Manage your chronic pain without popping pills

Prashanth Mally, M.D., a board-certified anesthesiologist and interventional pain management physician, offers alternative ways to keep your pain under control.

Man taking pills
© GKSD, Adobe Stock

Pain, as ubiquitous as it is damaging, is how your body lets you know that something isn’t right. Typically, it is pain that eventually prompts Americans to make an appointment with their doctor.

When pain becomes chronic—lasting three months or more, often outliving the injury or illness that originally caused it—it develops into an issue of its own, one that can be debilitating psychologically, emotionally and physically.

According to the Institute of Medicine, at least 100 million American adults live with chronic pain. That’s more than the number of Americans with cancer, heart disease and diabetes combined.

Understandably, patients with pain want relief. As an interventional pain management physician, I specialize in improving the quality of life for pain patients and helping them regain the function they have typically lost. This usually boils down to helping them regain movement through different therapies and sometimes medications.

Sometimes patients don’t want to move because they are afraid of hurting themselves. That’s when I talk to them about “hurt versus harm.” Just because it hurts doesn’t mean that the pain is harming your body. Many patients avoid any movement because it causes discomfort, though it is usually not causing any physical damage. The result is a vicious cycle: a loss of conditioning; depression resulting from feeling helpless; and a long-term increase in pain.

Some medications—notably anti-inflammatories, muscle relaxants, and anti-seizure and anti-depressant medications—can help ease discomfort. If pain persists, some providers will prescribe narcotics such as opioids, though these have not been shown to reduce pain or increase function in the long term.

Patients using opioids will get initial relief, but over time they will build up a drug tolerance and thus require higher doses, putting them at risk for addiction and possibly overdose.

These drugs can also interfere with their sleep, respiratory drive and endocrine system; increase the risk of infection; and cause sedation and constipation, all without providing sustainable, long-term relief.

Fortunately, taking pills isn’t the only way to treat pain.

In my office, after a thorough physical examination and review of records, we administer interventional injections, procedures that target the patient’s major pain generator. We can use X-rays or ultrasounds to guide needles to the location of significant pain and insert the medications directly into the source.

These injections usually consist of anesthetics and steroids along the spine or in joints, or specific nerves that we know are causing a large portion of the patient’s chronic issues.

Additionally, we can perform radiofrequency ablation. This is an outpatient procedure that involves sending an electrical current through a needle to heat targeted nerve tissue.

There are also a variety of alternative therapies that patients can pursue. I encourage these, too, because it usually takes more than one therapy to get pain under control. Relying on injections alone does not work as well as when they are combined with other therapies.

Be sure to check with your doctor before engaging in any treatment that you feel unsure about, and always remember that if one alternative therapy does not help, you can simply  try another. Being active in your own treatment makes all the difference.

Here are some medication-free alternative therapies to consider:

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT), talk therapy that helps you change patterns of thinking and combat negative thoughts, can help you feel more in in control and allow you to better focus on pain management. CBT can also reduce stress and make sleeping easier (crucial considering most chronic pain sufferers struggle with insomnia).

Mindfulness-based Meditation

This form of meditation involves focusing on breathing and bringing your mind’s attention to the present. In addition to helping reduce stress, it also helps focus the mind away from the pain, which is believed to reduce the processing of pain signals by the central nervous system. A 2016 study in the Journal of the American Medical Association showed that this form of meditation reduced the pain of people suffering from chronic back pain. It also can reduce insomnia.

Biofeedback

During a biofeedback session, you will have electrode sensors attached to your skin that relay information about your response to stress—breathing, muscle contractions, temperature, heart rate—to a computer or other digital device. This information can be used to teach different management techniques.

Acupuncture and Acupressure

Though their value in treating chronic pain has been debated, some studies have shown that the ancient Chinese practice of inserting needles and/or applying pressure to specific points on the body (to stimulate the body’s natural energy flow and release endorphins) can be beneficial for relieving chronic neck and back pain, headaches and arthritis. Moreover, these treatments have little to no risks or side effects. My rule of thumb is to give acupuncture or acupressure three or four sessions to see if it is effective for you.

Chiropractic or Osteopathic Manipulation

Chiropractic medicine is concerned with the relationship between the body’s structure and function. Practitioners perform adjustments (manipulations) to the spine or other parts of the body to correct issues with alignment. Some people have found it to be very helpful in alleviating neck pain, joint pain, fibromyalgia and even headaches. Osteopathic physicians are also trained to do these manipulations.

Massage Therapy

Massage therapy can help reduce all kinds of muscle and tissue pain. Though it has been deemed a safe treatment method, one downside is that massage therapy usually is not covered by insurance. If you decide to try it, make sure your therapist is licensed and certified by a national organization such as the American Massage Therapy Association.

Physical Therapy

I once heard a patient refer to physical therapy as “pain and torture,” but it doesn’t have to be that way. Physical therapists try to address the cause of the pain as well as the pain itself. They will likely recommend exercises and stretches that you can do at home, as well as treat the source of your pain with ultrasounds, heat or ice. Ask your doctor for their physical therapist recommendation.

TENS Unit

A Transcutaneous Electrical Nerve Stimulation (TENS) unit, a small battery-operated device that you can buy at a drugstore, delivers an electric current to the area where you’re feeling pain via electrodes attached to your skin. These electric pulses create a tingling sensation. They are believed to stimulate the production of endorphins and to stop pain signals from reaching the brain. They are a safe, alternative treatment for many, but should be avoided during pregnancy.

The National Fibromyalgia and Chronic Pain Association and the U.S. Pain Foundation both have detailed information about treating and coping with chronic pain for those interested in learning more.


KP11_01_Mally_Prashanth_MD_11172_IntervPainMgmt_FairOaks_05_06_11
Photo courtesy of Kaiser Permanente

Prashanth Mally, M.D., is a board-certified anesthesiologist and interventional pain management physician with the Mid-Atlantic Permanente Medical Group in the Washington, D.C., area. He sees patients in the Kaiser Permanente Tysons Corner Medical Center.

X