The Complex Science of Pain: Where To From Here?

Category: Healthcare Advances Written by Dr. Charles Shively / August 15, 2019

“Of pain you could wish only one thing: that it should stop. Nothing in the world is so bad as physical pain. In the face of pain there are no heroes”. This quotation, offered by George Orwell, author of the dystopian classic, 1984, is still valid. Most physicians will acknowledge that pain is a complex response that includes not a distinct sensation but also motor activity, changes in emotion and re-focusing of attention causing a brand new…elusive memory. Yet for most it is not a slow burning memory…it is ever present. Is state of the art today about not killing the pain but just making it go away?

Does every individual feel pain as the result of a similar pain pathway in the body? NO! Two pain paths exist and diverge in the body. Acute pain (nociception) that results from injury or disease is very different from the persistent pain that continues even after the damage is resolved and even in the absence of an acute injury. Researchers are learning that the differences in the way the body reacts to pain relates to a neural mechanism that triggers these distinct signals in the brain.

Persistent pain that continues long after or in the absence of injury can result from the misfiring of the normal nociceptive pathway. This often occurs in persistent pain and is triggered in the from a neutral stimulus, with the signal become amplified on its way to the brain. Additionally, persistent pain can arise even in the absence of any stimulus caused by the firing of neurons in spinal cord or brain circuits responsible for pain processing.

As the race to develop non-opioid drugs which define new approaches to pain relief evolves, primary research focus at major institutes (NIH and other USA agencies) and many worldwide Pharma companies are involved with intense commitment to evaluating how immune-like cells in the central nervous system (gila) are involved in the creation and maintenance of persistent pain. Gila is now recognized to contribute to the aberrant neural activation that causes persistent pain.

Acute pain, or nociception, results from the activation of peripheral neurons near the wound, challenged body part or surgical site and these neurons effects a subsequent transmission of signals along a connected series of somatosensory neurons up the spinal cord and into the brain. Research into persistent pain has opened the door to understanding how gila, long considered to be little more than cellular glue holding the brain together, is now appreciated as a critical contribution to the health of the central nervous system with recognized roles in the formation of synapses, neuronal plasticity and protection against neurodegenerations. Gila biology may hold important clues to some of the mysteries that have perplexed pain research, such as why the prevalence of persistent pain differs between the sexes and why some analgesic medications fail to work for both sexes.

While active research continues to define new approaches to pain management, many alternative therapies exist and manage pain differently…avoiding pharmacological treatments for pain. Today, an estimated 92 million USA adults use prescription opioids for pain and 11.5 misuse them according to an outdated National Survey on Drug Use and Health. Usage today has become a pandemic and the US government is mandating change through presidential decree.

Chronic pain is more common among women than men, and it becomes more common as people grow older. Why is this? It has been established through research that when women are given testosterone and men are given estrogen pain thresholds are changed. Why is this? It is because in males when the peripheral neurons respond to injury or challenge, and have inadequate levels of testosterone, a switch to the pain response seen in females occurs. Females who lack T cells switch to the pathway observed in males sending signals to the spinal cord. T cells are a type of white blood cell developed in the thymus bland and that plays a central role in a specific response to foreign substances in the body.

People who age are more likely to have chronic pain such as arthritis and gout (legs and feet). Not all people with chronic pain who have a health problem have been diagnosed by a health care practitioner of course. The most frequent conditions are low-back pain or osteoarthritis. Other common conditions involve rheumatoid arthritis, migraine headaches and associated issues, carpal tunnel syndrome and the various forms of fibromyalga.

Knowing these prevalent conditions of the human circumstance, what alternative therapies or complementary approaches to pain relief exist today? This begs the question: What are the differences between complimentary or alternative approaches? Although often used interchangeably, these approaches are different in the concepts used to effect therapy. Complementary suggest a non-mainstream approach other than conventional medicine. Alternative refers to using a non-mainstream approach in place of conventional medicine. A third approach, integrative health emphasizes a holistic, patient focused approach to health and wellness and often includes mental, emotional, functional, spiritual, social and community aspects.

What complementary health approach is best for pain relief? This article discusses ten important opportunities for complementary health approaches including dietary supplements and other natural products. Safety of the use of complementary health approaches are safe for healthy people but may not be safe for people with selected medical conditions. A physician or health care practitioner should be consulted before use which cause a question in the mind of the consumer or patient.

The following are various complementary health approaches with confirmed and safe success.

