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Innovations in Chronic Pain Management

Are you a patient who has tried "everything" and still regularly experiences pain? Are you a practitioner frustrated with current treatment options for chronic pain? New therapeutic approaches are available.

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“Every medical specialty will have patients that complain of some sort of pain, and it is critical that we find the root cause of the pain and not just band-aid the pain with opioids and other modalities.”

To truly understand how to treat pain, it is important to understand how the pain system works and the types of pain a person may experience. Acute pain begins suddenly and has a specific cause, such as a broken bone. Chronic pain is ongoing and continues after the injury or illness has healed or gone away. Some people suffer from chronic pain even when there has been no apparent injury or trauma, such as headache or arthritis. Many of the current pain management strategies that work well for patients in acute pain have been ineffective and even counterproductive in treating patients in chronic pain.

Chronic pain has placed a tremendous burden on the healthcare system over the past several years. The use of opioids has not provided a resolution for chronic pain. In fact, it has created new risks, such as abuse, addiction, and even overdose and death. It has become important to practitioners from multiple disciplines to approach the treatment of chronic pain differently. Many practitioners have found that they need to shift from a “one size fits all” treatment plan to an individualized approach.

To determine the root cause of pain, practitioners must look at the pain pathways and the entire ecosystem of the patient. All body systems work synchronously and if a single step in the pathway is altered or dysfunctions, it could cause pain. In addition to traditional therapies, a comprehensive treatment plan should be considered and could include manual therapies, novel pharmacologic and plant-based approaches, hormonal therapy, as well as psychological and lifestyle interventions. A person’s pain experience becomes even more complex when environmental, social, and psychological variables are considered.

Nociception is the pain system’s detection of a painful stimulus in a person’s body. Nociception exists at the intersection of the nervous system, immune system, and endocrine system. Shared receptors in these systems allow ligands (molecules) to have effects across all systems and create the pain system pathways. In a patient with chronic pain, the pain signal can vary in amplitude and frequency, and modulation as the signal travels from the point of creation to presentation. From the initial point of stimulation in the peripheral nervous system to the central nervous system, there are many opportunities for chronic pain to be suppressed or amplified.

The hypothalamic-pituitary-adrenal axis (HPA) is involved in the detection of painful stimuli and serves as an intermediary between the neuro, endocrine, and immune systems. It has been found that various types of white blood cells have receptors for various hormones in the body.

Therefore, neuronal cells and endocrine organs express receptors for immune-derived proteins that affect the interactions and communications between cells throughout the body. The interaction of these body systems could mean that treating chronic pain could be accomplished by addressing whole person care besides the nervous system. Chronic opioid therapy can affect hormonal balance which can further contribute to pain.

Addressing the many aspects of the neuro-endocrine-immune axis can help provide better personalized assessment and care of each patient. We must shift from one size fits all care to personalized care.

Are you a patient suffering from pain or a practitioner looking to help a patient who is suffering? The integration of multiple therapeutic options, such as hormone therapy, regenerative medicine, dietary supplements, and much more, will provide optimal therapy for chronic pain. It may take a multi-disciplinary team and lifestyle modifications to achieve freedom from pain.

For more information and to better understand pain and potential therapeutics, be sure to read the new book Advanced Therapeutics in Pain Medicine (S. Swidan, & M. Bennett, Eds.) CRC Press.

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