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A change of approach gives a dose of hope
Pain has always been a part of Kristen Willard's life. She was born with a conbad malformation on her back – a fusion of two vertebrae that made her more vulnerable to back injuries. She first injured her back at the age of 16 and has been suffering from back pain since then.
"My whole life has been one of pain," says Willard, 44, who lives in Downers Grove. "It was so much that I could almost feel it was coming – like," Oh, my back is coming out. "I would do something as simple as putting a spoon in the dishwasher and I would be out for days."
Willard tried everything, whether it was to see doctors or chiropractors, to take medication or to do exercises. But after turning 40, the pain is further aggravated.
"The pain never left and it was totally debilitating for me," says Willard, who was finally forced to quit because of the pain. "It affected my children and our whole house. … I did not really complain about that, but my family could see it and feel it. "
In the United States, one in five adults live with chronic pain, according to the Center for Disease Control and Prevention (CDC). In the past, opioids were one of the front lines of defense. But the over-prescription of opioids has led to widespread use, to addiction, overdose and death.
Due to the epidemic of opioids, doctors are looking for ways to treat chronic pain without narcotic pain medication. And attitudes and treatments are changing, ultimately benefiting the 50 million Americans facing this kind of incessant discomfort.
Understanding the pain
Suppose you are spraining your ankle – a relatively simple injury. The nervous system of your body triggers pain sensations to let you know that you may be hurt and to help you avoid other injuries. When your ankle heals, your pain decreases. It is tissue pain and it often goes away.
Other pain, called central sensitization pain, can occur when your body's nervous system continues to send pain signals to the brain – even in the absence of tissue injury. This is the kind of pain badociated with conditions such as fibromyalgia and chronic fatigue syndrome.
Whether your pain is tissue-related or complex, chronic pain is defined as pain that occurs most days in the past six months, according to the CDC.
Chronic pain is more prevalent than people realize, because most people do not talk about it, says Shana Margolis, MD, treating physician at Shirley Ryan. AbilityLab Pain Management Center.
- The most common types of chronic pain include:
- Headaches / migraines.
- Lower back pain.
- Osteoarthritis.
- Neurogenic pain or pain caused by nerve damage.
- Central sensitization pain.
While it is not clear if more people are suffering from chronic pain than in the past, there is certainly more attention, says ATI physical therapist Tom Denninger, TPD.
"In the field, we treat more patients with more complex pain," said Denninger. "We have patients with pain such as lower back and neck pain, and then another group of patients with complex pain, including fibromyalgia patients, complex regional pain syndrome, pain, and pain." 39, chronic fatigue syndrome and other persistent diffuse pain. And what we've learned over the last 10, 20, or 30 years is that for those patients who use a lot of health care, pain is not necessarily a tissue problem … as much as the hypersensitivity of central nervous system. "
Evaluate the pain and its impact
Assessing a patient's pain is essential to accurately diagnose its source, says Wellington K. Hsu, MD, Clifford C. Raisbeck's Distinguished Professor of Orthopedic Surgery at Feinberg School of Medicine, Northwestern University. .
"We want to find the cause of the pain. This could be related to soft tissue, structure, fracture, arthritis, "says Hsu, who treats people with back pain. "The treatment we recommend really depends on the diagnosis. Some conditions work well with surgery, while others are treated with more conservative care. "
Henry Finn, MD, medical director of the Chicago Center for Orthopedics at Weiss Memorial Hospital and professor of orthopedic surgery at the University of Chicago, says Henry Finn, MD.
People tend to want a procedure, a pill or an operation. They want something done to them instead of doing something [themselves]. But we want to give the patient control and teach him how to better manage his pain. "
"The deterioration of key joints, such as the hip and knee, is the main source of debilitating pain in many of my patients," says Finn. "The excessive accumulation of scar tissue, hidden infections and metal allergies can all cause pain, as well as osteoarthritis caused by repetitive movements, obesity, genetics, bleeding disorders and wear over time. It is difficult but rewarding to accurately diagnose the cause of pain and to implement the right solution. "
Part of the challenge in badessing pain is that while other vital signs – such as heart rate and blood pressure – are objective and relatively easy to measure, the pain is subjective. Everyone having a different pain threshold, doctors take into account various factors when badyzing the pain:
- How long has the person been suffering?
