Managing Perception and Experience of Pain

What is Pain?
Pain has both physical and psychological aspects and is a very personal experience. Our brain interprets pain based on signals such as chemicals from food, drugs, environment, and the immune system. With chronic pain, continually focusing on pain can be self-limiting, and strategies to change a person’s perception of pain and experience of pain can help. This means using strategies that address mind, body, spirit to support a person to look past or beyond their pain and work to address the root causes.

How do we approach pain?
Today’s societal approach is pain avoidance, and so, the mantra is a “Pill for every ill”. Providers have been trained to help patients address acute and chronic pain with predominantly anti-inflammatory drugs and opioids. We are now fighting not only the complications of long-term drug-related organ toxic effects from these drugs, but a significant battle of addiction we know as the current opioid crisis. This has stemmed from the first and easiest solution being to prescribe opioids for pain and a societal and regulatory mandate to manage patients’ pain. To address the opioid crisis, hospitals are currently implementing measures to monitor and restrict prescriptions of opioids to hope to prevent avoidable dependence and addiction from over-prescription.

Chronic pain is a process, as a person becomes sensitized to the chemical signals of pain, less stimulation may result in a faster pain experience. We need to reset our pain neural pathways to the brain by changing the body’s environment, improving blood flow, improving nutrients to the affected area, releasing inflammatory cytokines, releasing stem cells, and improving detox pathways.

Let’s face it. People are not tolerant of pain and non-medication measures often are not as fast or convenient as taking a pill. Pain can be frustrating, limiting, traumatic, and psychologically consuming. Addressing pain should include both physical and psychological measures. It should address the entire person…not just the symptom.

How is pain related to inflammation? Inflammation is pain. In Chinese medicine, the Qi is thought to be blocked, creating inflammation on one side of the injury and emptiness on the other. Increasing blood flow through the blockage releases pain.

NF-Kappa B (NF-kB or nuclear factor kappa-light-chain-enhancer of activated B cells) is the protein complex that controls gene expression of cytokines, the productions of cytokines, inflammation, and cell survival. Inflammation is where there is accumulation of fluid that impacts lymphatics and subcutaneous tissue, which then accumulates fluid and triggers an immune response and pain. Aside from acute injury, inflammation is influenced by diet, lifestyle, and stress.

How does a functional medicine (root cause) approach differ from traditional medical one? Traditional medicine typically looks at managing pain as the symptom, and not the root cause as to why and how that pain develop. Traditional medicines have focused on strong anti-inflammatories such as steroids, NSAIDs, and narcotics. These traditional approaches often just mask the pain symptom, whereas functional medicine looks at the whole person and the underlying causes as to how that pain developed. Functional medicine practitioners work on managing pain naturally. Tylenol or Advil or opioids can have significant side effects, particularly if taken long term. Some natural therapies may potentially take longer to provide effect but can result in significant pain relief. Functional medicine practitioners also support multi-modal therapy, meaning that they combine natural therapies to address pain.

