What is pain?
On one level, even a young child understands it instinctively: When you bump your knee and then rub it, you feel better.
Scientifically, that is because the brain is able to perceive only a limited number of sensations at one time, and pressure, heat, or cold can help aches feel better.
But pain can be surprisingly complex, and doctors and researchers are working hard to improve our understanding in order to develop better and safer ways to treat it.
This is partly because powerful pharmaceutical drugs have become the cornerstone of how American doctors and patients respond to chronic pain, with one unintended consequence — an epidemic of addiction, especially to strong opioids of the kind that killed Prince.
From the doctor's perspective, pain is defined as a "noxious stimulus," or unpleasant sensation, that affects your daily life and your ability to do the things you want to do.
Importantly, pain can be physical, emotional, or spiritual. Because pain is not only physical, we're increasingly looking to treat it in a more holistic way.
After all, the rest of the world treats pain without relying on high-powered pharmaceuticals. Americans account for only 5% percent of the world's population, but 80% of its opioid use.
Anybody who has chronic pain is potentially a candidate for nondrug pain control. Chronic pain is defined as pain that persists for longer than three to six months. Common causes include knee or back arthritis, and pinched nerves.
Many patients with chronic pain can't tolerate opioids well, which is another reason to try a different tack.
Alternative pain therapies take many forms, like massage, injections, acupuncture, Reiki, physical therapy, or even the simple act of exercise.
Cognitive behavioral therapy and meditation have also been found to help patients manage pain by changing the way they think about it.
And while the evidence for alternative therapies varies, we're seeing promising results. One study here at Mount Sinai Beth Israel compared patients who were taking opioids with patients who took part in a nondrug-based program of yoga. We found that the patients who had been weaned off opioids had less pain and higher function than the control group.
Two alternative treatments that compete with the pain sense are acupuncture and Reiki. Acupuncture is the placement of small needles along what we call the meridians, or lines of energy. Depending on the types of pain or maladies, different pressure points are chosen to treat those areas.
Reiki therapy is a placing of the hands over a patient; as opposed to massage, there is either no contact or very limited contact between the practitioner's hands and the patient. The traditional explanation is that the laying of the hands alters the life force; many doctors believe that the benefit comes from the patient's meditative component while getting the treatment.
From the perspective of Western medicine, we can't yet explain fully why these therapies are so effective. Some studies have found that acupuncture increases blood flow to the affected area, and with it, healing factors.
Another hypothesis is that a desensitization occurs as acupuncture and Reiki force the brain to focus on the sensations caused by the therapy, instead of painful sensations.
Another cutting-edge option is called AposTherapy, which uses technology to look at the mechanics of a patient's knee, hip or back pain. Depending on what we find, we strategically place pods on the bottom of your shoe to create a controlled imbalance.
This imbalance triggers the body to make small muscular movements to distribute your weight. (I'm an unpaid member of the medical advisory board for makers of the device, which was developed in Israel and has been clinically tested at hospitals around the world.)
You can wear the Apos shoes for an hour, while doing the dishes and walking the dog, and that whole time you are actually exercising. Those tiny movements can actually decrease your pain.
Which leads me to a fact that we're just beginning to understand scientifically: Exercise is the single best factor to combat pain. What we know is that those who start an exercise program have increased blood flow, more endorphins released, diminished pain complaints, and report better satisfaction with their life.
I am a big fan of yoga, because it includes a meditative portion that other fitness routines don't.
There are times when opioid use can be appropriate. However, as of 2016, the Centers for Disease Control and Prevention (CDC) recommends that opioid use be limited to certain scenarios: for cancer pain, end of life pain, and the first two to three weeks after surgery.
There's no doubt that these medications are powerful, but they create a lot of dependence and addiction.
Not all patients are immediately receptive to meditation or acupuncture, but the studies are pretty clear that these and other alternative therapies provide real, measurable benefits.
For more information about the full array of pain treatments, check the helpful websites run by the American Academy of Physical Medicine and Rehabilitation (aapmr.org), the North American Spine Society (spine.org), and the Arthritis Foundation (arthritis.org).
My biggest tip to patients is to listen to your body and talk to your doctor frankly about how you are responding to the treatment options. There's so much we can do to manage chronic pain. But it's always a question of finding the right treatment for each individual patient.
Joseph E. Herrera, DO, is Chairman of the Department of Rehabilitation Medicine at Mount Sinai Beth Israel and Associate Professor of Rehabilitation Medicine.
[The content provided through this article and www.nydailynews.com should be used for informational purposes only and is not intended to be a substitute for professional advice. Always seek the advice of a relevant professional with any questions about any health decision you are seeking to make.]
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