“When your whole body is a giant toothache, nothing fixes it,” observes Charley Pavlosky, 65, recalling the systemic pain that plagued him 14 years ago. A lifelong athlete, he was familiar with the aches and pains of being active – he’d even had surgery to repair a disc – but this was new to him.
His chronic pain was so severe that he was only getting two hours of sleep a night, and during the day he experienced anxiety and panic attacks. The Santa Barbara, Calif., resident found a comprehensive nonpharmaceutical pain management program developed by spine surgeon David Hanscom, MD, author of Back in Control: A Surgeon’s Roadmap Out of Chronic Pain.
With the exception of a temporary prescription for Ativan (lorazepam) to help him sleep, Pavlosky began to create a pain-reducing lifestyle. Pavlosky was mostly pain free within six months of working on sleep hygiene along with cognitive behavioral therapy (CBT) and twice-daily expressive writing techniques. Then he gradually weaned himself off the Ativan. He also eats a whole foods diet, stays physically active, drinks plenty of water, and allows himself a massage as needed.
Pavlosky is one of the estimated 50 million adults who live with chronic pain — 20 million have pain that limits life or work activities — according to the Centers for Disease Control and Prevention (CDC). Chronic pain is estimated to cost the United States at least $560 to $635 billion annually in healthcare expenses and lost productivity, according to a National Institutes of Health report.
People living with pain may be offered surgery or medications from numerous classes of drugs, including nonsteroidal anti-inflammatories (NSAIDs), corticosteroids, muscle relaxants, anticonvulsants, antidepressants, opioid pain medications and more.
The landscape of pain management is changing rapidly, as legislatures and federal health agencies seek to more tightly control and monitor opiate pain medication prescription practices. In 2016 the CDC issued new guidelines for physicians on prescribing opioids for chronic pain, meant to reduce the number of prescriptions as well as the risk of opioid use disorder, overdose and death. The number of opioid prescriptions declined by 19% between 2006 and 2017. Still, opioid-related deaths were more than four times higher in 2018 than in 1999, according to the CDC. Pain remains one of the leading reasons that people seek medical care.
“When we’re treating people with pain, are we treating suffering, or are we treating pain? The expectation of being pain free is an unrealistic expectation for the patient and the doctor,” says osteopath Doug Jorgensen, DO, founder of Patient360, a physician registry firm. Jorgensen observes that for the past two decades the trend has been to try to provide medication that would mask pain as much as possible.
“What medicine has done is, we keep throwing simplistic solutions at a complex problem. As the awareness of the complexity of pain grows, we believe in treating every aspect simultaneously,” says Dr. Hanscom, who lived with intense chronic pain for 15 years before developing his multilayered approach to pain management.
The complexity of Hanscom’s program reflects the recommendations for non-pharmaceutical pain management outlined by the American College of Physicians clinical practice guidelines and in the Academic Consortium for Integrative Medicine & Health Pain Task Force White Paper published in 2019.
People with chronic pain might still need medications or surgery. These eight strategies can be used on their own or with other medical treatments to reduce pain:
- Acupuncture. Nurse practitioner Elizabeth Spokoiny, RN, on staff at the University of Washington Medical Center in Seattle, found relief from pain with acupuncture after a car accident in 2015, and then was able to tackle 20 years of pain caused by an autoimmune condition. In addition to acupuncture, she uses dietary change, meditation, bodywork and yoga to manage pain. Her experience with acupuncture is mirrored by clinical data. A research review published in a 2020 issue of Evidence-Based Complementary and Alternative Medicine showed acupuncture provided better relief from pain and depression with fewer side effects compared to medication.
- Massage therapy. At least an hour a week of massage therapy or other soft tissue manipulation could improve your experience of pain. A 2020 review of 233 studies on nonpharmacological treatments for chronic pain conditions showed that massage was among the treatments that outperformed pharmacological or other usual care.
- Meditation, relaxation and biofeedback. These are practices that connect your mind and your body despite pain, and are recommended by the American College of Physicians for chronic low back pain. “My first experience with chronic pain was over 40 years ago, when I was 25 years old,” recalls biofeedback practitioner Cindy Perlin, LCSW, author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free, in private practice in Delmar, N.Y. “I also use exercise, nutrition, homeopathy, energy psychology, occasional massage, self-massage and, most recently, low-level laser therapy to deal with pain challenges that come up.”
- Yoga, tai chi and Pilates. Although pain can make you want to be still, movement can also reduce pain. “Movement causes us to produce endorphins, which are naturally occurring opioids,” says integrative medicine pain specialist Heather Tick, MD, associate professor of anesthesiology and pain management at the University of Washington in Seattle.
- Nutrition. Make sure your plate offers a rainbow of fruits and vegetables. “Most people don’t know that everything you eat can impact your body chemistry,” says Dr. Tick, lead author of the Consortium’s white paper. She recommends giving up sugary, fatty, processed foods. Instead, aim for the anti-inflammatory eating pattern outlined by the Academy of Nutrition and Dietetics. This approach emphasizes eating produce, whole grains, heart-healthy fats, plant-based proteins or fish, and fresh herbs as seasoning. Dr. Tick also advocates certain supplements, such as magnesium, vitamin D, fish oil and turmeric (curcumin).
- Hands-on manipulative therapies. Massage, osteopathic treatment, physical therapy and chiropractic treatments all are evidence-based approaches to pain management.
- Challenge your thoughts. CBT is an approach that helps identify harmful thought patterns and provide alternative thoughts, while also identifying and supporting your resilience. CBT has been shown to help with many aspects of pain management, according to a review of research published in a 2018 issue of Physical Therapy. Some research has shown that hypnosis may also be an effective and safe alternative to drugs. A review of 85 studies on the effect of the treatment for reducing pain found that hypnosis provided meaningful pain relief for most people.
- Sleep better. The relationship between pain and sleep is dynamic: Pain interferes with getting the sleep you need, and sleep deprivation makes pain feel worse. Taking steps to improve the quality of your sleep will be part of your pain management strategy. Pavlosky stresses the value of being more mindful about quality sleep habits. “I don’t look at screens for at least an hour to two to three hours before sleep. I dim the lights after sundown, so my body can slowly start preparing. I don’t have any coffee or caffeine after noon and no alcohol late at night,” he says.
Finally, whether you opt for any of these approaches, or medication or surgery, make sure your expectations for pain relief match up with the reality of the treatment, advises Sal Raichbach PsyD, LCSW of Ambrosia Treatment Center. Raichbach recommends a substantial conversation so that you and your physician understand both your hopes for pain relief, as well as what you might expect from any given mix of therapies.