4 P’s That Can Help Lower Pain Levels

By Barby Ingle, Columnist

Having lived with chronic pain for 21 years -- with diagnoses such as arthritis, TMJ disorder, endometriosis, hypothyroid, ischemia, seizures, reflex sympathetic dystrophy (RSD) and thoracic outlet syndrome -- I know what life with a chronic condition is like.

I have tried many different treatment options, yet still have not found “the cure.” That doesn’t mean I have stopped looking. As part of my continuing alphabet series on alternative pain treatments, this month I am covering 4 P’s of pain management: physical therapy, pain medications, prolotherapy and psychology. 

Physical Therapy

Also known as PT and physiotherapy, physical therapy uses movement through manual therapy, exercise, and electro-therapy to improve range of motion, mobility, function and daily living.

Used incorrectly, physical therapy can be harmful. It is very important to get a physical therapist that understands your health condition, knows when to push you and when to hold you back, and can teach you exercises you can learn to do independently.

A good physical therapist will do research on your condition and help educate you about your body’s limits and potential for improvement. They will also be in regular contact with your doctor and other healthcare providers.

Due to insurance practices in the United States, the number of physical therapy sessions is often limited and rarely lasts throughout a chronic illness. But many of the techniques can be continued at home on the patient’s time, once they learn how to do them properly.

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When I first started physical therapy, I did all of the wrong exercises because my therapist didn’t know or understand the conditions I have. My mentality at the time was no pain no gain, so we both over-worked me. It made things far worse than if had I done nothing in the first place.

Once I was with the right physical therapist, I began to see improvements in my daily function. We learned together it wasn’t about pushing my limits, but more about working as a team to find ways around the physical limitations I had.

Pain Medication

When the average person hears the words “pain medication” they often think about opioids. But there are a many different types of pain medication available, including medical cannabis, NSAIDs, benzodiazepines, tricyclic antidepressants, alcohol, kratom, cox-2 inhibitors, and muscle relaxers.

Based on my speaking with medical professionals and researchers, I believe that all options -- including opioids -- should be on the table when a provider is deciding what is best for the patient.

I have heard from thousands of patients (of the millions who use opioids daily) who swear by two things. First, they have no other treatment option due to access or cost.  Second, there is no other treatment option that works as well as opioid medication.

I know that the evidence is weak on the long-term use of opioids. Every test, assessment and research study can be torn apart by opioid critics. But for me, it all comes down to this: If I have something that helps me function better and live a better quality of life, I want to have access to it. I have lost many friends to suicide due to uncontrolled pain and a few to addiction.

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Opioids are not typically the first line of treatment. More and more, due to insurance company policies, guidelines and legislation, pain patients will get acetaminophen or NSAIDs, or be given nerve blocks, spinal injections or some other invasive procedure. Opioid medications are far less prescribed than they used to be. And many patients can’t get them at all.

Doctors are now being taught in medical school that what they prescribe should be determined by the type of pain someone has. For neuropathic pain, they are taught that traditional analgesics are less effective. Therefore, many providers will prescribe tricyclic antidepressants and anticonvulsants for nerve pain. And they will use topical NSAIDs creams and ointments for muscle sprains and overuse injuries.

Prolotherapy

Prolotherapy is an injection-based treatment used for pain conditions that involve musculoskeletal disorders, such as low back pain, tendonitis and knee osteoarthritis.

The injection is typically administered where joints and tendons connect to bone.  In theory, the injection creates an irritation to the injured area that helps stimulate healing. This technique that has been practiced since Roman times, when they used hot needles on gladiator injuries to promote healing.

Patients may report mild pain and irritation at the injection site, which usually goes away within 72 hours. They also may report numbness or minor bleeding right after the injection. There have been cases of disc and spinal injuries reported.

I used to hear a lot about prolotherapy 10-15 years ago, but I hear less and less about it now, as it is not typically used to treat nerve diseases. It is also not well reimbursed by insurance companies and Medicare has decided not to cover prolotherapy injections for low back pain at all.

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Psychology

Psychology is used to help prevent the reliving of psychological distress or dysfunction, and to promote positive thoughts, well-being and personal skills. Psychology should not to be confused with psychiatry, which is the medical specialty devoted to the diagnosis, prevention and treatment of mental disorders.

I have undergone psychological counseling in both group and individual settings over the years. The time when I found it most helpful was before I finally got a proper diagnosis of RSD and started infusion therapy. At the time, I was beginning to feel like a guinea pig. Some providers didn’t know what to do with me and having a psychologist providing support and making sure my mental attributes were strong was very helpful. 

I still use some of the mindfulness techniques he taught me to this day. When I was getting ready for infusion therapy, I felt like I had tried every treatment available on earth. Having a professional psychologist to speak with and go over what happens if the infusion didn’t work prepared me for a worst-case outcome.

Luckily, I didn’t need it, but it did teach me that even though I felt like I had tried everything, there are always new options being created and that I had not actually tried everything.

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This is one of the reasons I am so sure that the alternative treatments I have been presenting over the last 8 months are helpful to others. I never realized until I did the research that there are so many different things to try. Using a multi-modal approach to pain and understanding that the mind, body and spirit connection are real is important not to neglect.

There were times when my providers suggested that I go to a psychologist, and other times when I had to get psychological clearance for different procedures. I found that when I went to a session, I felt better about myself. It was "me time" -- a time to focus on getting through the depression and anxiety of living with a chronic illness.

I learned that chronic pain affects our brains and causes depression and anxiety, and that it was not the other way around. That there are tools and medications to address them, and that knowing myself and what is going on with my health was one of the best ways to get past the depression and anxiety.

Psychologists gave me aptitude tests to check my general knowledge, verbal skills, memory, attention, reasoning, and perception. A few also gave me personality and neuropsychological tests. The more I learned about myself, the better I was able to navigate through chronic illness, the people around me, and the better relationships I was able to achieve.

I once again look forward to reading your comments. What treatments have you tried, what has worked, and what didn’t work? What tips do you have to pass on to other readers? Have you found the treatment protocol that works for you?

I personally don’t believe that there is a magic pill or procedure that can cure chronic pain - yet. I also strongly believe that the patient and their providers should be making the decisions for what is best for the patient.

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Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics.

More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.