PAIN

WHAT IS PAIN?

Pain is a way for your central nervous system to signal that something is wrong in your body.  Pain can vary greatly from sharp to dull or from constant to off and on. Also, pain can come from anywhere in the body.  Usually, pain is separated into two categories, acute pain and chronic pain (1).

• Acute pain: Acute pain is a normal physiological response to damage or potential damage to the tissues.  The acute pain usually stops when the source of the pain resolves (2,3).
• Chronic pain: Chronic pain long outlives its original cause.  It usually worsens over time and takes on a life of its own.  The American Medical Association describes it as pain that lasts for six months or longer.  Recent research has shown that chronic pain is destructive to the body.  The longer chronic pain goes untreated, the worse it becomes.  Chronic pain unleashes a cascade of harmful hormones, such as cortisol, that adversely affect the immune system and kidney function.  It is not normal and does not serve a function.  Often the exact cause of the chronic pain is unclear.  Chronic pain often leads to behaviors that lead to unhealthy behavior patterns, such as inactivity (2,3).

RISK FACTORS OF PAIN

• Injury
• Surgery
• Being female
• Obesity
• Increased age (4)

SYMPTOMS OF PAIN

• Pain that can be described as a dull ache, throbbing, burning, shooting, squeezing, stinging, soreness, or stiffness.

Additional symptoms may include:

• Decrease appetite
• Trouble sleeping
• Changes in mood
• Weakness
• A lack of energy (5)

CHRONIC PAIN FACTS AND STATISTICS

In 2010, an estimated 100 million Americans suffered from chronic pain.  Some estimates say that chronic pains cost between $560 billion and $635 billion (in 2010 dollars) in the United States, which combines the medical costs of pain care and the economic costs related to disability days and lost wages and productivity (6).

According to a National Institute of Health Statistics survey, 27% of respondents reported having lower back pain, 15% reported having severe headaches or migraine pain, and 15% reported having neck pain (6).

Over 26 million Americans between the ages of 20 and 65 experience frequent back pain making it the leading cause of disability in Americans under the age of 45 (6).

MEDICAL TREATMENT OF CHRONIC PAIN

• Opioids work directly on the opioid receptor.  Opioid receptors are molecules or receptor sites in the body that capture the opioid molecule and begin a cascade of events that eventually helps reduce pain.  However, activation of the opioid receptor only leads to a minimal reduction in pain.  Opioids are the least effective treatment for acute or chronic pain and have the most side effects of all treatments (7).
• Ibuprofen and acetaminophen are effective over the counter drugs for acute pain but have little or no effect on the pain that is caused by central sensitization. Adding acetaminophen to nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be an effective way to improve pain relief. In fact, in Europe, there are products that combine the two. But one study shows the combination could potentially increase the risk of gastrointestinal bleeding. Perhaps more disturbing is that an acetaminophen overdose can also lead to acute liver damage, which could be deadly (8).
• Amitriptyline is an antidepressant and may be helpful for chronic pain.  This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.  Amitriptyline can increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults. Your doctor and family members should watch you closely for signs of changes in your behavior or worsening depression when you start taking this drug (9,10).
• Gabapentin: Neurontin and pregabalin are used for chronic neuropathic pain.  May cause side effects like drowsiness, depression, and multiorgan hypersensitivity (DRESS) (11).
• Muscle relaxers: seldom benefit chronic pain and can be deadly when used with opioids. May cause serotonin syndrome, heart arrhythmias, drowsiness, dizziness, hallucinations, and delusions (12,13).
• Surgery based on the cause of pain (14)

NATURAL WAYS TO HELP RELIEVE PAIN

Practices to Help Relieve Pain:

• Acupuncture (15)
• Biofeedback (16)
• Cognitive-Behavioral Therapy (CBT) (17)
• Exercise Therapy (Active Therapy) (18)
• Massage Therapy (19,20)
• Weight Loss (21)

Natural Supplements That Help Relieve Pain:

• White Willow Bark (22,23)
• Vitamin D3 (24,25)
• Vitamin B6 (26,27)
• Vitamin B12 (28)
• Acetyl L-Carnitine (29)
• Coffea Arabica (30)
• L-Tetrahydropalmatine (31)
• Turmeric (32,33)
• Ginger (34)
• Valerian (35)
• Omega 3 Fatty Acids (36,37)

