Chronic Pain Resolution - A Case Based Approach
Chronic pain is incredibly common in modern society, and it ranges in severity from a recurring mild discomfort to a constant & debilitating pain; some conditions even cycle between these two extremes. While pain itself is universal to these conditions, the causative factors are often very different. For example, with osteoarthritis the gradual degradation of joint cartilage and bony tissues are very different from the stretching, tearing, and cramping that is seen with kidney stones; obviously the pain type and location is different, but each of these patients would agree that their respective condition causes pain that is taking away from their overall joy in life.
While pain and hurting are a necessary part of life, the amount of pain most people deal with is much higher than need be, as a number of options are available to improve both function and comfort. This can allow us to stop focusing on pain and pain avoidance, and get back to the things we love and enjoy.
Three Tips for Anyone Dealing with Chronic or Recurring Pain:
1. Seek help before the condition worsens, not after. If you have pain on a regular basis, there is very likely a solution that will improve, or even resolve the discomfort you are feeling.
2. Don’t give up! Different practitioners can offer a variety of perspectives and options. Unfortunately, given the wide range of causes and perpetuating factors, there is no one single treatment (or treatment provider) that will work for everyone. A team approach is necessary for some cases.
3. There is no single healthcare provider who has all of the answers. If one practitioner tells you they cannot help you, this does not mean that no one else can. Practitioners are generally well trained in their respective discipline and not in others, thus one practitioner saying that another cannot help is often not based on truth. By using a global assessment method and personalized treatment approach, I have helped a number of patients who were told by another clinician that their condition would never improve.
The following are a few cases to demonstrate my approach to chronic pain.
A 42-year-old woman came to see me after partially falling from her horse, which led to numerous sprain-strain type injuries. After applying a simple treatment including heat, massage, gentle mobilizations, and adjustments, she was able to walk around the treatment room with greater ease and comfort than she had come in with; we repeated variations of this treatment 3 times over the course of 2 weeks alongside nutritional support and targeted supplements, all of which helped her deal with the pain of her injuries and worked to speed up her recovery. As this resolved, she finally told me of her chronic and apparently untreatable foot injury from a horse that reared up, and slammed a hoof down which just glanced off her shoe and foot. This left her foot injured, which never seemed to heal completely and continued to cause pain. During an assessment, I noted a significant decrease in mobility of one her upper foot joints. I adjusted this joint, and we ended our treatment. Two months later the patient came back for a general follow-up, and noted that her foot pain was completely resolved, and had been ever since the simple foot treatment. While we did not expect this degree of relief from a single and simple treatment, we were both happy that she had originally brought it up, and that she was willing to attempt treatment despite having written off her condition as permanent and untreatable. This success was made possible by her willingness to ask for help, and her willingness to try.
A 72-year-old man with longstanding low-back pain and symptoms of sciatica – his sciatica was a painful and sometimes burning sensation that would shoot from his right gluteal (buttocks) region down to his calf and foot whenever he would stand or sit for a period of time. After a complete global assessment and 3-month treatment period involving active stretching, exercise, myofascial work, some acupuncture, and homework addressing the perpetuating factors such as his repetitive and asymmetrical postures while sitting, his discomfort was almost completely resolved. He very rarely felt the pain from his sciatica (the burning sensation was resolved completely), and both the sciatic pain and his low back pain were decreased in severity to about 25% of where they were 3 months before. As his symptoms decreased, he reported spending more time having meaningful interactions with his friends, as he didn’t have the distraction of significant pain and discomfort. The outcome was not only pain resolution – he now had more freedom to enjoy his life.
Both of these patients had seen other practitioners to address these issues before, but were not successful. They were also told that they would never improve. Because of this, they accepted their conditions as permanent and unavoidable. After experiencing the global approach and treatment personalized to their unique situation and condition, their pain was drastically improved. To be clear, I am not saying that all conditions can be completely resolved or that I can guarantee success in every case. However, I do believe that the vast majority of those in pain can experience a significant degree of relief, and that a good number of these can even be resolved or “cured” over time.
As a naturopathic physician in the province of BC I have the privilege of having a very wide scope of practice, which allows for a wide variety of treatment options and combinations. Some of the therapies used in my global approach to acute and chronic pain include:
- Nutritional counselling
- Targeted supplementation & botanical (plant) medicines
- Physical medicine including myofascial work and spinal adjustments
- Various methods & techniques for stretching, strengthening, and improving posture
- Acupuncture and intramuscular stimulation (dry needling)
- Myofascial trigger point injections, and regenerative injection therapies including prolotherapy and platelet rich plasma (PRP)
- Intravenous nutrients and therapeutics
- Cold laser therapy, or therapeutic ultrasound
- Prescription medications including bio-identical hormones and analgesics
Having many therapeutic tools to use allows me to better support and enable my patients to overcome their unique obstacles and challenges. I offer truly unique treatment plans because I have a wide variety of options at my disposal.
In contrast to a common one-sided approach to treating pain using a single modality,
I enjoy using a global and multi-modal approach as appropriate for each condition. I love this part of what I do, as I feel that the patient’s best chance for success is a targeted and multi-faceted approach that addresses the cause or causes of imbalance, while offering numerous layers of support to further improve outcomes and treatment success.