Pain is considered chronic when it lasts for weeks, months and even years. Etiologies include trauma and conditions such as arthritis, cancer, infection, degenerative disc disease and neuropathies. Common complaints are headaches, low back pain, arthritis and neurogenic pain (pain that results from damaged central nervous system or peripheral nerves).
According to the American Academy of Pain Medicine, more than 1.5 billion people worldwide suffer from chronic pain. In 2016, the Centers for Disease Control (CDC) estimated 20.4% of U.S. adults had chronic pain (defined as pain most
days or every day in the past six months). That equates to more than 50 million Americans. What may be even more concerning is the fact that the 2016 National Survey of Children’s Health reported a 6% prevalence of chronic pain among U.S. children.
How does chronic pain impact quality of life? The National Institutes of Health (NIH) survey revealed that almost two-thirds (59%) of respondents reported deleterious impact on their overall enjoyment of life. More than three-quarters (77%) reported feeling depressed; 70% said they have trouble concentrating; 74% said their energy level is impacted by their pain; and 86% reported an inability to sleep well.
Chronic pain is a very complex and difficult health concern to treat. One reason is that the longer it goes on, the more systems become affected, along with many people experiencing the phenomenon of pain sensitization syndrome.
This is when even mildly noxious stimuli activate receptors and cause more pain. This can happen to the point where pain can be constant even without a triggering event. It can also increase in intensity and in other regions of the body.
Pharmaceutical strategies include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, topical and oral steroids, narcotics, opioids (in the class of narcotics), anticonvulsants and antidepressants. These may help with acute pain but are not very effective with chronic pain, and the side effects tend to be worse than what they are
A lot of people take acetaminophen because they think it’s safe. When the maximum recommended dose is not exceeded, it relatively is. However, it must be used at high doses for effective pain control, and it is often combined with other
medications. Thus, it is easy to overshoot the maximum amount in a 24-hour period. Acetaminophen toxicity is the number one cause of acute hepatic (liver) failure in the U.S. I saw this a few times during my rotations in the emergency department. The treatment is N-acetyl-cysteine (NAC), which naturopathic physicians use all the time for other health issues!
NSAIDs such as ibuprofen (Advil, Motrin) have cardiovascular and gastrointestinal side effects, including ulcers and GI bleeding. Oral steroids suppress the immune system, leaving one more prone to infection. They also have blood sugar
regulation issues and can cause insomnia, bone loss and thinning of the skin, which in turn can cause easy bruising and bleeding along with swelling.
Narcotics may make people extremely tired, constipated and spacy. They are also highly addictive, and the body builds tolerance to the medications, thus causing the individual to have their dosage increased and typically more medications added to address the chronic pain.
Anticonvulsants (e.g., gabapentin and pregabalin) have common side effects of constipation, difficulty walking or controlling muscle movements, nausea, slurred speech, tremors and weight gain.
Antidepressants can cause nausea, increased appetite and concomitant weight gain, sexual side effects, fatigue, drowsiness, insomnia, dry mouth, blurred vision, constipation, dizziness, agitation, restlessness and anxiety.
In my experience, by the time patients seek out a naturopathic physician they are usually on a combination of the aforementioned medications, which normally are not working very well and/or the side effects are too debilitating. My treatment strategies are usually two-fold: 1) decrease the side effects of the medications, and 2) target pain management so the drugs work better and therefore can be decreased or discontinued.
The science and mechanisms of how natural therapeutics address chronic pain are beyond the scope of this article. Instead, I will discuss ways to address chronic pain from a therapeutic order standpoint — i.e., least invasive/least forceful interventions first, drugs and surgery last. My patients have usually been dealing with chronic pain for many, many years. This necessitates being very aggressive with natural agents to get ahead of the pain, and then gradually decreasing them.