Chronic pain sufferers are finding relief in holistic solutions that involve innovative mind-body approaches and new therapeutic techniques. It's a far cry from the days of popping painkillers and curling up with a hot pack.
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The consequence of chronic painThe root cause of chronic pain often remains a mystery. Another survey carried out last year, by Harris/Decima for Pfizer Canada, found that among those who have been regularly suffering from two or more symptoms of chronic pain for more than six months, almost half (47 per cent) have not been diagnosed.
Chronic pain is also costly, with nine per cent of women and 10 per cent of men with chronic pain reporting that their pain interferes with their ability to work. The price tag is an estimated $12,558 in lost income per person with pain per year, according to SES.
Worse, it can have devastating consequences on self-esteem. When Nicole St-Laurent-Ward, 53, of Moncton, N.B., developed fibromyalgia in 1995, the excruciating pain in her hips began to limit her mobility and led to chronic fatigue. She was forced to quit her job at Radio-Canada and became depressed and anxious. "I felt scattered, disconnected," she says.
Seeking help
Like Kelly, Nicole sought help from traditional pain drugs. But while over-the-counter pain relievers, such as hot packs and analgesic rubs, are readily available in drugstores, they're not likely to do the trick for chronic, unremitting pain. It's often a challenge for chronic pain sufferers to get effective prescription pain medication, partly because doctors are leery of taking on the task. "Are patients undertreated? I think so," says Dr. Zohar Waisman, a psychiatrist with the Wasser Pain Management Centre in Toronto. "Unlike an infection, where we give a person antibiotics," he says, "chronic pain is much more complicated to deal with."
That's not to say there isn't a wide variety of effective prescription pain relievers. First, there are the opioids, such as codeine, morphine, oxycodone and methadone, which can be critical in chronic pain management, says Mary Lynch, president-elect of the Canadian Pain Society and director of pain management at Queen Elizabeth II Health Sciences Centre in Halifax. These drugs, which are most often taken orally but can be infused (administered through intravenous, intraspinal, epidural or subcutaneous routes) or applied through the skin with a patch, can be important in managing pain. However, doctors need to screen for risk of addiction and watch for signs of overdose (recently reported with the use of fentanyl patches) and long-term dependence. "About 10 per cent of the population has the disease of addiction," says Allan Gordon, a neurologist and director at the Wasser Centre.
As well as the opioids, there are analgesic combinations – an antidepressant taken with an anticonvulsant – that act as aneuro-modulators, explains Lynch, meaning they alter the way the brain processes pain. Included in these combinations can be Gabapentin and Carbamazepine, anticonvulsant drugs formerly used solely to treat epileptic seizures.
Also emerging are the cannabinoids, drugs derived from cannabis, such as medical marijuana. "It's a field that is developing," says Lynch.
Accurate diagnosis
Before a doctor prescribes any of these drugs, though, he should make an accurate diagnosis. And that can be difficult because of the many different types of pain; for example, there are various forms of arthritis pain, neuropathic pain (stemming from an injury to the nervous system), multiple sclerosis pain, migraine pain and fibromyalgia, to name a few.
Accurately pinpointing the source of pain takes some detective work, but it's important because it can affect treatment, notes Marlene Noble, a physiotherapist at St. Paul's Hospital in Vancouver. "There's a whole different way of treating pain if it's peripheral pain due to a new injury than if it's long-term chronic pain," she says.The waiting gameUnfortunately, given an aging population that demands an increasing level of services, the waiting period for a thorough assessment and treatment plan can be long. Many pain clinics across the country have waiting lists of a year or longer.
But once patients do get assessed at a clinic, they're likely to be greeted with a whole new approach to treatment. They may be seen by a pain specialist and a psychiatrist, as well as a neurologist and a physiotherapist – all under one roof.
It's part of the new mind shift in chronic pain management that's been burgeoning over the last 10 years. The emphasis has changed from a quick fix to patients learning how to self-manage their pain for a lifetime, explains Noble. Today, there is also more of a team approach; members of a treatment team work together on all aspects of the pain problem, including psychological, social and physical. "You really have to look at all areas of that person and not just the pain problem," she says.
Alternative therapy
Chronic pain is also costly, with nine per cent of women and 10 per cent of men with chronic pain reporting that their pain interferes with their ability to work. The price tag is an estimated $12,558 in lost income per person with pain per year, according to SES.
Worse, it can have devastating consequences on self-esteem. When Nicole St-Laurent-Ward, 53, of Moncton, N.B., developed fibromyalgia in 1995, the excruciating pain in her hips began to limit her mobility and led to chronic fatigue. She was forced to quit her job at Radio-Canada and became depressed and anxious. "I felt scattered, disconnected," she says.