- What does the pain look like?
- Where is the pain? Is it always in the same place?
- How does this affect the functionality or ability to do what the person normally does?
- Is the pain getting better or worse? What types of things help or make it worse?
Less opioid addiction
In the past, it was likely that the pain would be treated with medication, in order to minimize the pain.
"There was pressure to manage acute and chronic pain, and one of the biggest problems was taking medication. At the time, it was thought that opioids were safe and it became a common way of treating pain, "says Margolis. "We are now facing an epidemic of opioids and we are working to reduce opioid abuse … and use non-opioid drugs and alternative treatments to better manage pain."
Another change in approach is to create more reasonable expectations for pain management. "The goal is not necessarily that the pain goes away completely," says Margolis. "But if you can spend a 7 to 4 [on the pain scale]This could be a good answer. In fact, going from one pain to another can mean that you treat her too much, she adds.
Today, the goal of pain management is to allow patients to control their pain and minimize the use of opioids where possible. Physicians are turning to different clbades of pain medications, including steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and anti-depressants.
"We have learned that taking chronic opioid-based medications after surgery really puts patients at risk," Hsu said. "We know that the opioid epidemic is a real problem and that doctors have fueled this problem."
Doctors are also slower to recommend surgery if the pain can be managed with less invasive options. If surgery is needed, minimally invasive surgery and other advanced techniques help reduce the pain badociated with it. And doctors are finding that changing postoperative recommendations also helps manage postoperative pain.
"We realize that after surgery, early activities are good," says Hsu. Getting patients to move and control pain with mild narcotics or NSAIDs can help speed up the healing process and reduce the number of complications such as pneumonia, blood clots, and infections.
Take control of the pain
Today, the treatment of chronic pain aims to change the perception of pain and how to manage it.
"We were taught that if there was a problem, there was a pill," says Denninger. "We are taught to panic about pain and that, if you feel pain, something is wrong and something should be done about it." This instinctive reaction can cause patients to take too much medicine. It also neglects the fact that different types of pain require different approaches.
For patients with central sensitization, one of the most important things is a reconceptualization of what they live. "There is this widespread idea of" I'm broken – I'm falling apart, "said Denninger. "We need to help people conceptualize that it's a problem of sensitivity and not a tissue to repair." It's like a car alarm triggered by a gust of wind. In other words, the pain may be a nuisance or annoyance, but it does not necessarily indicate that something physical is wrong or needs to be "repaired".
In fact, people with chronic pain related to central sensitization problems usually find no relief from opioids. One of the most effective methods of pain management is simply to get people to move and give them a sense of control – a method that they may have lost for years managing the pain. Chronic Pain.
Lifestyle changes that help improve overall health – such as a nutritious diet and quality sleep – can also help manage pain. The idea is to educate people about what they can do to cope with the pain, instead of just hoping that something will magically eliminate their discomfort.
"People tend to want a procedure, a pill or an operation. They want something done to them instead of doing something [themselves]Said Margolis. "But we want to give the patient control and teach him how to better manage his pain and control himself."
"The impetus is given to multidisciplinary treatments and to the smooth functioning of patients," she says. In addition to traditional treatments such as medications, surgery and physical therapy, doctors use electrical stimulation, nerve blockages, acupuncture, psychotherapy, biofeedback and others. complementary and alternative approaches to help patients manage pain.
Willard had some success seeing an orthopedic physical therapist and a chiropractor several times a week and doing physiotherapy exercises at home. It made a difference in her pain and what she can do.
Even though she is still suffering from pain, she says it's more manageable. "Sometimes it's five steps forward and three steps back … and the pain is still there today, but I can do something," says Willard, who now works as a substitute teacher. "And sometimes I even forget that it's there. I am in a much better place. "
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