Treatment for Chronic Pain

Chronic pain affects over 100 million Americans, which is more than diabetes, heart disease and cancer combined.  Total health care cost due to pain ranges from $261 to $300 billion annually combined with economic costs related to disability days and lost wages and productivity totals $560 to $635 billion annual cost (Gaskin and Richard).  More concerning than cost is the current epidemic of opioid abuse.  With few options in conventional medicine to address chronic pain the over prescription of opiates is at an all-time high.  In the CDC Guideline for Prescribing Opioids for Chronic Pain in March of 2016 they estimated that in 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills (Dowell, Haegerich and Chou).

The most common types of pain according to the National Institute of Health Statistics survey indicated that lower back pain was the most common (27%), followed by severe headaches or migraine pain (15%), neck pain (15%) and facial aches or pain (4%) (“American Academy of Pain Medicine – Get The Facts On Pain”).  This type of pain is most often neuropathic pain meaning the nerve fiber itself is damaged or injured.  Perineural injection therapy specifically targets this type of pain. It involves superficial injections of dextrose along nerve pathways.  The dextrose calms down the inflammation around the nerve allowing time for the nerve to heal.  People often experience instant relief from their pain that can last hours to days and eventually years.  Most patients will usually need 6-8 treatments done weekly resulting in gradual reduction of pain eventually resulting in prolonged periods of relief.  Prolonged periods could be years to permanent relief from pain.  Dextrose which is a form of glucose is extremely safe and widely used as an injectable and as an IV solution.  There is minimal risk of infection or adverse reaction with the subcutaneous injection and there have been no allergic reactions observed.

There are many different causes and perceptions of pain and a thorough work up needs to be done to adequately determine the source or sources of that pain. The causes for chronic pain includes infection, malignancies, various autoimmune disorders, vasculitis, diabetes, sarcoidosis, nutritional deficiencies, compression or trauma, drug induced, inherited or idiopathic neuropathies, among other possibilities.  

Like the many causes and perceptions of pain, there are many alternative treatments for pain not only including perineural injection therapy, but also including yoga, meditation, mindfulness, breathing exercises, manual/structural therapies, tai chi and qi gong.  These modalities are less invasive and should strongly be considered as a first line treatment for pain.

I will leave you with one final quote from the director of the CDC discussing the current opioid epidemic. “For the vast majority of patients, the known, serious and all too often fatal risks far outweigh the unproven and transient benefits, and there are safer alternatives.” CDC Director Tom Frieden, MD, MPH.  (“CDC Press Releases – Prescribing Opioids Guidelines”)

Resources

“American Academy Of Pain Medicine – Get The Facts On Pain”. Painmed.org. N.p., 2016. Web. 27 Dec. 2016. http://www.painmed.org/patientcenter/facts_on_pain.aspx#prescription
Gaskin, Darrell and Patrick Richard. “The Economic Costs Of Pain In The United States”. Ncbi.nlm.nih.gov. N.p., 2016. Web. 29 Dec. 2016.. https://www.ncbi.nlm.nih.gov/books/NBK92521/
Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. “CDC Guideline For Prescribing Opioids For Chronic Pain — United States, 2016”. CDC. N.p., 2016. Web. 29 Dec. 2016. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
“CDC Press Releases – Prescribing Opioids Guidelines”. CDC. N.p., 2016. Web. 29 Dec. 2016. https://www.cdc.gov/media/releases/2016/p0315-prescribing-opioids-guidelines.html

 

1 thought on “Treatment for Chronic Pain”

  1. Dr. Squires:

    Congratulations on your first blog. Very informative and well written. While I am quite familiar with chronic pain situation, I am alarmed by the fact that in USA the first course of treatment is drugs. In Europe and Asia the first line of treatment is the modalities that you mention in the blog. There should be a massive movement towards that alternative treatments first in USA. Last year I went through a PRP treatment on my shoulde and I saved time (A year down with surgery) money, ($3600.00 vs 38,000.00) and most important a 100% successful outcome.

    Looking forward to your future blogs

    Nili Eli Leemon

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