Seeking help
Like Kelly, Nicole sought help from traditional pain drugs. But while over-the-counter pain relievers, such as hot packs and analgesic rubs, are readily available in drugstores, they're not likely to do the trick for chronic, unremitting pain. It's often a challenge for chronic pain sufferers to get effective prescription pain medication, partly because doctors are leery of taking on the task. "Are patients undertreated? I think so," says Dr. Zohar Waisman, a psychiatrist with the Wasser Pain Management Centre in Toronto. "Unlike an infection, where we give a person antibiotics," he says, "chronic pain is much more complicated to deal with."
That's not to say there isn't a wide variety of effective prescription pain relievers. First, there are the opioids, such as codeine, morphine, oxycodone and methadone, which can be critical in chronic pain management, says Mary Lynch, president-elect of the Canadian Pain Society and director of pain management at Queen Elizabeth II Health Sciences Centre in Halifax. These drugs, which are most often taken orally but can be infused (administered through intravenous, intraspinal, epidural or subcutaneous routes) or applied through the skin with a patch, can be important in managing pain. However, doctors need to screen for risk of addiction and watch for signs of overdose (recently reported with the use of fentanyl patches) and long-term dependence. "About 10 per cent of the population has the disease of addiction," says Allan Gordon, a neurologist and director at the Wasser Centre.
As well as the opioids, there are analgesic combinations – an antidepressant taken with an anticonvulsant – that act as aneuro-modulators, explains Lynch, meaning they alter the way the brain processes pain. Included in these combinations can be Gabapentin and Carbamazepine, anticonvulsant drugs formerly used solely to treat epileptic seizures.
Also emerging are the cannabinoids, drugs derived from cannabis, such as medical marijuana. "It's a field that is developing," says Lynch.
Accurate diagnosis
Before a doctor prescribes any of these drugs, though, he should make an accurate diagnosis. And that can be difficult because of the many different types of pain; for example, there are various forms of arthritis pain, neuropathic pain (stemming from an injury to the nervous system), multiple sclerosis pain, migraine pain and fibromyalgia, to name a few.
Accurately pinpointing the source of pain takes some detective work, but it's important because it can affect treatment, notes Marlene Noble, a physiotherapist at St. Paul's Hospital in Vancouver. "There's a whole different way of treating pain if it's peripheral pain due to a new injury than if it's long-term chronic pain," she says.The waiting gameUnfortunately, given an aging population that demands an increasing level of services, the waiting period for a thorough assessment and treatment plan can be long. Many pain clinics across the country have waiting lists of a year or longer.
But once patients do get assessed at a clinic, they're likely to be greeted with a whole new approach to treatment. They may be seen by a pain specialist and a psychiatrist, as well as a neurologist and a physiotherapist – all under one roof.
It's part of the new mind shift in chronic pain management that's been burgeoning over the last 10 years. The emphasis has changed from a quick fix to patients learning how to self-manage their pain for a lifetime, explains Noble. Today, there is also more of a team approach; members of a treatment team work together on all aspects of the pain problem, including psychological, social and physical. "You really have to look at all areas of that person and not just the pain problem," she says.
Alternative therapy
Acupuncture is an increasingly important part of this new holistic approach. A mainstay of Chinese medicine, acupuncture balances the body's energy by inserting fine sterile needles under the skin at specific points along energy pathways (meridians). When treating pain, the needles are sometimes placed on the opposite body part to that afflicted with pain (on a right hand, for example, if the left hand is affected), says David A. Bray, a doctor of traditional Chinese medicine in Toronto.
There's mounting evidence that acupuncture reduces pain, especially for people with muscular, nerve and lower-back pain. German researchers recently found that patients who were treated with acupuncture over six weeks experienced a nearly 50 per cent decrease in pain intensity, while those treated with conventional treatments over the same period had a less than 25 per cent decrease in pain.
A growing body of research is uncovering the benefits of other alternative approaches to pain, too. For example, a study released last September found that tai chi, qi gong and yoga in particular improved arthritis pain, joint pain and stiffness; and in other studies, yoga improved hip extension and stride length, and reduced joint tenderness and hand pain.
As well as traditional drugs, Nicole uses the holistic approach, including massage, reflexology and meditation, to keep her pain manageable. "I think it was a wake-up call for my health," she says.
As for Kelly, both meditation and acupuncture helped reduce her pain. Recent personal issues made it difficult for her to continue these practices, but she says she wants to get back to them. "I'm open to anything that works."