REFERENCES

1. Pain. MedlinePlus. https://medlineplus.gov/pain.html. Accessed July 17, 2018.
2. What Causes Chronic Pain? Healthline. https://www.healthline.com/health/chronic-pain#risk-factors. Accessed July 17, 2018.
3. Do I Have Chronic Pain? WebMD. https://www.webmd.com/pain-management/guide/understanding-pain-management-chronic-pain#1. Accessed July 17, 2018.
4. AAPM Facts and Figures on Pain. The American Academy of Pain Medicine. http://www.painmed.org/PatientCenter/Facts_on_Pain.aspx#refer. Accessed July 17, 2018.
5. Rosenblum A, Marsch L A, Joseph H, Portenoy R K. Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions. Exp Clin Psychopharmacol. 2008 Oct; 16(5): 405–416. doi:10.1037/a0013628
6. Over-the-Counter Meds Have Risks Too. Arthritis Foundation.  https://www.arthritis.org/living-with-arthritis/treatments/medication/safety/acetaminophen-ibuprofen-side-effects.php. Accessed July 17, 2018.
7. McQuay HJ, Carroll D, Glynn CJ. Low dose amitriptyline in the treatment of chronic pain. Anaesthesia. 1992 Aug;47(8):646-52.
8. Amitriptyline (Oral Route). Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/amitriptyline-oral-route/description/drg-20072061. Accessed July 17, 2018.
9. Yang JY, Lee W, Shin WK, Kim CH, Baik SW, Kim KH. Administration of four different doses of gabapentin reduces awakening from breakthrough pain and adverse effects in outpatients with neuropathic pain during the initial titration. Korean J Anesthesiol. 2013 Jul; 65(1): 48–54. doi:10.4097/kjae.2013.65.1.48
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11. Cyclobenzaprine, Oral Tablet. Healthline.  https://www.healthline.com/health/cyclobenzaprine-oral-tablet. Accessed July 17, 2018.
12. Chronic Pain. American Associations of Neurological Surgeons. http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Chronic-Pain. Accessed July 17, 2018.
13. Vickers A J, Linde K. Acupuncture for chronic pain. JAMA. 2014 Mar 5; 311(9): 955–956. doi:10.1001/jama.2013.285478.
14. Biofeedback. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664. Accessed July 17, 2018.
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16. Hayden J A, van Tulder M W, Tomlinson G. Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain.  Ann Intern Med. 2005;142(9):776-785.  DOI:10.7326/0003-4819-142-9-200505030-00014
17. Hernandez-reif M, Field T, Krasnegor J, Theakston H. Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy. Neuroscience. 2001;106(3-4): 131-145.
18. Preyde M. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. CMAJ. 2000;162(13): 1815-1820.
19. McGoey B V, Deitel M, Saplys R J F, Kliman M E. EFFECT OF WEIGHT LOSS ON MUSCULOSKELETAL PAIN IN THE MORBIDLY OBESE. J Bone Joint Surg [Br] 1990; 72-B:322-3.
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25. Shobeiri F, Oshvandi K, Nazari M. Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia. Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):723-7. doi:10.4103/1735-9066.170003.
26. Liu HL, Chiu SC. The Effectiveness of Vitamin B12 for Relieving Pain in Aphthous Ulcers: A Randomized, Double-blind, Placebo-controlled Trial. Pain Manag Nurs. 2015 Jun;16(3):182-7. doi:10.1016/j.pmn.2014.06.008.
27. Li S, Li Q, Li Y, Li L, Tian H, Sun X. Acetyl-L-Carnitine in the Treatment of Peripheral Neuropathic Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.  PLoS One. 2015; 10(3): e0119479. doi:10.1371/journal.pone.0119479
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29. Kang DW, Moon JY, Choi JG, Kang SY, Ryu Y, Park J B, Lee JH, Kim HW. Antinociceptive Profile of Levo-tetrahydropalmatine in Acute and Chronic Pain Mice Models: Role of spinal sigma-1 receptor. Sci Rep. 2016; 6: 37850. doi:10.1038/srep37850.
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For more information on chronic pain and diagnosis:  1. Talk to your doctor  2. Visit the National Institute of Neurological Disorders and Stroke website 3. Visit the National Center of Complementary and Integrative Health website