What are examples of integrative approaches to pain? There is a lot of jargon used to describe different approaches to pain. Traditional medical approaches generally focus on treating the organ or system affected by pain. Complementary approaches mean that they are used in conjunction with a traditional approach, whereas alternative medicine means in lieu of traditional medicine. An integrative approach addresses the whole person in a coordinated way that is both holistic and patient centered. It is holistic, meaning that it includes physical, mental, emotional, functional, spiritual, social, and even community aspects of the person. Integrative therapies can be combined with other integrative approaches and/or a traditional approach to reduce pain. Below are some examples of integrative approaches to pain:
• Acupuncture- Is used to treat many conditions. Common uses include tendinitis, arthritis, headaches, chronic pain, chronic fatigue syndrome, respiratory disorders, skin problems, dysmenorrhea. and digestive disorders. Acupuncture promotes relaxation. It triggers a state modulating gene expression and modulating this activity. It allows space in body. A systematic review of chronic knee pain and acupuncture did not show conclusive evidence, citing that further studies were needed, but supported that 12-weeks of acupuncture may help with chronic knee pain. Another review comparing neck pain with conventional therapies showed similar effectiveness on pain and disability with treatment, and additive relief when combined, especially when electro-acupuncture was added.
• Biofeedback- Your involuntary body functions like heart rate, skin temperature, and blood pressure are controlled involuntarily by your nervous system. Biofeedback techniques can help you gain more control over these involuntary functions. Biofeedback use the power of the mind to create awareness to manage and control pain such as migraine headaches and chronic pain, as well as other conditions.
• Biohacking- Biohacking is trying to understand your personal biology, body and mind and taking steps to control and to be the best version of yourself through understanding the current science and technology.
• Breathing techniques- We often unknowingly hold our breath, and this is very true when we experience pain. Breathing techniques can help promote relaxation and manage pain.
• Cannabinoids and Cannabidiol (CBD)-Relatively recently, we have learned that we all have an endocannabinoid system. This system contains receptors for CBD. CBD is is a derived from hemp from the marijuana plant as an extract oil and does not contain the active THC or hallucinogenic component. It has been used to manage chronic pain and even neuropathic pain and reduces inflammation. It is used in many forms such as topical, particularly to alleviate arthritic pain, as well as variety of oral and inhalation formulations. CBD lowers the CNS response (sympathetic fight or flight response) and balance the limbic system (portion of the brain that controls emotion and behavior). It can help with the emotional side of pain, eg. PTSD, anxiety.
Laws across states on the various formulations vary and CBD continues to grow as a popular method to address pain. There is a great deal of ongoing research on the various components and formulations of CBD to address various conditions. All CBD extracts are not the same and it depends on the manufacturer, so it is important to research the site and product information. Dosing, processing, are very important. Manufacturers’ websites should provide more specific information. Research is ongoing, and current contraindications would be pregnancy and breast-feeding until more is learned.
• Coaching-The psychology of pain is a tremendously important as well as staying on a path to manage physical treatment. Coaching may help people with chronic pain to not become their pain and work on behaviors and strategies to take them out of a pain victim role. Coaching can help people look past their pain, find meaning in it, rather than solely than focusing in on it.
Coaches help to empower people, showing them where they have control and helping them connect to what they may be doing that exacerbates pain. They help encourage hope in finding solutions. A coach can helps you to take responsibility and be a part of the solution, and not rely on just the practitioner to fix pain.
• Detoxification from Opioids-There are many detoxification programs to help people with chronic pain detoxify from opioid use and transition to natural therapies that can help the body heal itself and manage pain without toxic side effects from drugs.
• Essential Oils -There are many essential oils that contain anti-inflammatory and pain relief benefits. The use of the particularly oil may be better used depending on which area of the body is impacted, such as skin, abdomen, bone, etc. and the type of pain. Examples of essential oils include boswellia (Frankincense), lavender, clary sage, peppermint, thyme, rose, clove, eucalyptus, fennel, bergamot, ginger, helichrysum, patchouli and others.
• Exercise/Movement- Exercise and movement are valuable in helping people with pain move and regain flexibility and muscle tone. Physical therapy and a number of exercise practices may be beneficial. For example, a 2015 review of studies on Tai Chi showed immediate effects on chronic osteoarthritic and low back pain and a valid duration of Tai Chi practice of 5 weeks.
• Fulvic- Antioxidants protect us from the damages of free radicals, which ultimately cause the release of inflammation in the body. Fulvic is one of the components of humus, which is the product of naturally decomposing organic substances over time. Fulvic acid transports ionic trace minerals and other nutrients effortlessly through all cell walls. Moreover, fulvic acid speeds up the absorption of vitamins and trace minerals, which are needed to keep our immune system (and inflammation) in check.
