Natural Pain Management- Part 1
If you’ve read my past column on the Opioid Crisis in America, you can understand how my mind is still spinning. Until I really dug in and collected all of the data on this “National Public-Health Emergency”, as stated by President Trump, I really had no idea how bad our current system for pain management was. These skyrocketing statistics for prescription pain meds, overdose deaths, and drug addictions prompted me to write this follow-up article focusing on safer alternatives to pain management.
As stated by the CDC’s Guideline For Prescribing Opioids for Chronic Pain, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain”. The CDC has also gone on to say that “non-opioid therapies” should be used whenever possible. In regards to the recommended duration of opioid use for acute pain, “Three days or less will often be sufficient; more than seven days will rarely be needed.” is also recommended by the CDC. (1)
What About Other Pain Meds?
Non-steroidal anti-inflammatory drugs (NSAIDs) are extremely common and can be purchased in any grocery store or gas station. NSAIDs include generic names like ibuprofen as well as brand names such as Aleve®, Advil®, Motrin® and others. According to a recent study involving the use of NSAIDS taking ibuprofen for only one to seven days increased the risk of heart attacks by 48%. The same study showed that naproxen users (found in Aleve) suffered 53% more heart attacks. (2)
Other prescription pain medications, such as Cox-2 Inhibiters, were more recently introduced and intended for those with more chronic pain and to take place of the damaging effects of chronic NSAIDs use. Currently, Celebrex remains on the market but Vioxx and others were withdrawn due to an increase risk of heart attacks, stroke, and severe skin complications. The bottom line with this category is that we just don’t know what the long-term effects are and have not been proven to be any better than acetaminophen, ibuprofen, or naproxen.
Natural Pain Relief through Active Care
Chiropractic Care
The most common type of pain being managed is musculoskeletal, which makes sense to have a musculoskeletal specialist such as a Chiropractor as a primary component of one’s chronic pain management team. The most prevalent causes of pain are arthritis related conditions; neck and back pain; injuries from sports, work, falls, military service, and osteoporosis.
Recently, both the Journal of the American Medical Association (JAMA), and Annals of Internal Medicine have published and supported new clinical practice guidelines that recommend spinal manipulation over medication for patients suffering from back pain. (3, 4) Research shows patients with low back pain who undergo chiropractic care have better outcomes (5) with lower rates of opioid use (6), surgery (7), and overall healthcare costs (8).
Not surprisingly, several governing bodies, including the FDA, CDC, and 37 State Attorney General’s, have concurred that physicians and healthcare decision makers should consider non-pharmacologic therapy for those suffering low back pain. In fact, the 2018 Joint Commission guidelines mandate that hospitals include conservative options for chronic musculoskeletal pain management, specifically naming chiropractic as a potential option. (9,10)
Acupuncture
Acupuncture can have an effect on the naturally occurring opiate substances: dynorphin, endorphin, and enkephalin. Endorphins and enkephalins are potent pain modulators arising from the musculoskeletal system. Dynorphin is a powerful modulator of visceral pain that targets all other organ systems of the body. (11) This is only one mechanism of how acupuncture may be helpful in the treatment of chronic pain. Endogenous corticosteroid release, increasing localized blood flow,
The World Health Organization (WHO) has identified over 40 medical conditions that may be effectively treated with acupuncture which include the following pain-related conditions: pelvic pain, migraines, trigeminal neuralgia, other neuralgias, peripheral neuropathies, sciatica, low back pain, osteoarthritis, fibromyalgia, and dental pain- just to name a few. A major study, published in the Annals of Internal Medicine, involved 570 patients and looked at the effect of acupuncture on osteoarthritis of the knee and found this treatment to be very effective in both relieving pain and improving movement. (12)
Body Work and Soft Tissue Therapies
When it comes to improving chronic pain in most individuals, addressing the root cause is crucial. Often times this involves correcting muscle imbalances, joint dysfunction, improving biomechanics and gait, and focusing on restoring tissues to their pre-injury state.
Many chiropractors, physical therapists, and massage therapists focus a great deal on soft tissue therapies such as Active Release Therapy (ART), Instrument Assisted Soft Tissue Mobilization (such as Graston® and Gua Sha), trigger point therapy, rolfing, and others. These safe alternatives can be very effective in reducing chronic muscle tension responsible for creating pain generating postural imbalances and breaking up scar tissue and adhesions. Evidence shows that bodywork including deep tissue massage should be strongly recommended as a pain management option. (13)
Exercise is also key to healthy musculoskeletal function and aides in improved strength, stability, flexibility, bone density, and balance which can all be beneficial for pain management. Physical activity also produces endorphins which act as analgesics and diminish one’s perception of pain. Of course, proper guidance by a trained professional such as a physical therapist, chiropractor, or personal trainer is recommended for not creating further pain from improper form and technique.
Infrared Sauna Therapy
It turns out the sun does much more than just boost our vitamin D levels. The infrared wavelengths produced by the sun have a significant effect on reducing pain. With our modern day world often going to great lengths to “protect” us from sun exposure, we are often deprived of the many health benefits the sun provides. Thankfully, we have harnessed these wavelengths through infrared technology, which is now being utilized in infrared saunas.
In a randomized, controlled study of 46 patients with chronic pain, a variety of treatments with and without the use of far infrared sauna therapy were tested. The far infrared sauna group had much more significant decreases in depression, anger, and pain.(14) Another study on patients with chronic pain showed nearly a 70% decrease in pain after just one session!(15) Infrared saunas are commonly used for sports injuries, chronic fatigue syndrome, fibromyalgia, joint pain/stiffness and other chronic pain conditions.
