Chronic Pain: How Chiropractic Physicians Can Help
Chronic Pain – How Chiropractic Physicians Can Help
More and more articles appear in the news regarding the opiate problem in the United States, which means that chronic pain is a pandemic in our country. While researchers can debate the many details about opiate addiction, a fundamental point that can be agreed upon is that these medications are initially prescribed due to a painful event, such as an injury or surgery. No matter the reason for the initial prescription, the point that needs to be appreciated is that for too many individuals, pain does not go away, which is why patients end up depending on opiates and other medications.
In contrast to the above chronic pain scenario, for many chiropractic patients, their pains do go away. Most of these patients will return when a new problem or an exacerbation arises, which is why many DCs maintain a successful practice by keeping a returning patient base of persons the DC has helped in the past.
Another key to a successful practice is to be viewed by your community as a resource for pain management, which is currently not the case for most chiropractic physicians. In other words, it would be great if patients with acute pain were sent to chiropractic physicians to prevent the transition into chronic pain. It would also be great if patients who are already in chronic pain were sent to chiropractors. If this were the case, our offices would be filled and most regions of the country would need more doctors of chiropractic.
At present, the treatment of chronic pain represents a major challenge in America and, as chiropractic physicians, we need to do more to participate. We also need as a profession to understand chronic pain better, and we are not alone. It turns out that “pain” is not a focus of training in chiropractic, physical therapy, or medical training. While we learn a little about pain in various classes, no specific class is devoted to the details of pain expression and what changes occur in the nervous system during the transition from acute to chronic pain.
This can lead to confusion for practitioners and can create a mindset of “pain avoidance” for practitioners, meaning that they prefer not to deal with patients in pain, as is true for many chiropractic and medical doctors. If we added a heavy dose of “pain education” to our chiropractic college curriculums, we could become the profession of choice to deal with the emerging pain epidemic in America.
Although a complete review of pain physiology is beyond the scope of this article, it is useful to highlight some basic pain triggers and treatment that may assist in dealing with chronic pain patients and help to prevent patients from making the transition from acute to chronic pain. As chiropractic physicians, we are able to address some of the known perpetuators that may cause acute pain to become chronic.
The most tangible perpetuator is deconditioning. Exercise is the recommendation that should be encouraged individually based on patient tolerance. Faulty respiration that leads to low blood levels of carbon dioxide, called hypocapnia, can promote pain and dysautonomic symptoms. Teaching patients to breathe properly can address this important perpetuator.
Less tangible perpetuators of chronic pain include stress and a lack of sleep. Each must be addressed according to the needs of the patient. The final perpetuator that is also less tangible is diet. When we are young, a pro-inflammatory diet consisting of large amounts of refined sugar, flour, and oils, generally just tastes great and is not associated with symptoms. Years later, the inflammatory state created by these foods can perpetuate chronic pain.
Practicing chiropractic is easiest and most enjoyable if you have lots of patients who respond to manual care, and then return as needed. However, it is rare to have this type of patient population exclusively. Most doctors of chiropractic have a small to large percentage of patients who do not respond as well as we would like, and these patients need to have their pain perpetuators addressed in an efficient fashion. Addressing the pain perpetuators can help to prevent the transition from acute to chronic pain and more effectively treat those who have chronic pain. If we excelled in this area, we might need several more chiropractic colleges to handle the demand.