Chronic Pain

By: Dr. Robert Inesta

Over 100 million Americans suffer from chronic pain, costing a total of $560 billion – $635 billion between medical expenses and cost related to disability days and lost wages, according to the Institute of Medicine of the National Academies. Those are large and disturbing numbers. So what is chronic pain and what can we do about it?

Chronic pain is different than acute pain, or the initial pain following an injury.  Acute pain usually originates from a specific incident in which a tissue is damaged, or potentially damaged, and as a defense mechanism, the brain alerts the conscious mind with a pain signal. The purpose is to prevent activities or situations that may further insult the tissue. This acute pain pattern is a healthy neurological response and necessary for survival.

Chronic pain on the other hand, lasts longer and is often due to increased sensitivity in the nervous system. This can occur without an acute incident, or it can be the result of a transition from acute pain to a chronic state. Chronic pain may be present without any actual tissue damage at all. A tissue may have been damaged or injured and then fully healed, but because the nervous system was sensitized and not treated appropriately, the pain pattern became embedded and remained. It is as if the brain were a computer and pain software was running, leading you to falsely believe that there was a problem somewhere in the hardware. The true problem is a programming glitch.

A recent study by Mansour, et al, in the journal “Pain”, showed that structural properties in certain areas of the brain can indicate whether someone is likely to have chronic pain or not and whether they are likely to transition from acute to chronic pain, or have their acute pain resolve with treatment. This is important because it demonstrates that much of the chronic pain process is truly in the brain. So, one can conclude that in order to effectively treat chronic pain, we must treat the brain. We must reprogram the computer and install different software. How do we do this?

There are different natural ways to treat, or influence the brain, or central nervous system. Among these include rehab techniques such as neurosensory training, proprioceptive training, Graded Motor Imagery, meditation and acupuncture. Often a combination of these methods is best, with a good balance of active and passive care. All of the above methods can potentially alter brain morphology and function in a positive way.

Acupuncture, which has been around for thousands of years, has been shown through much modern research to directly influence the brain. Studies using functional MRI have demonstrated that areas of the brain that play a significant role in the pain process are altered by acupuncture treatments. In addition, areas related to nervous system imbalances due to mental/emotional stress, such as the hypothalamus, medulla oblongata, midbrain and somatosensory cortex, are also directly influenced by acupuncture. Some of the ways acupuncture affects the brain are by modulating activity in sensitive areas and regulating neurotransmitter and hormone activity.

This is very promising information for those who suffer from chronic pain. Many of these patients so not know where to turn. They have spent thousands of dollars on imaging and testing that is inconclusive, and treatments that are ineffective. They bounce around to different professionals and grow overwhelmingly frustrated when their efforts remain fruitless and they are told there is nothing more that can be done. They become hopeless and depressed. This unfortunately is extremely common. But there are solutions. Successful treatment often takes work, time and diligence. It is a process of reprogramming and it may be different for everyone. With the right treatment strategies, I believe chronic pain can be overcome.

Posted in Summer 2014 Newsletter.