Fifty million Americans suffer from chronic pain, and in many cases there is no definitive cause, according to the Centers for Disease Control and Prevention. Sometimes patients are told it’s all in their head.
And it turns out that chronic pain may in fact be in your head – but not in the sense that it is imaginary and not serious. That was the finding of a recent study conducted by researchers at the University of California San Francisco and published in Nature Neuroscience.
The UCSF study identified chronic pain biomarkers and potential pain management treatment targets. Prasad Shirvalkar, MD, Ph.D., associate professor of anesthesia and neurological surgery at the University of California, San Francisco, was the lead author of the study. He said that despite pain being one of the most basic human sensations, there is much we don’t understand about how pain works, suggesting that better tools to study and potentially affect pain responses in the brain offer hope to people living with chronic pain.
Dr. Regina Morris Solis, who is double board-certified in Pain Management and Anesthesiology and is affiliated with Health First’s Holmes Regional Medical Center in Melbourne, says that chronic pain currently needs a multi-modal approach in which medication is just one part.
“Chronic pain is, by definition, pain that has lasted six months or longer. It can be caused by an injury that has healed but the nerve pathways were involved and now they’re dysfunctional,” says Morris Solis.
“One of the areas we focus on during treatment is the psychological,” she adds. “We identify patients’ stresses, whether they’re economic, the death of a loved one or trauma. Those, in turn, put stress on the nerves, which affects pain.”
Technology has an important role, too, as biofeedback becomes a more widely used tool in the arsenal of chronic pain fighters, she says.
According to Everyday Health, a newsletter sharing evidence-based health and medical information, biofeedback is a promising treatment for those living with chronic pain, helping patients alleviate stress.
Your body is constantly working on things like breathing and pumping blood without you even thinking about it. When you experience something stressful, like chronic pain, these unconscious processes go into overdrive – your breath becomes shallow and your pulse quickens.
With mindful intervention, you can reverse these automatic responses, providing yourself with physical and emotional relief in the process. Biofeedback therapy creates a window into your stressed body so you can see measurable results showing what techniques reduce stress and pain for you. Biofeedback gives you bodily insights that can help you develop the skills to recognize and gain control of those unconscious physical reactions – which is great in and of itself. On top of that, it is a noninvasive therapy that involves no medications.
In another area of research, the accuracy of nerve blocks keeps improving and they continue to be one of the most effective ways to relieve chronic pain.
Morris Solis says that virtually any nerve in the body can be blocked and that your anesthesiologist or pain management doctor will decide what kind of block to use depending on what is being blocked.
According to Johns Hopkins Health newsletter, nerve blocks are often injections of medicines that block pain from specific nerves. The best-known nerve block is an epidural used during childbirth.
Nerve blocks require needles, usually along with a fluoroscope, ultrasound or CT scan to properly guide the needle, which injects pain-relieving or anti-inflammatory drugs around a nerve or group of nerves. Blocks can be temporary or longer lasting.
Nonsurgical nerve blocks used to manage chronic pain include:
- Epidural analgesia or anesthesia in which the healthcare provider may inject medicine outside the spinal cord.
- Spinal anesthesia or analgesia in which the healthcare provider may inject medicine in the fluid surrounding the spinal cord.
- Peripheral nerve blockade in which the healthcare provider may inject medicine around a target nerve causing pain.
Doctors say that nerve blocks can help people who have chronic pain function better in their daily lives, allowing them to go to work, exercise and do daily tasks.
Peripheral nerve stimulators are another promising tool to help people with chronic pain feel better. The stimulators have been around since the 1960s, but earlier this year the FDA cleared a new version that serves as a minimally invasive treatment for patients with chronic pain.
With the PNS treatment, physicians use imaging guidance to insert a very fine wire, or lead, not much larger than the size of a hair, into the skin close enough to stimulate a target nerve and interrupt the pain signal. The stimulating lead connects to an external battery power supply. Once in place, the miniature PNS device sends gentle pulses, which feel like a small vibration, through the lead to stimulate the nerve.
Patients will work with a team to determine the best stimulation level for their condition and use a simple hand-held remote to control stimulation level and turn the device on and off.
After 60 days, the lead is removed, and treatment is complete.
Morris Solis says one reason chronic pain is so difficult to characterize is because the experience of pain is highly complex and subjective.
“We use 11 different scales to rate pain,” she says. These include numerical rating scales in which numbers are used to rate pain, visual analog scales in which you’re asked to select a picture that best matches your pain level, and categorical scales, which primarily uses words, possibly along with numbers, colors or location(s) on the body.
“If you’re suffering from chronic pain, the best place to start is with your primary care doctor,” Morris Solis said. “Although some pain management doctors take patients without a referral, your primary care doctor will know to which specialist you need to go.”
Regina Morris Solis, MD, is double board-certified in Pain Management and Anesthesiology and is affiliated with Health First’s Holmes Regional Medical Center through a partnership with The B.A.C.K. Center in Melbourne. She completed a Pain Medicine Fellowship at Harvard Medical School-Beth Israel Deaconess Medical Center in Boston and an Anesthesiology Residency at Cooperman Barnabas Medical Center in Livingston, New Jersey. She earned her MD degree at Creighton University School of Medicine in Omaha, and an MS in Medical Laboratory Sciences at Florida International University in Miami. Her office is at The B.A.C.K. Center, 2222 South Harbor City Blvd., Melbourne, where she is accepting new patients. The phone number is 321-723-7716.