June 9, 2023
Pain and Pain Management
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Stan and Clarence chat with Dr. Douglas Kennedy and Dr. Brent Leininger about pain and pain management.
Dr. Kennedy - Assistant Professor with the Integrative Health and Wellbeing Research Program - and Dr. Leininger - Assistant Professor with the Integrative Health and Wellbeing Research Program - research pain and pain management for the Earl E. Bakken Center for Spirituality and Healing. Both also work with Partners 4 Pain - a collaboration between patients, community members, organizations, and researchers to learn, develop, and evaluate solutions to pain and opioid crisis.
More about their great work can be found at partners4pain.org
Join the conversation at healthchatterpodcast.com
Brought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships. More about their work can be found at http://huemanpartnership.org/
Research
- Definition of Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
- Understanding Pain: Pain is most often grouped by the kind of damage that is causing it; can also be classified by the type of tissue that's involved, or by the part of the body that's affected.
- Examples: the most common types of pain are
- tissue damage (also called nociceptive pain)
- pain caused by nerve damage (also called neuropathic pain)
- Emotional pain and physical pain are neurologically similar.
- Physical pain and social pain rely on shared neural circuitry suggesting that the experience of physical pain and social pain may have the same neurological basis.
- Chronic pain is a major public health problem with devastating consequences to patients and families, leading to a high rate of healthcare utilization, and huge society costs related to lost work productivity.
- Back pain is one of the most common causes for patients to seek medical care in both primary care and emergency settings.
- In the US, low back pain accounts for the most common reason for disability (link to disability episode).
- An estimated 200 billion dollars are spent annually on the management of back pain
- 80% of people will experience low back pain at some point in their lives
- 60% of those with low back pain also have leg pain.
- Some studies have shown that up to 23% of the world’s adults suffer from chronic low back pain. Some estimates of lifetime prevalence are as high as 84% in the adult population.
- Complications of pain
- Physically - There are countless physical complications of pain here are a few:
- Any area of the body that experiences severe persistent pain will soon “decondition.” Muscle, nerve, and joint weakness, and deterioration result. It is not uncommon to see patients with severe, uncontrolled pain progressively deteriorate due to muscle atrophy and contractures.
- uncontrolled persistent pain affects the endocrine system.
- acute pain is often accompanied by hypertension and tachycardia
- Reduced quality of life
- Socially - pain physically takes people away from their social networks.
- Pain flares can be a disincentive to planning and engaging, and can inhibit participation in activities.
- Fear of judgment can also lead to social withdrawal.
- Mentally - People living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders.
- An estimated 35% to 45% of people with chronic pain experience depression.
- Chronic pain can affect sleep, increase stress levels and contribute to depression.
Improving Outcomes:
- A patient's primary care provider is essential in the evaluation and treatment of back pain.
- The physical therapist should be involved early in the care and urge the patient to exercise regularly.
- Continuing to engage in physical activity as fear-avoidant behaviors worsen disability.
- The best patient education that can be provided to prevent back pain is to maintain a healthy body weight with a body mass index (BMI) less than 25, as a higher BMI correlates with worse outcomes
- chronic pain patients may benefit from seeing a chronic pain specialist for possible medication management and/or interventional procedures.
- Management of comorbid depression is also paramount. Cognitive-behavioral therapists and/or psychiatrists are needed to help co-manage patients with back pain with comorbid mental health disorders
- Patients of all ages should avoid smoking as it increases rates of back pain in all ages
- Pain management:
- Studies suggest that a person’s emotional well-being can impact the experience of pain. Understanding the cause and learning effective ways to cope with your pain can improve your quality of life. Key pain management strategies include:
- pain medicines -
- Opioids are natural or synthetic chemicals that bind to receptors in your brain or body to reduce the intensity of pain signals reaching the brain.
- Opioids have been regarded for millennia as among the most effective drugs for the treatment of pain
- Research shows that opioids, though effective at blocking short-term pain signals, don’t offer much help for people with chronic pain because opioids become less effective the longer you take them.
- if opioids are taken in prescribed doses and as instructed, they can help patients who have been suffering from severe and chronic pain.
- The United States makes up 4.4% of the world's population and consumes over 80% of the world's opioids.
- The FDA has received reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased. These include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.
- physical therapies (such as heat or cold packs, massage, hydrotherapy and exercise)
- psychological therapies (such as cognitive behavioral therapy, relaxation techniques and meditation)
- mind and body techniques (such as acupuncture)
- community support groups.
Health Disparities & Back Pain
Very little research has been done examining the social conditions that contribute to health inequity in the treatment for
back pain conditions. However, we know large disparities exist. Here is what is known so far:
- Those with less education and lower incomes tend to have worse back pain outcomes.
- Black Americans often experience greater pain severity and disability.
- Black and Hispanic Americans receive less health care and experience poorer outcomes than White Americans.
Ideas for questions for the guests:
- Thoughts on managing pain and improving quality of life for those who live with pain?
- How do we cope with the different types of pain (mental, physical, social, etc)?
- How do we support our loved ones that are experiencing pain, especially chronic pain?
- How can society be more inclusive to people with pain?
Source:
https://www.ncbi.nlm.nih.gov/books/NBK538173/
https://www.practicalpainmanagement.com/complications-uncontrolled-persistent-pain
