low-back pain and some knee pain. A special needle is heated and inserted near the nerve that is sending the pain signals. The heat results in scarring which interrupts the nerve signal for up to a year. The treatment can be repeated once or twice a year if needed.
Steroids and local anesthetics are often administered together to ease inflammation and acute pain flare-ups. Trigger-point injections are injected into spasms or knotted muscles. Epidural steroid injections help with spinal problems such as herniated discs, degenerative disc disease and/or pain from the disc.
The medication is injected around the affected area and can last from weeks to a year. Some people require a series of injections to achieve the best results. Facet injections are steroid injections that target the arthritic joints in neck or back.
Physical therapy is one of the best approaches to improve and manage pain. Focusing on the area(s) of pain by doing daily specific strength and mobility exercises allows the joints and muscles to work better, reducing pain. Exercise, even walking, and even just movement in general, is beneficial.
Complementary therapies such as chiropractic, yoga, massage, stretch therapy, meditation, sound, acupuncture, acupressure and aromatherapy can help decrease stress, improve sleep patterns and help create a sense of control.
Behavioral counseling is often recommended as pain affects every aspect of life. Good coping and pain management skills are important, especially since anxiety is often present in someone living with chronic pain. Biofeedback, cognitive behavioral therapy and mindfulness based stress reduction have been instrumental in helping people cope with pain.
Opioids are powerful medications that act on receptors in the nervous system, require a prescription and include hydrocodone, oxycodone, morphine, codeine and other related drugs. Risks associated with their use include tolerance, dependence, addiction, brain shrinkage and cognitive changes to name a few. Often many side effects are limiting. Research has not been supportive of the use of opioids in long-term, non-cancer, pain control. When other treatments (as above) fail to provide relief then carefully monitored, opioid therapy may be an option.
Michelle Boyer, PA-C, has nearly 16 years of experience caring for those suffering with ongoing pain. Boyer is part of Northern Arizona Orthopaedics Spine and Pain Center. As a pain specialist, Boyer takes the time to accurately pinpoint the source of an ailment, then determine a treatment plan to decrease pain, enhance performance and function and increase overall quality of life.
By Michelle Boyer
Certified Physician Assistant
Northern Arizona Orthopaedics Spine and Pain Center