Embracing the holistic approachAs the pain management community embraces a holistic approach to care, it's also beginning to view pain itself in a whole new light. Increasingly, pain is seen less as a physical affliction and more as the result of an injury that permanently changes the brain and leaves a lingering fear. "When someone hurts you as a kid, you remember it really well," explains Min Zhou, a pain researcher at the University of Toronto. "The idea is that the injury leaves a mark that doesn't go away, which can trigger pain long after the initial symptoms have subsided." Zhou's research focuses on the part of the brain that may be responsible for that – the anterior cingulate cortex, located in the prefrontal cortex. It's an area that "lights up" in diagnostic tests, such as a functional MRI, when a person is exposed to painful stimuli.
Zhou has developed a genetically mutant mouse that feels pain such as a needle prick, but not chronic pain. He's optimistic that this model will lead the way to the development of a drug that reduces chronic pain but preserves other sensations like hot and cold in humans – something that current pain medicines can't do. (Many patients who take drugs like oxycodone lose sensation of hot and cold.) But Zhou acknowledges that such a drug could take at least 10 years to develop.
Kelly certainly hopes that day will come a lot sooner. Dosed up on oxycodone and still suffering from chronic inflammation, she says even short trips to Tim Hortons can be gruelling and are a regular reminder of her reduced quality of life. But she's determined nonetheless. "You've got to keep going," she says.
Managing
Dealing with long-term pain can be exhausting and emotionally draining. Here are some tips for coping.
• Chronicle the pain. Day-to-day tracking of pain and paying attention to the variations in intensity can provide clues as to the nature and severity of the condition, while providing a scale on which to grade the pain, says David A. Bray, a doctor of Chinese medicine in Toronto.
• Get a referral to a pain clinic. Such a referral may be key since some family doctors don't feel comfortable managing chronic pain, says Dr. Zohar Waisman, a neurologist in Toronto. Beware: You may have a long wait ahead of you.
• Learn the stages of pain. By doing so, you'll understand the different treatment approaches, including the physical and cognitive techniques such as meditation, says Marlene Noble, a physiotherapist in Vancouver.
• Keep moving. With help from a pain clinic specialist or doctor, develop an exercise routine, such as yoga, that keeps you limber. The worst thing patients can do is not exercise, says Noble.
• Be your own pain advocate. "You can't just sit back and let the doctors do it," says Kelly Corry, a chronic pain sufferer In Hillsdale, Ont. What you can do: search out pain specialists on the Internet, join a support group to share findings, know your treatment options and be vocal about your concerns to doctors, employers, friends and family.
Zhou has developed a genetically mutant mouse that feels pain such as a needle prick, but not chronic pain. He's optimistic that this model will lead the way to the development of a drug that reduces chronic pain but preserves other sensations like hot and cold in humans – something that current pain medicines can't do. (Many patients who take drugs like oxycodone lose sensation of hot and cold.) But Zhou acknowledges that such a drug could take at least 10 years to develop.
Kelly certainly hopes that day will come a lot sooner. Dosed up on oxycodone and still suffering from chronic inflammation, she says even short trips to Tim Hortons can be gruelling and are a regular reminder of her reduced quality of life. But she's determined nonetheless. "You've got to keep going," she says.
Managing
Dealing with long-term pain can be exhausting and emotionally draining. Here are some tips for coping.
• Chronicle the pain. Day-to-day tracking of pain and paying attention to the variations in intensity can provide clues as to the nature and severity of the condition, while providing a scale on which to grade the pain, says David A. Bray, a doctor of Chinese medicine in Toronto.
• Get a referral to a pain clinic. Such a referral may be key since some family doctors don't feel comfortable managing chronic pain, says Dr. Zohar Waisman, a neurologist in Toronto. Beware: You may have a long wait ahead of you.
• Learn the stages of pain. By doing so, you'll understand the different treatment approaches, including the physical and cognitive techniques such as meditation, says Marlene Noble, a physiotherapist in Vancouver.
• Keep moving. With help from a pain clinic specialist or doctor, develop an exercise routine, such as yoga, that keeps you limber. The worst thing patients can do is not exercise, says Noble.
• Be your own pain advocate. "You can't just sit back and let the doctors do it," says Kelly Corry, a chronic pain sufferer In Hillsdale, Ont. What you can do: search out pain specialists on the Internet, join a support group to share findings, know your treatment options and be vocal about your concerns to doctors, employers, friends and family.
http://www.canadianliving.com/health/prevention/how_to_deal_with_chronic_pain_5.php
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