Acupuncture involves the stimulation of a special point on the body. This is achieved by inserting thin needles through the skin. It is a centuries old practice used in traditional Chinese medicine. Although scientists do not fully understand how acupuncture works in the body to relieve pain…it does work in most individuals. It often is used to affect a slight improvement in low-back pain. It also is used for osteoarthritis, tension-type headaches, neck pain and even fibromyalgia.

Massage therapy has been practiced in most cultures, both Eastern and Western throughout human history. It was one of the earliest tools people used to relieve pain. There are many different types of massage therapy, but in general, they all involve manipulating the soft tissues of the body with the goal to help to manage a health condition or enhance wellness. Massage therapy can help to relieve low back pain, neck and shoulder pain, cancer pain, arthrithis, and fibromyalgia. It has not been studied extensively for successful headache or migraine relief.

Meditation, mindfulness and music support has a history that goes back more than 3,000 years. Most mediation techniques started in Easter religious or spiritual traditions. These can include Transcendental Meditation or techniques that keep attention on awareness of the experience of the present moment. Meditation, mindfulness or music support for pain has not been shown to be more effective than cognitive-behavorial therapy (a type of psychotherapy) for chronic pain. These approaches may lead to a small short-term improvement in low-back pain or headache pain. Perhaps a surprising element for complementary medicine is the use of therapy associated with listening to music. Each individual understands which type of music assists them in the release of temporary pain. This author knows this from personal experience. Music is relevant in that it lets my mind and pain float away. A refuge for troubles and pain!

Relaxation techniques such as progression relaxation, guided imagery, biofeedback, self- hypnosis and deep breathing exercises. These activities produce the same natural relaxation response characterized by slower breathing, lower blood pressure and a feel of satiety (calm and well-being). Relaxation techniques have been shown to be helpful in irritable bowel syndrome, temporomandibular disorder (pain and loss of motion in jaw joints), fibromyalgia, headaches and abdominal pain in children.

Spinal manipulation provided by chiropractors or other health professionals used by their hands or an appropriate device applies a controlled force to a point of the spine. Spinal manipulation can provide mild-moderate relief from back pain. It may help with chronic tension-type or cervicogenic (neck-related) headaches and even be helpful in preventing migraines. The relief of neck pain using this technique is still being researched.

Tai Chi, which originated in China as a martial art many ages ago, is a mind and body practice. It involves moving the body slow, gently and with awareness, while breathing deeply. Often studies for have been shown comparable to physical therapy in relieving pain in people with osteoarthritis of the knee. Clinical practice guidelines issues by the American College of Physicians has recommended tai chi as one of several nondrug treatments that patients with chronic low-back pain should consider. It does offer moderate relief of some fibromyalgia symptoms.

Yoga is a complex practice, rooted in Indian philosophy, which originated several thousand years ago. Classical yoga includes many elements but practice in the USA typically employs physical postures, breathing techniques and meditation. A 2017 National Health Interview Survey indicated one in seven USA adults practice yoga during this year. Interestingly, in children ages 4 to 17, it was about stated to be a surprising 1 in 12. Several studies have shown that yoga can be helpful for low back pain. Yoga may have short-term benefits for neck pain. Limited research has been done on yoga for arthritis.

Natural products or dietary supplements used in complementary health include herbs (botanicals), vitamins, minerals, probotics and other substances such as glucosamine and fish oil are widely marketed and often support different pain conditions. Select ingredients have been shown to be effective for short term use in low back pain. It is still uncertain that glucosamine and chondroitin have a meaningful impact on osteoarthritis symptoms. Omega fatty acids have been shown to have a small beneficial effect on rheumatoid arthritis symptoms. The American Academy of Neurology acknowledges that the herb butterbur is effective and others such as magnesium and riboflavin are conserved probably effective while Coenzmye Q10 is possibly effective for migraine prevention. Irritable bowel disease and stomach discomfort has long been known to be calmed by peppermint or the old-fashioned tinctures made by pharmacist.

CBD oil and hemp derivatives are a new addition to the pain relief scene and with the various different forms being presented which include oral drops, liquids, topical and other forms including gummies, there is considerable FDA government activity regarding the safety and efficacy of these products produced by different organizations. The regulatory status of various products is being evaluated as to claims and effectiveness.

In summary, where to from here? Comfort without pharmaceutical medications for acute or persistent pain which kills the pain…not just which makes it go away… continues to be an elusive mystery. Alternative or complimentary approaches do help while the future evolves. Know this!

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Thank for sharing!

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