En español | For the many years Christina Wei, 52, of Albany, Calif., suffered from back pain, she didn’t do so passively. But seeking out acupuncturists and chiropractors, experimenting with back braces and different types of mattresses — even consulting a posture specialist — never quite solved the problem. “Nothing really worked,” she says. “Or something would kind of work but only very briefly and then I’d feel the pain all over again.”
Wei’s experience is not unusual. Some 50 million — or 1 in 5 — adult Americans live with the misery and frustration of chronic pain, defined as pain that persists beyond the expected time of healing from an injury or beyond a certain duration of time, usually three to six months.
The issue can be compounded in people over 50. “They are likely to have more than one pain problem, such as osteoarthritis or pain associated with nerve injuries,” says Charles Argoff, M.D., a professor of neurology and director of the Comprehensive Pain Center at Albany Medical Center in Albany, N.Y. But chronic pain is finally getting some overdue attention, in part due to the nation’s opioid epidemic, which could lead to better ways of measuring and treating it.
Getting a handle on the hurt
It’s hard to think of pain in positive terms, but it plays a vital role in survival. “Short-term pain motivates us to escape from harm,” says Beth Darnall, a clinical professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University. “But once pain persists and becomes chronic, it is no longer a useful signal. It leads to changes in the nervous system, in our behavior and in our mood.”
Unfortunately pain also encourages people to stop moving. “Your back hurts, so you reduce your activities,” Darnall says. “This leads to deconditioning and to the worsening of pain over time.”
Yet health providers aren’t usually equipped to help people with persistent pain. Most physicians get only seven to 11 hours of pain training during medical school, says Darnall.
Plus pain is just complicated. No two people experience it the same way, and there’s no good way to measure or even describe it.
“Therapeutic decisions are based on the measurements or our understanding of the pain that a patient is experiencing,” says Daniel Lopez Martinez, a researcher at the Harvard-MIT Division of Health Sciences and Technology and the MIT Media Lab. “And currently the only way to quantify pain is to directly ask the patient, ‘On a scale of 1 to 10, how much pain are you experiencing?’ ”
Better methods may be on the way. Lopez Martinez, for instance, has devised a method of assessing pain using artificial intelligence technology to read facial expressions. Other potential rating systems rely on sensors to measure the bodily processes that often accompany pain. And scientists are delving into the brain’s contours with imaging technologies like MRIs and PET scans to find the regions and systems responsible for pain.
Such technologies could make the measurement of pain more objective, allowing physicians to standardize treatment or assess whether treatment has been successful. They also could help to create better pain medications or predict which patients may benefit from a medical intervention, such as surgery. As it is, many pain patients are pushed toward procedures that they are not likely to benefit from, or drugs with a high potential for addiction, Argoff says.
And it turns out that opioids aren’t even that effective at reducing common sources of pain. In one recent study, patients with back pain and pain due to knee and hip arthritis got less relief from narcotics than over-the-counter medications like acetaminophen and ibuprofen.
Using your head to break pain's hold
Researchers are also exploring the role patients’ thoughts and emotions play in promoting pain. “Unfortunately, many times people with persistent pain may have heard that their pain is ‘in their head,’ ” Darnall says. “All pain is real and most pain has a medical basis. That said, our psychology has a profound influence on pain intensity and the trajectory of our pain.”
For instance, worrying about pain tends to intensify it, whereas relaxation strategies that calm the nervous system have been shown to decrease the impact of pain on the brain and the body — when practiced regularly, and in the right way. “You can literally start to steer your brain, body and nervous system away from pain,” Darnall says.
Simply educating people about pain makes a difference. In recent research from Belgium, published in JAMA Neurology, back and neck pain sufferers were taught about the neurophysiology of pain — what happens in the peripheral and central nervous systems and the brain when people are in acute pain.
Researchers then explained to study participants what happens when a person has chronic pain, which occurs when the nerves and spinal cord become oversensitive, amplifying messages that pass from the body to the brain. When the messages from the nerves reach the brain, the brain reacts by feeling pain, even when there is no active damage or injury. If the pain persists for a long time, the brain may even react to messages from parts of the body near the site where the initial injury occurred, and patients can experience pain there as well.
“We compared the nervous system to an alarm that is too sensitive and is firing when it shouldn’t,” says study lead author Anneleen Malfliet of Vrije Universiteit Brussel. Patients also were reintroduced gradually to activities they had been avoiding due to pain.
Result? Compared with a control group, “the experimental group had better results in pain, function, a greater decrease in fear of movement and less attention to pain,” says Malfliet.
Learning about pain through books with similar information, such as Healing Back Pain: The Mind-Body Connection, by John E. Sarno, M.D., and practicing relaxation ultimately freed Wei from chronic pain’s grip. As she came to see her pain as a sign of emotional stress, it gradually dissipated. “I have been free of chronic pain for about five years now,” she says. “I can still get stressed out, though, and if I don't calm down, I start feeling tension in my body. The difference is that I now know how to address that tension, and I don't ever let it get to the point of pain.”
Not everyone will benefit from any one approach alone, however, experts say. “Comprehensive care can include medical therapy — surgeries and medications — complementary approaches like acupuncture and chiropractic, and cognitive behavioral strategies, depending on the person’s needs and appropriateness,” Argoff says.
A comprehensive pain treatment clinic is the ideal place to find help. If there isn’t one in your area, seek out chronic pain specialists from various disciplines, including doctors and physical therapists. Cognitive behavioral therapy and relaxation techniques can be taught by a health or pain psychologist with experience in these approaches.
“We have a lot of wonderful treatments for chronic pain,” says Darnall. “We just need to do a better job of helping patients find the approaches that work for them.”
Read the full series on chronic pain
Read the full series on chronic pain