What Is Chronic Pain?
Chronic pain is defined as pain that persists for more than three months. It is a common cause of suffering, disability, and economic hardship in the United States. It has been estimated that approximately 116 million people in the U.S. suffer from chronic pain each year which costs society an estimated $560 to $635 billion each year in medical costs, lost wages, and lost time from work. Chronic pain is a complex problem that needs to be understood in a multi-dimensional way for effective management.
Effective management of chronic pain patients should include a comprehensive, holistic approach using conventional therapies in combination with complementary, alternative, and integrative medicine (CAM) approaches.
Overview Of A Comprehensive Approach To Pain Management
A variety of treatment options exist for the management of chronic pain, including conventional and complementary therapies.
Conventional approaches include:
- Medications: Typical medications used for the treatment of chronic pain include non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, anticonvulsants, muscle relaxants, or opioids.
- Nerve block procedures: Typical procedures for the treatment of chronic pain include epidural steroid injections, facet joint injections, lumbar sympathetic blocks, celiac plexus blocks, or stellate ganglion blocks.
- Invasive procedures: Typical procedures for the treatment of chronic pain include viscosupplementation, spinal cord stimulation, intrathecal pain pumps, or radiofrequency ablation procedures.
Complementary, Alternative and Integrative Medicine (CAM) approaches include:
- Chiropractic treatments: Typical treatment approaches for the treatment of chronic pain include spinal and extremity manipulation, modalities (ultrasound, TENS, electrical stimulation, or traction), as well as exercise and nutrition recommendations.
- Physical therapy: Typical treatment approaches for the treatment of chronic pain include education, manual therapy, flexibility and strengthening exercises, modalities (ultrasound, TENS, or electrical stimulation), and postural and ergonomic instruction.
- Acupuncture: Involves inserting small needles into the skin at various points throughout the body, which may be located at the site of pain as well as at distant sites that may be contributing to the pain.
- Massage therapy: Involves soft-tissue manipulation by trained therapists for therapeutic purposes applied to single or multiple body parts. Various different styles of massage exist, including Swedish massage, Shiatsu, Rolfing, craniosacral therapy, and reflexology.
- Hyperbaric oxygen: Involves oxygen administration in a pressurized chamber, which helps to increase oxygen delivery to the tissues in the body.
- Active interventions: Includes therapies that engage the patient including education, exercise, functional training, tai chi, qigong, yoga, or guided imagery.
- Psychological and behavioral interventions: Includes pain psychology, general behavioral medicine, and mental health counseling (i.e. cognitive behavioral therapy).
- Fear avoidance training: Involves helping the patient understand their diagnosis, the physiology of why movement is not damaging, and the difference between damage and pain.
- Mind-body interventions: Includes therapies such as biofeedback, meditation, relaxation, and hypnosis.
Often a combination of conventional and CAM therapies can provide optimal benefit for patients suffering from chronic pain conditions.
Overview Of Chiropractic Treatments
Chiropractic is a complementary healthcare profession that focuses on disorders of the nervous and musculoskeletal systems. It is often used to treat conditions such as back pain, neck pain, extremity pain, and headaches.
Chiropractors use a hands-on approach to treatment that includes a detailed patient history and physical examination, and diagnosis followed by treatment. Further, chiropractors are trained in therapeutic and rehabilitative exercise as well as nutrition so they often provide dietary and lifestyle recommendations as part of their treatment plan. Chiropractors may use additional modalities, including transcutaneous electrical stimulation (TENS), electrical stimulation, ultrasound, or traction for symptom relief in some patients.
The most common treatment approach performed by chiropractors is spinal manipulation (chiropractic adjustment). The goal of spinal manipulation is to restore normal joint range of motion by applying a controlled force to hypomobile joints in the body. The adjustment helps to restore mobility and helps to alleviate pain and muscle stiffness and allows the injured tissues to heal.
Research Into Chiropractic Treatments
The benefits of spinal manipulation include relief of acute and chronic neck and back pain and improved spinal range of motion. Studies have shown that spinal manipulative therapy can be just as, or more effective, than conventional medicinal treatment options.
The American College of Physicians and the American Pain Society have included spinal manipulation as one of several treatment approaches for practitioners to consider when pain is non-responsive to self care.
Research has revealed that spinal manipulation can be more effective for the treatment of chronic back pain than treatment with bed rest, topical gels, traction or no treatment. Additionally, some studies have shown that spinal manipulation is superior to acupuncture and physical therapy for the treatment of low back pain.
What Are The Risks Of Chiropractic Treatment?
Chiropractic is considered a safe, drug-free and non-invasive therapy for the treatment of chronic pain. However, as with all treatments, there are potential adverse effects that may occur.
While many patients experience immediate relief after chiropractic treatment, some patients may experience mild aching or soreness after treatment. Research has shown that this discomfort usually diminishes within 24 hours.
Cervical manipulation has been associated with vertebral artery dissection; however, recent research has suggested that this type of injury often occurs spontaneously, or after participating in every day activities such as swimming, turning the head when driving, or after having a shampoo at a hair salon. The best source of evidence reveals that the incidence of vertebral artery injury associated with chiropractic manipulation of the upper cervical spine is extremely rare, occurring in approximately 1 in 5.85 million cervical manipulations.
For more extensive information on the role of chiropractic treatment in chronic pain management, visit the links below. If you suffer from chronic pain, speak to your healthcare professional to learn how chiropractic care may help to manage your chronic pain symptoms.
- org. ACA – Chiropractic: A Safe Treatment Option. 2015. Available at: https://www.acatoday.org/content_css.cfm?CID=2205. Accessed December 20, 2015.
- Medicine A. Treatment options for chronic pain. Asracom. 2015. Available at: https://www.asra.com/page/46/treatment-options-for-chronic-pain. Accessed December 20, 2015.
- Spinal Manipulation for Low-Back Pain. 2015. Available at: https://nccih.nih.gov/health/pain/spinemanipulation.htm. Accessed December 20, 2015.
- Pendick D. Acupuncture is worth a try for chronic pain – Harvard Health Blog. Harvard Health Blog. 2013. Available at: http://www.health.harvard.edu/blog/acupuncture-is-worth-a-try-for-chronic-pain-201304016042. Accessed December 21, 2015.
- Smith B. Chronic pain in primary care. Family Practice. 1999;16(5):475-482. doi:10.1093/fampra/16.5.475. Available here: http://fampra.oxfordjournals.org/content/16/5/475.full
- org. American Chronic Pain Association – Resource Guide to Chronic Pain Medications & Treatment. 2015. Available at: http://www.theacpa.org/Consumer-Guide. Accessed December 21, 2015.
- Tsao J. Effectiveness of Massage Therapy for Chronic, Non-Malignant Pain: A Review. Evidence-Based Complementary and Alternative Medicine. 2007;4(2):165-179. doi:10.1093/ecam/nel109. Available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876616/