• Herbals- A variety of herbal therapies can be used for inflammation and pain management. For example, white willow bark contains salicin, similar to aspirin, and is often used for osteoarthritis or bone pain. Like aspirin, caution should be taken when using this if you have diabetes, liver disease, kidney disease, or are on anti-coagulants. Curcumin (tumeric), Kava kava, valerian root, St. John’s Wort, green tea, capsaicin, black pepper, resveratrol, pycnogenol, cat’s claw, and cinnamon are other examples.
• Mind-Body Techniques-Practices like guided imagery, visualization, reframing your thoughts, repeating a mantra, prayer, or using the emotional freedom technique could improve pain. Mind-body practices help modulate NF Kappa B. while biofeedback and meditation are not as fast as a pill, they can have long term positive effects.
• Methylsulfonylmethane (MSM)-An anti-inflammatory agent with limited research studies, considered to be useful for osteoarthritis pain, muscle recovery and other conditions. MSM probably inhibits NF-kB, a protein complex involved in inflammatory responses in your body and the production of cytokines linked to inflammation. It can increase levels of glutathione, a potent antioxidant produced by your body. It has been paired with glucosamine and Boswellia (frankincense) to decrease inflammatory pain.
• Nutrition-Sometimes we have food sensitivities that we are aware of or unaware of that cause inflammation. This inflammation can take years of a particular food consumption or overeating of foods that lead to diseases of pain such as arthritis. Through eliminating foods that cause inflammation, pain may be relieved. Techniques such as Intermittent fasting or fasting promote autophagy which reduces inflammation and oxidative stress. Autophagy is a cellular self-cleansing process.which leads to destruction of unwanted cells and cell regeneration and increases mitochondrial health.
• Ozone therapy-Ozone, or O3 is a pressurized, an unstable form of oxygen which stimulates blood supply to tissue, helps get nutrients to tissue, repair neuropathies, promote wound healing, repairs micro-injuries, destroys bacteria, viruses, and fungi, and helps the body release inflammatory chemicals. May be used in conjunction with regenerative therapy and or nutritional protocols to help regenerative stem cells reach the damaged tissue that is compromised by limited circulation. Used to help deliver nutrients to tissue and to treat a variety of conditions such as diabetic neuropathy, traumatic brain injury (TBI)/concussions, dementia/Alzheimer’s disease, MS/ALS, arthritis, cancer, autoimmune, autism, ADD/ADHD, and even aging. A number of sessions may be required to be effective. Ozone therapy is different than hyperbaric oxygen therapy, where 100% oxygen is delivered. However, the therapies can be used in combination. A resource is The American Academy of Ozone Therapy, https://aaot.us/.
• Prolotherapy-Prolotherapy is an alternative therapy that is used to help repair ligaments and injured joints. It stimulates tissue repair through injection to the affected area. It is not well-researched but is well-tolerated. It’s also used to treat arthritis, whiplash, and degenerative disc disease. Prolotherapy can be used to treat a number of areas of your body, including your back, neck, knees, shoulders, hips, pelvic floor, and hands
• Proteolytic enzymes- Proteolytic enzymes are specific enzymes that play important roles in protein digestion, immune function and other vital processes. Two of the best food sources of proteolytic enzymes are papaya and pineapple. Papayas contain an enzyme called papain and is a powerful proteolytic enzyme. Pineapples contain a powerful proteolytic enzyme called bromelain. Both have been used for centuries as a natural treatment for a number of ailments. They help with digestion and decrease joint and muscle pain through decreasing inflammation.
Regenerative Cell Therapy- The field of regenerative cell therapy to heal the body has been growing rapidly. There are a number of types of cells that can help with chronic conditions. Mesenchymal stem cells, umbilical cord stem cells and exosomes are examples. For example, exosomes are signaling molecules which help modulate inflammatory response and in combination with stem cells may be even better. Some cells are not FDA approved in the U.S. Refer to https://www.regmedfoundation.org/.
• Vitamin therapy-Vitamin therapy can help manage pain but should be used with caution.
o Vitamin B12-This vitamin could help with back pain or mouth sores.
o Vitamin C-anti-inflammatory and is useful in rheumatoid arthritis through stimulating the immune system
o Vitamin D is essential for bone and muscle function and may have anti-inflammatory effects. It has been know to help with menstrual cramps and joint pain.
o Vitamin E especially used to treat neuropathic pain

Summary: While opioid therapy can be useful short term for uncontrolled pain and trauma, the goal should be to use integrative therapies to manage pain. While this is not a conclusive list of inflammation and pain strategies, there is hope to manage chronic pain. Working with a functional medicine practitioner can help approach your pain holistically and to develop a plan with you. A health coach can help support you to reframe your pain and work with your practitioner as well as with mind-body techniques to help approach your pain.

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