On Chronic Pain

I’ve lived along side chronic pain suffers for about 20 years. I’ve had it myself. Chronic pain is a matter of time not sensation. The Mayo Clinic describes pain as chronic if it lasts 12 weeks or more. Chronic pain can be steady. It can be intermittent. The pain might ache, it might burn, it might throb, it might be dull, it might be sharp but if it lasts for three months or more it’s chronic.

The US census bureau reports the US population to be about 328.2 million people. The Mayo Clinic says there are about 3 million reported cases of chronic pain in the US each year. Less than one percent of the population sounds pretty good if you’re not one of those cases and you’re not a person who loves one of those people reporting their cases. When chronic pain has affected your life less than one percent of the population seems like a woefully underreported number. By contrast Wikipedia’s entry on “Opioid Epidemic” says in the 1990’s 100 million US citizens were affected by chronic pain. Whatever the current numbers are their big enough to warrant 5120 active research studies on chronic pain as of today. At least better help might be on the way.

Nothing activates my ready, fire, aim response more than the pain of people I care about. I see it, I feel it, sorta, through empathy pain, and I want to fix it. “Feel bad? Take a pill.” I think. Thanks for that thought I say to my American mind. That cognitive knee jerk reaction is a good reminder that my first thoughts are often not my best thoughts. When it comes to living around chronic pain I’ve made more than a few mistakes. 

Most want pain to go away. Whether it’s our pain or our loved one’s pain we just want it gone. When the mind/body connection is working well pain is a signal our bodies send to our brains that something is wrong. Something is wrong and immediate attention is needed. Ideally once the message is received and the right attention is given the signal stops. With chronic pain, however, the signal keeps blaring.

When the pain signals won’t stop the best next step is to go back and find the cause. Get the best most specific diagnosis that you can.

Amateur tip: Don’t passively accept the first diagnosis you get as the best diagnosis. Get second, third, and forth opinions. Get to the right specialists.

I’ve know football players whose chronic pain started with repeated collisions that seem like car crashes. I’ve seen rheumatic diseases up close and personal. Arthritis and joint dysfunction can cause chronic pain. Cancer can do it. Infections can cause chronic pain so can nerve disorders. There are as many causes as there are potential treatments. A good diagnosis provides a path to the right treatments.

Amateur tip: If your chronic pain is localized go to the best specialist in that body part that you can find. If the chronic pain is generalized go to the best rheumatologist you can find.

Pro tip: If you’re having chronic genital pain get a consultation from San Diego Sexual Medicine.

Treatment for chronic pain has come under great and appropriate scrutiny given the over prescribing of opioid medications in the United States for the last 25 years.

Amateur tip:: For a heartbreaking illustration of this disaster check out The Pharmacist on Netflix.

What can we do about chronic pain besides taking a pill? There has been some evidence that shows chronic pain suffers have lower levels of endorphins in their spinal fluid than non-suffers. Acupuncture and electroacupuncture increase endorphins in that same fluid.

I’ve bought more than one TENS unit in my life. These help some episodes of nerve pain and low-endorphin levels.

There are medications that are not opioids that can help. For more information call your friendly neighborhood rheumatologist. Humira is a drug that treats chronic pain among other things and in 2018 alone the drug brought in $13.7B (that’s billion) of revenue for AbbVie.

The supplemental treatment that’s caught my eye is a specific protocol of psychotherapy – CBT-CP – or cognitive behavioral therapy for chronic pain. Cognitive behavioral therapy is a type of psychotherapy that focuses on changing our actions and our thinking so that we can influence our feelings. It’s been around since the 1960s and is one of the approaches to psychotherapy that has a lot of evidence to prove that it works. CBT works well for a lot of people with depression. CBT works well for a lot of people with anxiety so it doesn’t surprise me that CBT has been applied to people carrying the burden of chronic pain.

The protocol that I found is a manualized treatment which means in part that there’s a book telling therapists how to do it. Manualized treatments are also in theory easily replecated so that their outcomes can be more easily quantified, studied, and published. I have my reservations about this whole trend in psychotherapy. That said I’m glad to have the manual because I’m going to use this in my practice next month. The more I figure out the more I’ll share.

Love y’all,

– c

Pro Tip: If you can’t find a provider to help your client then be that provider that can help your client.