What is Comprehensive Pain Management?
The most important issue in pain management is a focus on managing chronic pain symptoms as opposed to forcing a “quick fix” or masking symptoms without addressing their root and meaning. Pain management generally encompasses a variety of techniques to be used in combination over time.
This multi-modal approach can include medication management, physical medicine, and frequently involves lifestyle changes (e.g. diet, exercise, stress management) for optimal management of symptoms.
To manage your condition, it is useful to think of chronic pain as a chronic disease. Much like heart disease or diabetes, chronic pain may require a long-term treatment approach encompassing medication or nutraceutical use in conjunction with behavioral changes to keep your pain symptoms in check.
Chronic Vs Acute Pain?
Chronic pain, characterized as pain that persists for longer than a period of six months, is enormously different from acute pain, which is characterized as temporary pain that has an identifiable cause and purpose.
Chronic pain is not just a symptom of an underlying problem – it is the problem. It often does not respond to treatments used for acute pain. In fact, acute pain treatment can often make it worse. For instance, when we injure ourselves, rest is important; it allows the body time to heal. If we have chronic pain, however, this approach won’t work; we can’t waste our entire lives resting.
Excessive rest brings about harmful physiological and psychological changes such as neuromuscular weakness, an elevated heart rate, harmful elevations in fats, cardiovascular deconditioning, and muscular contractions.
Behaviors perfectly appropriate in the case of acute pain (such as resting) now become part of the problem. The guarding and bracing that are protective mechanisms with acute pain may lead to additional muscular pain if the muscles are now unable to relax and become tight or contracted.
The body is supremely economical; muscles become tight when they are not regularly stretched to their full length. If we fail to routinely stretch a muscle, it will eventually shorten. Normally, we strengthen muscles by lifting something or bearing the weight that the muscle supports, or by applying a force that the muscle must resist. If we do these things less frequently, our muscles, which aren’t challenged as much, will get weaker. For instance, if we lie in bed all day and do not use our muscles, in 24 hours we will lose 1 to 3 percent of our muscle strength. In one week we can lose 7 – 21 percent of our strength and in 3 to 5 weeks, half of our original strength will be gone!
This applies to our heart as well – which, after all, is a muscle. Inactivity will reduce the physical challenges on our heart and eventually lead to weakness. Resting heart rate is one indicator of health.
An athletic person will have a lower-than-average heart rate, and an Olympic athlete will have a still lower resting heart rate. This is because the heart has become so strong and efficient that it doesn’t need to beat as often to do the same job another heart must do at a faster rate. But with inactivity, which may be brought about from fear of pain, the body becomes less efficient, less able to deal with the physical stresses of life, and our resting heart rate gets faster and faster.
For every two days of bed rest, our resting heart rate increases by one beat per minute. In fact, it has been shown that after three weeks of immobility there is a 25 percent decrease in cardiovascular performance.
Excessive inactivity often leads to tightness in the muscles of the back and legs and weakness in the abdominal and back muscles. This tightness alters the posture and spinal alignment, increasing the concavity (the inward curve) of the lower back, which can lead to the development or worsening of lower-back pain. Under such conditions, just trying to stretch the muscles back to their original length can result in pain.
Finally, we can become so inactive that we begin to breathe with shallow breaths. At some point, it may become uncomfortable to take a deep breath because we are so used to not doing it. This is a serious problem. It is necessary to breathe deeply to exercise aerobically, and aerobic exercise is a basic prerequisite to regaining our lost endurance.
Avoiding is not the Solution
It’s not only our muscles and tendons that shrink when we avoid pain; our fear of pain makes our world shrink. As we cut ourselves off from painful activities, our world gets smaller and smaller.
Sadly, the things that offer us the most joy are often the first things we give up. Long vacations, trips to distant relatives or friends, going out socially, sports, hiking, and physical intimacy are left off, one by one. As we let go of the activities we like to do – those things that bring us joy – we are cutting ourselves off from what enriches our lives.
It’s as if we’re trying to bargain with a threatening stranger: “All right, I’ll give up dancing with my wife. But if I do that, you have to stay away…I’ll do anything if it keeps you away.”
Unfortunately, all of our bargaining fails to give us what we want.The “stranger,” our pain, doesn’t stay away. He may become more sluggish, more predictable, but he remains right outside our door, ready to knock at any time.
If we are always trying to avoid pain, we are on the path of retreat. Our world will get smaller and smaller as we avoid more and more activities that hurt. The path of retreat is the road to self-oblivion, which is a road we cannot afford to travel. Pain may be a stranger, it may be mysterious and unwelcome, but it should not be allowed to become our master. We must make a stand.
It will not do us any good to retreat. We need to meet our enemy face to face. After totally exhausting ourselves seeking the latest and greatest snake-oil treatments, after placing ourselves in the hands of the right doctor, the right osteopath, the right psychotherapist, the right physical therapist the right massage therapist, the right acupuncturist, the right chiropractor, the right herbalist, the right nutritionist, the right healer or the right astrologer – all for the purpose of finding the perfect cure – now, exhausted and weary, and still with pain, we must take up our cross and carry it.
That is to say, we must face our pain. Such a step requires a paradigm shift, a new way of thinking…