Chronic Pain Management

Local resources to help those suffering with chronic pain.

Everyone knows somebody who seems to always be in pain–someone who can’t go on family walks, who can’t sleep properly, that can’t pick up their child–perhaps you’re even the one suffering from this debilitating hurt. Days seem endless because it’s hard to think about anything else.

Chronic pain can be the result of everyday events like joint pain, carpal tunnel syndrome, headaches or sinus pain, as well as from injuries or specific traumas. Even a diabetic who’s had a limb removed can suffer from phantom pain.

Chronic pain is generally defined as pain that lasts beyond the expected length of time it should take for the body to heal. So if your doctor thinks your torn ligaments will be healed in three months and five months later you’re healed but still in agony, that would be considered chronic pain.

The three month marker is often used in the medical profession. If you still hurt after that amount of time, your pain is considered chronic.

Barbara Shay, Associate Professor in the Department of Medicine at the University of Manitoba, defines it as this, “Chronic pain is a pain that persists in the absence of tissue injury.”

Shay is a physical therapist who now specializes in research, as well as teaching in the grad program at the U of M. She explains how research has shown how a sort of distraction of the brain by giving new sensory information through the spinal cord can cause an immediate reduction in pain. This can be done with many of the therapies available for pain sufferers. Acupuncture, for example, is used to send new sensory information when a needle is pushed into specific points on the body.

Through your nervous system, your brain registers this new sensation and takes the emphasis off the chronic pain. “The pain is there, but it’s being dialed down. Your brain is now receiving a new message,” says Shay.

The same effect can be had from massage, by using a TENS (transcutaneous electrical nerve stimulation) machine on the painful area, physiotherapy and others.

These treatments don’t work for everyone though, and they aren’t a permanent solution. They’re referred to as complementary therapies, as they are usually used in conjunction with some other form of treatment.

There are many methods to help keep chronic pain in check. There are even some basics that you can do at home: maintain a healthy diet, exercise on a regular basis, get a full night’s sleep. Of course, these are all things to help keep you healthy in day-to-day life as well. 

In decades past, medication was the most recommended and used treatment in pain management. As research continues though, and as practices like acupuncture and massage have become more popular, it’s clear that there are other methods that can help chronic pain sufferers. There are other things like herbal remedies, hot stone therapy, therapeutic massage and others that can help as well.

Deciding how to go about feeling better when you have chronic pain can be a daunting task. There are many therapies available, and it can be difficult to know where to start.

Patricia Mykytiuk, BsC, MD, FRCPC is the Medical Manager for the Acute Pain Service at the Health Sciences Centre, WRHA Anesthesia Program. She recommends going to see your family doctor first. “Family practitioners are a front line resource in the diagnosis and treatment of chronic pain. They will often initiate testing to ensure serious disease processes can be excluded and make the appropriate referrals as required. As we do in the Chronic Pain Clinic, family doctors also apply a multi-disciplinary approach in managing their patients with chronic pain. Their treatment may involve medications, psychological therapy, or referrals to physiotherapies, massage therapists, occupational therapists, psychologists or other allied health care professionals,” says Mykytiuk.

The connection between physical pain and emotional state is one that is widely recognized. “Pain is not just a physical response–it’s an emotional response as well,” says Shay.

Clinical depression causes fatigue, changes in appetite, a lack of motivation, difficulty sleeping, and feelings of general helplessness. Chronic pain can cause all of these and more. It’s no wonder that the two are so intertwined.

“Chronic pain is associated with higher rates of depression and anxiety. Psychological assessment and treatment methods have become an integral component of chronic pain treatment,” Mykytiuk explains. “Many physicians, psychologists, and social workers have experience and training in this area. Often pain support groups may be useful. Patients often will search out these resources through community organizations, the Internet, local hospitals or pain clinics. Psychological interventions help patients regain control of their lives. Although, the physical pain may persist, with psychological treatments they are better able to deal with their discomfort and their pain becomes less disabling,” says Mykytiuk.

Dealing with the depression is often an excellent first step in chronic pain management. With a clear mental state it can be much easier to put things into perspective and figure out how to deal with the pain itself.

Gentle exercises, tai-chi, yoga, and stretches are all calming movement patterns that can help to improve mental focus, in turn helping in dealing with chronic pain. Meditation is another method with can be learned to help release endorphins into the body. Endorphins are a naturally occurring “high” which can make people feel better.

Of course, there are people that champion the use of medications to deal with chronic pain, and there are those that balk at that idea. It’s best to explore all areas of treatment to find what’s best for you. “Certainly, I have seen many patients benefit from various pain medications, but unfortunately there are those in whom these medications have not benefited. Any drug also has the potential for side effects that may make it impossible for patients to tolerate. In the treatment of chronic pain, medications alone should not be used without other avenues of therapy,” says Mykytiuk.

The Winnipeg Pain Treatment Centre offers another alternative that has made an appearance on the treatment market in more recent years. Open since November 2007, they offer low intensity laser therapy (LILT) among some of the more common treatments.

“LILT is the use of light energy to stimulate cells, helping the body to heal itself naturally,” says Merrilyn Irvine, Director at the Centre. “There are three stages to the treatment: red light, infrared light and a more specific laser probe, which penetrates deeper into the tissue, muscle or bone. The treatment heads are applied to the affected area and the patient can receive the treatment sitting up or lying down, depending on what area is being treated.”

The treatment is painless and has no dangerous side effects. It is generally used along with massage therapy, and improvement can be achieved much faster than with other traditional therapies.

Speaking to your family doctor and researching the therapy options available to you are the best ways to go about finding what’s going to work. Discover what’s out there and get back your quality of life. Shay makes an excellent point, which is true about so many things in life: “The more tools we can give people to have more control, the better served they are.”

In short, knowledge is power.