About 7.6 million Canadians report living with chronic pain, and as medical director of Medcan’s Pain Management and Recover Program, I see patients every single day for the very same reason. Pain is the body’s way of letting us know that something’s wrong; that part of our body is injured or inflamed. If the pain lingers for weeks, months or even years after the injury has healed, it can be debilitating, isolating and all-consuming. About one in three people over 65 will experience chronic pain in their lifetime, and maybe surprisingly to some readers, understanding what chronic pain is can be just as effective as medications or therapies.
Pain that persists for more than three months is considered to be chronic, whether it’s a constant or intermittent pain. While the pain is often caused by other conditions, such as arthritis or fibromyalgia, the World Health Organization and the International Classification of Diseases both consider chronic pain to be a disease in itself.
We feel pain in our tissues, ligaments, joints or muscles. But it’s actually our nervous system sending signals to the brain that controls how much pain we feel. Once you’ve healed and your body knows it’s safe from harm, those transmissions usually stop, and those pathways within the brain remain small, like a dirt path or trail.
When you experience chronic pain, it’s because the body is constantly sending those alarm signals to the brain and the fear response is regularly triggered. Those smaller pathways grow into superhighways. As a physician treating chronic pain patients, it’s my job to try to shrink those superhighways back into dirt paths.
“It’s not about treating the pain… but treating the person,” says Dr. Andrew Miners, Medcan’s clinical and product director of sports medicine, therapy, rehabilitation and fitness. “What are the things that are contributing to why that person has pain? What’s their experience with pain, and how is that pain affecting their life?” Then, we factor the answers to these questions holistically into a biopsychosocial approach to pain management, because we understand that biological, psychological and social factors all play a role in the ways we experience pain.
“A lot of my patients come to me saying, ‘Fix me, Doc!’,” says Dr. Miners. While he empathizes with these feelings of helplessness or hopelessness, he also knows that these emotions can intensify chronic pain. We utilise medications and other interventions in the short term to help get the pain under control by treating its biological aspects, and then we use cognitive behavioural therapy, mindfulness practices and psychology to educate chronic pain patients, replace their fear response with a sense of safety, and get them to think about their pain differently. This is how we treat the psychological elements of pain.
Other lifestyle changes can help, too. Unhealthy habits like smoking, poor eating habits, sedentary lifestyle and inadequate sleep could all worsen chronic pain, so in treating the social elements of chronic pain we show patients how to make healthy changes that will help to treat their chronic pain as well as lower their risk of other chronic diseases.
Pain medications can be a very useful initial step in reducing one’s response to pain, allowing us to get the pain under control and allow us to then focus on therapy and lifestyle changes. It’s important to be careful how much medication you take, how long you take the medication, and how you combine the medication with other medications. Drugs such as pregabalin or gabapentin are commonly used to treat seizures, but they also help to calm nerves that have been inflamed or damaged by chronic pain. Serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed antidepressants, which are also often used to treat chronic pain. Often, those with chronic pain have suppressed levels of serotonin and norepinephrine, so SNRIs can increase those levels to help the brain suppress and calm pain. With any pain medication, it’s best to start with as low a dose as possible and increase as necessary, in order to minimize side effects such as drowsiness, dizziness or weight gain.
Some people cannot or prefer not to take pain medications, and some might not feel any relief through their use. In these cases, interventions such as lidocaine infusions, an anaesthetic, may help. Image-guided procedures such as facet injections or nerve blocks can also help decrease pain and improve function. Many patients also find relief after receiving an epidural, which is typically administered up to three times a year. These interventions, however, may cause drowsiness, headaches, nausea and dizziness. They should be part of a holistic, multi-pronged approach to managing pain.
While medication and intervention may be helpful in “turning down the volume of the pain,” as Dr. Miners puts it, the best way to keep the volume down is through education, psychology and lifestyle changes.
Often, chronic pain patients have negative beliefs about their situation and their future. Helping them to refocus those beliefs through mindfulness-based therapies and practices like meditation, yoga or tai chi can start them on an effective management journey with a new understanding of, and relationship to their pain. Nutrition plays an important function in chronic pain management, too. Eating a Mediterranean diet, an anti-inflammatory diet or intermittent fasting have also been shown to help with relief of chronic pain.
People living with chronic pain are often fearful of causing more damage or aggravating their pain, but exercise plays a key role in helping to manage it. Moving your body regularly makes it stronger and builds its tolerance for pain or other stressors. If you’re living with pain, try your best to do something you enjoy. If your pain is too severe, start by simply moving your arms or legs while seated. “Try moving to pain, not through pain,” says Dr. Miners. If it’s painful, stop. Move until you feel your pain go past a four or five on a scale of one to 10. Over time, gradually build your tolerance until you’re able to increase the duration or the intensity of your movements.
If you are experiencing lingering pain, it’s best to talk about it with a family doctor early. Ask about Medcan’s Pain Management and Recovery Program, which includes all of the above interventions as a holistic, multi-disciplinary pain management service. Start to engage in healthy lifestyle and mindfulness habits, and find someone who you feel comfortable talking to about your pain. The sooner your chronic pain is addressed, the better the outcomes.
Too often, people living with chronic pain become isolated because they don’t want to repetitively share their experience of pain with others who don’t understand. It’s important to remember that you’re not alone—more than 20% of all Canadians are living with chronic pain. Most of all, don’t underestimate the power that your mind has over how pain is interpreted in your body. And the first step in treating your pain is understanding of your pain, and your beliefs around it.
If you’d like to talk about chronic pain or pain management therapies, contact a member of Medcan’s pain management team at PainManagement@Medcan.com.