Early intervention could prevent chronic pain
By American Osteopathic AssociationFeatures Clinical Patient Care adjustment chiropractic chronic pain cognitive behavioural therapy musculoskeletal manipulation osteopathy research yoga
CHICAGO—Half of Americans (50%) report suffering from chronic pain lasting three months or longer, according to a recent Harris Poll commissioned by the American Osteopathic Association. More alarming, unless early intervention is prioritized, patients may suffer indefinitely, say osteopathic physicians who specialize in pain management.
Treatment during the subacute phase—typically the second and third month of pain—that addresses the source can eliminate the physical and mental changes that lead to chronic pain. Once pain becomes chronic, it is unlikely to completely resolve, according to John C. Licciardone, DO, FACPM, director of the PRECISION Pain Research Registry at the University of North Texas Health Science Center. Chronic pain is the number one cause of long-term disability in the US.i
“Many patients and some physicians do not realize pain management is on a relatively tight time schedule,” says Dr. Licciardone. “Rather than prioritize drug therapy, which may simply mask pain, new research emphasizes the need to rapidly identify and address the pain trigger.”
When the body repairs an acute injury, the pain signals normally subside as healing occurs. In cases of chronic pain, the brain continues to receive signals that often magnify the pain that patients experience over time. This delays and often limits the patient’s ability to recover from chronic pain, Dr. Licciardone explains.
Changes in care
Over the past decade, a shift occurred in the recommended treatment of pain that runs counter to the common belief that bedrest and medication are the mainstays of care. Recent medical guidelines recommend patients actively pursue non-pharmacological treatments that improve function, and limit medication when the pain is no longer acute.ii Yoga, cognitive behavioral therapy and musculoskeletal manipulation are among the recommended interventions for chronic pain.
These therapies can improve alignment and circulation, and are believed to reduce the signals to the central nervous system that cause ongoing pain, says Sheldon C. Yao, DO, chair and associate professor of the Department of Osteopathic Manipulative Medicine at New York Institute of Technology College of Osteopathic Medicine.
The AOA survey, conducted in June 2018, finds physical therapy has been an effective treatment for 26 percent of chronic pain sufferers, and 11 percent report yoga/movement therapy as an effective pain reliever. Some 7 percent found effective pain relief from medical marijuana, with an equal proportion citing a psychiatrist or therapist as having effectively helped with chronic pain.
“Like addiction, even when resolved chronic pain is never truly gone. That’s why long-term adherence to a therapeutic regimen is the key to successful management,” says Dr. Yao. “It becomes more about the process of understanding which treatments are a good long-term match for the patient.”
Pain is a personal and subjective experience, notes Dr. Yao, and is tied closely to emotional health. Even when not in pain, a patient may worry about the pain returning, which then may cause anxiety, stress or even depression. Those emotions can trigger physical pain, creating a cycle that is difficult to break.
Aging was cited as the cause of chronic pain for 37 percent of Americans who suffer from pain, while 31 percent believe work or repetitive motion is the cause. More than 10 percent attribute their pain to depression or mental illness.
“In many cases low back pain will resolve on its own,” says Dr. Yao. “As a result, I fear not enough emphasis is being placed on proactive care during the crucial 90 days period after it starts, which offers the best opportunity to avoid long-term pain.”
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