National Pain Week 2020 launched on Monday 27 July, bringing attention to the needs of the estimated one in three Australians that live with chronic pain.
Chronic pain is a major community health issue that is now widely acknowledged requires a multidisciplinary approach that avoids the use of opioid drugs as much as possible.
We tend to think of pain as an acute, short-term problem resulting, for example, from acute disease or injury. We expect our bodies to resolve this type of pain by itself. While this is often the case, for many people the pain doesn’t go away, which instead stays around and develops into a chronic condition that is often physically and psychologically debilitating.
While acute pain tends to be self-limiting and associated with physical injury, chronic pain is ongoing and associated with increased sensitivity/reactivity of the nervous system.
Chronic pain often arises from a wide array of different causes. These can be physical, emotional, mental, environmental, or inherited (genetic) factors or a combination of these triggers.
In developed countries such as the United States and Australia, low back pain is the most common form of pain and the third most common reason people visit their doctor. It is a leading cause of disability worldwide and one of the main reasons people leave the workforce.
No two people experience pain the same way, with each individual reacting to stressors in unique and complex ways. Since pain is experienced so individually, this has a fundamental bearing on how it needs to be managed/ treated.
For years opioid drugs have been prescribed by medical practitioners as the main conventional option offered to manage chronic pain. However, misuse and overuse of opioids often compound people’s suffering due to problems of dependence (addiction), accidental overdose, hospitalisation and even death.
The Australian Institute of Health & Welfare (AIHW) has identified opioid use and its associated harms as an issue of great public health interest, both within Australia and internationally, stating:
“Rates of opioid deaths and opioid poisoning hospitalisations in Australia increased in the last 10 years. In 2016, pharmaceutical opioids were involved in more opioid deaths and opioid poisoning hospitalisations than heroin.”
Whereas in 2017-17 an estimated 40,000 Australians used heroin, 3.1 million had one or more prescriptions dispensed for opioids (most commonly for oxycodone). Figures show that legal or pharmaceutical opioids (including codeine and oxycodone) are responsible for far more deaths and poisoning hospitalisations than illegal opioids, such as heroin.
This situation is reflected in other jurisdictions such as the US, which has recorded a quadrupling of the rate of overdose deaths involving opioids since 1999, with over 165,000 people recorded as dying just from prescription opioid overdoses. The US Department of Health and Human Services refers to the situation as ‘the US opioid epidemic’.
Although prescription opioids and common over-the-counter medicines like ibuprofen and aspirin have a role to play in managing chronic pain, alternatives exist that are becoming increasingly needed.
An effective, side-effect-free alternative that more and more people are turning to manage their chronic pain is cannabidiol (CBD), which is available to consumers in over-the-counter products in a number of overseas countries (including a number of European countries, the UK and several US states). Australia’s Therapeutic Goods Administration (TGA) has recently conducted a public consultation on the future availability of CBD.
In fact, the ‘opioid crisis’ is increasingly resulting in their prescription as first-line options being actively discouraged in favour of alternative, non-drug interventions.
In 2017 the American College of Physicians (ACP) updated its evidence-based clinical practice guideline recommending that physicians and patients should treat acute or subacute lower back pain with non-drug therapies, including traditional and complementary therapies/practices such as massage, acupuncture, spinal manipulation (chiropractic/ osteopathy), mindfulness, tai chi and yoga.
These are just a few of more than a dozen traditional and complementary therapies that have a long history of effectiveness in lowering pain and inflammation and scientifically documented to help ease chronic pain.
A recent world-first study by researchers at Southern Cross University found favourable evidence for naturopathic medicine in the treatment of a wide range of chronic conditions, including chronic pain.
Chronic pain is complex and people usually achieve the best outcomes by working with a collaborative ‘team’ of health care professionals across different disciplines. This may include conventional medicine (e.g. GP, specialist), allied health practitioners (e.g. physiotherapist), and traditional and complementary medicine practitioners (e.g. osteopathy, chiropractic, therapeutic massage, Feldenkrais, naturopathy, herbal medicine, yoga, tai chi, homeopathy, acupuncture).
According to advice issued by Chronic Pain Australia:
“Trying to work out who is the best health professional to see when you have chronic pain is often difficult. It can be helpful to have a ‘team’ of health care professionals that you feel comfortable with and have confidence in. This may involve a bit of trial and error.”
All forms of traditional and complementary medicine share a common approach, centred on the principle of ‘holism’. What this means in practice is that each person is assessed and treated on an individual basis, recognising the fact that no two people suffer alike. Traditional and complementary therapies seek to understand the unique and varied causes of an individual’s pain.
For example, is the person’s pain associated with a chronic injury? Poor posture in the workplace? Grief? Emotional trauma? Is it a symptom of an underlying condition such as arthritis? Is it due to inflammation and what is causing that inflammation (e.g. allergy, food intolerance, environmental chemical intolerance, spinal misalignment, bone degeneration etc).
Understanding what is causing a person’s chronic pain is paramount to successfully treating and/or managing it.
For example, pain associated with fibromyalgia may in fact be an expression of an undiagnosed thyroid problem. Therefore, the best way of helping the person would be to address the underlying thyroid problem, instead of prescribing analgesics to suppress the pain (whether conventional or ‘natural’). Then there is the question of what caused the thyroid issue: is it familial (genetic), stage of life related (e.g. menopause), related to stress factors such as chronic unhappiness or grief, or a combination?
Similarly, pain associated with physical tension in the body may be due to environmental factors, such as stress or anxiety in the home or workplace (chronic workplace stress can be cumulative and profoundly impact people’s health).
While pain-management strategies have an important role to play in providing symptomatic relief of chronic pain and helping a person function day-to-day, treating the underlying cause is also important.
Until such underlying, causative factors are addressed, targeting drugs or other approaches at the surface symptoms in an effort to suppress them is unlikely to be clinically effective or cost-effective for the patient in the long run.
Moreover, chronic suppression of symptoms may keep people unwell and inadvertently result in secondary problems arising down the track.
All such factors need to be taken into account and the above examples illustrate why treating and managing chronic pain often requires a team approach.
Traditional and complementary health practitioners are professionally trained to be able to provide you with treatment options best suited to your individual circumstance.
If you are looking at taking a herbal medicine or supplement, a trained naturopath or herbalist is best placed to guide you as to which product or regimen may be most suited to you that also harmonises with other treatments and/or medications you may be undergoing and/or taking. Every botanical medicine and supplement has its own unique indications and contraindications that practitioners are trained to kwo about.
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