Behind the PainThe National Institutes of Health (NIH), estimates one-third of the U.S. population suffers from chronic pain, and 5 to 8 million people are on long-term opioid medications to manage their condition. Unfortunately opioid medications have a host of unwelcome side effects, and also carry the risk of abuse and overdose.
Although opioid prescriptions are a common treatment according to the NIH, it is not necessarily the most effective. A study in JAMA found that patients with osteoarthritis pain who took non-opioid medications had significantly better pain intensity and significantly fewer adverse medication-related symptoms over the course of a year than those who were on opioid medication.
“Opioid prescription medications used to be the primary way to address persistent pain, but we’ve discovered that those medications aren’t addressing the source of the pain or even managing it very well,” said Kellie Lewis, who has a doctorate in physical therapy. Dr. Lewis helped develop the Pain Solutions program at Samaritan. The program teaches people tools to manage their pain in daily life.
“We’re trying to change the lingo from chronic pain to persistent pain because we know now that chronic pain doesn’t have to last forever,” said Dr. Lewis.
Acute pain occurs when there is an injury and eventually goes away as the body heals. Chronic or persistent pain lasts beyond the healing processes, usually three months or more, and is managed differently by the body. Persistent pain can impact your well-being and quality of life.
“Part of pain science is understanding how much the brain plays a role in how we feel pain,” said Christopher Smith, PhD, a clinical psychologist who works with Pain Solutions. “If we can use interventions that don’t rely on medication to change the way we think about our pain and relate to it, then we can reduce the pain that we experience.”
Solutions for WellnessPersistent low back pain is a common complaint that Lewis helps people address. The condition can have many causes, from spinal stenosis where there is pressure on the spinal cord, to weakening core muscles or osteoarthritis. Lewis’ first step is to evaluate what each person is capable of before creating a routine that safely challenges the body.
“It helps to establish a baseline so you know realistically where you’re starting from,” said Dr. Lewis. “People tend to start too fast, or remember themselves how they were 10 or 20 years ago.”
Depending on what is causing back pain, exercises that relieve pressure on the spine or that strengthen the deep interior muscles can help bring relief.
When working to reduce pain, Dr. Lewis reports that the people who have the best results take a holistic, well-rounded and proactive approach.
“There’s no one movement or stretch that is going to fix everything,” said Dr. Lewis. “It’s a combination of exercise, changing the thought process and examining lifestyle factors like diet and sleep. Once you can commit to those things, it opens the door and you realize that you can manage your symptoms and feel better. It’s very empowering.”
Dr. Smith also touts the value of learning you have power over pain.
“The common belief is that pain is automatic and something we can’t control, and that if we have it for a long time we’ll have it forever. That’s a hopeless view,” said Dr. Smith. “In the medical field we’ve learned that you do have control over how you experience pain and we want to give people the right tools so that they feel more in control and can get back the life they had. It might not look exactly the same but you can feel a lot better, like you did before you started experiencing pain.”
Tools to Conquer Pain
Address Automatic Negative ThoughtsImmediately following an injury, it can be easy to worry about how it will impact your daily life and mobility. But as pain persists for weeks or months, that worry can start to take up more space in your head. Maybe you begin to catastrophize and feel that you will always have pain and can never enjoy your life again. Dr. Smith calls this damaging thought process “automatic negative thoughts.”
“It’s helpful to set aside the negative thoughts and visualize separating yourself from them,” she said. “You don’t get rid of them, but give yourself a little space to make the choices you need in life so the pain isn’t right in front of you all the time.”
Try to identify the trigger of those thoughts and stop yourself when you notice it happening. Just like you have to practice exercise to get stronger, you will have to practice stopping negative thoughts and reframing them in a positive light that focuses on your values and abilities.
The body was made to move and moving can help you feel better.
“There’s a common misconception that hurt always equals harm or damage,” said Dr. Lewis. “With physical therapy we can evaluate how much movement your body can safely tolerate, and then improve it in a controlled and guided way.”
According to Dr. Lewis, most people benefit from daily gentle stretching for at least 10 minutes. Don’t worry about specific stretches, just do what feels good. She also recommends adding in exercise, even if you start with just five minutes of walking a day.
Overcoming persistent pain with the goal of getting off opioid medication requires coordination with your medical care team. In a supportive environment like Pain Solutions, Dr. Smith and Dr. Lewis work with people to address the physical and behavioral aspects of pain.
“There’s often a fear of coming off medication because people are experiencing pain even while they’re on it, but with the combination of their doctor’s help, physical therapy and cognitive behavioral therapy, they can absolutely be successful,” said Dr. Lewis. “Patients report having less pain and clearer thoughts, which helps them feel like they’ve gained a little part of themselves back.”
Pain Solutions: First Steps is a free, six-week workshop to teach you the tools you need to manage persistent pain. See our next class coming up in Corvallis.
Learn more about the science of pain and treatment at an evening workshop in Lebanon, on Tuesday, October 15.