Sunlighten Sauna Full Spectrum InfraredNot all saunas are created equal. Although you will still get a reduction in pain from a far infrared sauna, I’m a big fan of the full spectrum sauna made by Sunlighten Saunas. Pain relief is best achieved through all three infrared spectrums which include mid, near, and far infrared wavelengths. The shallowest penetrating wavelengths (near infrared) penetrate just under the skin and increase the superficial circulation which aids in reducing inflammation, collagen stimulation, and wound healing. Mid infrared also reduces pain through much of the same means. Far infrared is the deepest penetrating wavelength and enhances the deeper circulation and muscle relaxation.
Shock Wave (or Radial Pressure Wave) Therapy
Shock wave or Radial Pressure Wave therapy is a noninvasive treatment that involves the application of acoustic waves to areas of pain and restriction of soft tissue to break up scar tissue and adhesions. Bascially, it creates micro-trauma to tissue to improve a chronic conditions healing potential. I compare this more cost-effective and less invasive modality to PRP or Prolotherapy when explaining it to patients. It has a more pro-inflammatory effect and has often been a "magic bullet" for more chronic musculoskeletal conditions in my clinic. A study published in a Pain Medicine journal concluded that this modality showed radial shock wave therapy to be significantly more effective than one session of prolotherapy regarding pain and function in the management of chronic lateral epicondylosis. (16)
Pulsed Electromagnetic Field (PEMF) Therapy
Nicola Tesla was the first to demonstrate the healing principle of electromagnetic fields and his research has now evolved into Pulsed Electromagnetic (PEMF) Therapy. In December 2011, Dr. Mehmet Oz aired a special show on the pain-relieving effects of this ground-breaking therapy and called it the biggest breakthrough in pain management he had ever seen. Since then, healthcare practitioners have begun utilizing this technology in their practices and successfully combating chronic pain.
The root cause of PAIN can stem from many things, but essentially networks of nerves are stuck in a rut of constant inflammation. PEMFs represent a non-invasive therapy modality shown to have anti-inflammatory effects that contribute not just to pain relief but overall wellness and cellular health.
PEMF therapy aids in pain relief in three powerful ways:
- Releasing hormones including endorphins and serotonin
- Temporarily interrupting the pain signals to the brain.
- Increasing the electrical charge of the body and cells- improves cellular function.
- The FDA has registered or approved many PEMF devices, some specifically used to: fuse broken bones, enhance wound healing, reduce pain and tissue swelling, support muscle function, and even treat depression. As there are 1600 Double Blind Studies published and available on the platform of the National Library of Medicine on PEMF, I will likely devote a future column to this exciting topic.
In some cases, over the counter and prescription pain medications are necessary for short-term use, however as you can see there are numerous other effective options for managing pain. Pain is multi-dimensional and is better addressed through an integrative approach by implementing multiple adjunctive therapies and lifestyle modifications, rather than a magic pill.
In my next column I will focus more on the “Self Care” side of things which will expand on additional dietary and lifestyle changes required for optimal pain management.
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References:
cdc.gov/drugoverdose/prescribing/guideline.html
Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016.
Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317(14):1451–60.
Qaseem A, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
Schneider et al. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial. Spine 2015 Feb 15;40(4):209-17.
Whedon J. Association between Utilization of Chiropractic Services and Use of Prescription Opioids among Patients with Low Back Pain. Presented ahead of print at the National Press Club in Washington DC on March 14, 2017. Accessed online at: http://c.ymcdn.com/sites/www.cocsa.org/resource/resmgr/docs/NH_Opioids_Whedon.pdf
Keeney BJ, et al. Early Predictors of Lumbar Spine Surgery After Occupational Back Injury. SPINE Volume 38, Number 11, pp 953–964
Liliedahl RL, et al. Cost of care for common back pain conditions initiated with a chiropractic doctor vs medical doctor/ doctor of osteopathy as first line physician: experience of one Tennessee-based general health insurer. J Manipulative Physiol Ther. 2010;33:640–643
The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in 2018 Comprehensive Accreditation Manual for Hospitals.
Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
Hans JS, Xie GX, Zhou ZF, Folkesson R, Terenius L. Acupuncture mechanisms in rabbits studied with microinjection of antibodies against β-endorphin, enkephalin, and substance P, Neuropharmacology , 1984, vol. 23 (pg. 1-5)
Scharf H, Mansmann U, Streitberger K, et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial, Ann Intern Med , 2006, vol. 145 (pg. 12-20)
https://academic.oup.com/painmedicine/article/17/7/1353/2223191
Masuda A1, Koga Y, Hattanmaru M, Minagoe S, Tei C.; The Effects of Repeated Thermal Therapy for Patients with Chronic Pain.; Psychotherapy and Psychosomatics. 2005;74(5):288-94.
Matsushita K, Masuda A, Tei C. The First Department of Internal Medicine, Kagoshima University Hospital, Kagoshima, Japan. Internal Medicine (Tokyo) Aug 15, 2008
Ahadi T, Esmaeili Jamkarani M, Raissi GR, Mansoori K, Emami Razavi SZ, Sajadi S. Prolotherapy vs Radial Extracorporeal Shock Wave Therapy in the Short-term Treatment of Lateral Epicondylosis: A Randomized Clinical Trial. Pain Med. 2019 Sep 1;20(9):1745-1749. doi: 10.1093/pm/pny303. Erratum in: Pain Med. 2019 Dec 1;20(12):2612. PMID: 30698771.
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Chiropractic
Brain & Mental Health
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Inflammation
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