CHRONIC PAIN

Pain alerts us to an illness or injury. It tells us to stop what we are doing and shift our focus to identifying the origin of the pain and alleviating that underlying problem. 

Soreness can be a symptom unto itself. It may arise from unknown etiologies or persist following resolution of a diagnosed problem. Nerve or tissue trauma, vascular disease, and toxin exposure are some of the causes of chronic pain. The nerve pathology that produces pain can express itself as numbness, itching, dullness, achiness, intermittent, sharp, shooting, vibrating, or spasms. Whatever the manifestation, it is considered pain if it is bothersome. And one should seek remediation. Sometimes we can find the solution on our own. We may need to seek the advice of a healer.

Whatever the cause, pain is a drain on the body’s resources. It predisposes to the development of illness and weariness.

Fibromyalgia is a pain syndrome. Microscopic examination of the sensory nerve in this condition reveals abnormal nerve structure. Neuron damage is the pathology in this and many other chronic pain disorders.

Chronic Fatigue Syndrome, Long Haul COVID, Chronic Lyme DIsease, Post-Surgical and Post-Traumatic Malaise are examples of chronic illnesses that often have fibromyalgia-like pain as one of the symptoms. I have renamed Chronic Fatigue Syndrome – which includes many symptoms and fatigue may not even be the most prominent – as a Syndrome of Chronic Symptoms, or SOCS. These maladies often follow an acute infection or injury. I categorize them as “After-Illnesses.” They are all pain syndromes. Although symptoms can be severe and disabling, no abnormalities are found on physical examination or laboratory workup. Treating the pain component is essential for healing the problem. 

Arthritis, bursitis, tendonitis, fasciitis, and myositis are some of the joint and soft tissue inflammatory illnesses. Although the cause may be diagnosed, the treatment often boils down to managing the pain. These conditions are pain syndromes.

The first step in evaluating unremitting pain is to see a doctor. Your physician will order tests to diagnose disease and rule out treatable causes. When there is no specific recommendation for therapy, then the next step is to treat the pain itself. 

Relieving pain is an art. There are a multitude of approaches. Some people try many before finding respite.

The persistence of pain is a self-sustaining process. The pain becomes its own entity, divorced from the original cause. It then produces the circumstances that create more of the same pain. Nerve anatomy has become abnormal, transforming the neuron itself into the producer of the pain. When this has occurred, treating the pain is as important as resolving the cause of the pain.

Any of the modalities used to treat chronic pain can break that self perpetuating feedback loop. The strategies discussed below, therefore, can be healing while the long term fix is instituted. Medications can have side effects and are best used with the guidance of a doctor.

Getting good sleep, proper stretching several times a day, meditation, relaxation exercises, and epsom salt baths are effective therapies for chronic pain. An experienced psychologist can help mitigate anxiety, fear, and anger using some form of cognitive behavioral therapy. This is an effective method to reduce pain, especially back pain.      

Over-the-counter therapies for pain, like acetaminophen, NSAID’s (nonsteroidal anti-inflammatory drugs), cannabinoids, are for temporary relief and may have important side effects. Same is true with narcotic medicines and the prescription NSAID’s. Any or several of these medicines may interrupt the cycle of pain. This can be a cure.

Physical therapy, massage, chiropractic, acupuncture, hypnosis, and nerve stimulation are other modalities worth looking into.

People who are suffering discover alternative medicine providers who specialize in various tools to relieve pain. Virtually all these approaches have benefitted some patients. It is time consuming and may be expensive. But if you are in pain, you may feel that you must do something.

Although various pain medicines can break the cycle of pain, chronic pain is a pattern making it liable to reactivate in the future. This is similar to an old injury that becomes a pain problem years later. Injury, anxiety, surgery, and acute illness are some of the etiologies that help to establish this pattern of pain. 

Part of the pathology of pain is that the sensory nerves themselves are unhealthy. They have become deficient of the intracellular vitamins and minerals needed for proper functioning. Stress and normal biological processes drain cells of these micronutrients while the ability to replenish becomes increasingly impaired over time. (This abnormality is illustrated by loss of bone calcium in osteoporosis.) To prevent and treat this problem, we must rebuild the deteriorated neurons with nutrient supplements. This restoration takes time.

In my experience treating chronic pain, I have observed that the damaged nerve itself is amenable to repair. Just as the After-Illness occurs within a milieu of cellular nutrient depletion, neuronal micronutrient deficiencies set the stage for chronic nerve dysfunction and pain. 

Treating the underlying nerve cell disorder requires replenishing vitamins and minerals in the tissues. High doses must be taken to be effective.   

In my blog “Micronutrients to Enhance Health and Resist COVID-19” (April 23, 2020), explicit and detailed advice is given about micronutrient supplementation and which one I have recommended.

When self-treatment methods fail, medications are used. You will have to work with your physician to take advantage of these therapies.

I have had success using epilepsy medicines to treat pain. Epileptic disease and pain disorders are both characterized by nerve cell dysfunction.  Thus, the pharmaceuticals used to treat seizure disorders are also successful in quieting pain. There are many drugs in this category, with differing effectiveness and side effects. 

An antidepressant medication used alone or with the epilepsy drugs achieves greater pain control. There is a wide choice in this therapeutic category. Each has unique characteristics which contribute to effectiveness and reactions.

Combining several different medicines is a method that confers significant relief. Using several oral agents allows lower doses of each, thus minimizing iatrogenic problems. Good responses are noted with many of the options. 

Working with your physician, start with low doses. Be sensitive to any reduction in pain. When you know something works, strategize the next steps. Increase this medicine gradually or add low dosage of one or two additional agents. By tweaking the regimen, you will be getting relief while searching for the optimal program for yourself.

Keeping a written record on device or paper is key to success. You will have to be able to see long term trends in your symptoms, treatments, activities, and sleep. Your pain chart should have as many details as possible so you can assess your response over time.

The evolving therapy also allows taking some of the medicines alternate days or pulsing one medicine for a week at a time while others are taken constantly. I have employed a strategy of rotating some of the drugs to best utilize their actions.

Some Rx may be taken constantly. Some may be pulsed intermittently. Some may be rotated in some sequence with one or two others. The challenge is to devise a schedule that works.

While developing unique regimens of pain control as outlined above, repairing the underlying pathology is mandatory to realize a more complete and long lasting remission of pain.

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