Most people who have pain start with a visit to their primary care doctor. When they don’t improve, some are referred to other MDs who specialize in pain medicine (usually an anesthesiologist), or orthopedic surgeon. When those doctors fail to achieve adequate results, pain patients are often told there is nothing more that can be done. Few are referred to other healthcare specialists who are highly trained in pain relief, who offer nonpharmacological and nonsurgical treatment.
The Primary Care Physician and Chronic Pain Treatment
Forty percent of visits to primary care doctors are for complaints of pain. Unfortunately, because of the way our medical system is set up, with doctors expected to push through as many patients as possible per hour, he or she will only spend a few minutes with the patient and won’t have time to explore the root causes of the problem. And because of the way their medical education was delivered, they will know very little anyway about pain and how to treat it. A survey of medical school curriculums in the U.S. a few years ago found that the average medical school spends less than two hours educating future doctors on anything having to do with pain.
Most doctors will just reach for their prescription pads. It’s quick and it’s all they have been taught to do. This is especially the case since most of their postgraduate education is delivered by the drug companies, in the form of drug company salespeople visiting their offices or in pharmaceutical company-funded continuing education or journal articles.
The drugs they prescribe (opioids, NSAIDs like Celebrex, gabapentinoids including gabapentin and Lyrica, anti-depressants) are designed to numb the pain, not fix it. If the drugs don’t work, the doctor will either tell the patient there is nothing more that can be done or they will make a referral to a “pain specialist” or “pain management” or they might order an MRI and if “disc disease” or other structural “abnormality” is found, refer the patient to an orthopedic surgeon.
If the patient asks about alternative therapies, such as chiropractic or acupuncture, they are usually told that these therapies are unproven or dangerous. Some primary care physicians will write a prescription for physical therapy, the only nonpharmacologic, noninvasive treatment for pain generally accepted by conventional physicians.
The Pain Specialist and Chronic Pain Treatment
Chances are the “pain specialist” will be another MD, usually an anesthesiologist, who is trained to numb pain, not to fix the source. He or she will either prescribe more pain meds or propose an invasive procedure, usually an injection of a numbing agent (another drug) that will, if it has any impact at all, provide some temporary relief. Sometimes they will prescribe more extreme procedures, such as destroying the nerves in the area (nerve ablation) or a surgically implanted spinal cord stimulator designed to provide a distracting sensory signal. Again, none of this gets to the root of the pain and can cause significant harm.
If the patient is a little luckier, the pain management doctor will specialize in physical medicine and rehabilitation and may prescribe a physical therapy program that has a higher likelihood of getting to the source of the problem.
The Orthopedic Surgeon and Chronic Pain Treatment
The orthopedic surgeon will look at the patient’s MRI, and if there is “disc disease” such as bulging discs, degenerated discs or herniated discs, the surgeon might recommend spinal surgery. The problem is that as people age they are very likely to have “disc disease”, with most people having no pain. This has led many experts to conclude that the presence of “abnormal discs” is in most cases coincidental and not the real cause of the pain.
Experts estimate that as many as 40% of the one million or so first spinal surgeries performed in the US each year fail, leaving the patient no better off or worse off than before the surgery. Subsequent surgeries have a much higher failure rate than first surgeries. It’s important to keep In mind that even surgeries have a placebo effect, and that the more onerous the treatment, the more likely a patient is to experience an improvement even if given a sham procedure.
Studies have shown that patients who receive orthopedic surgery for other pain conditions, such as meniscal tears in the knee, or orthoscopic knee surgery do as well or better with other, nonsurgical treatments.
The Other Pain Specialists
Fortunately for pain patients, there are other types of healthcare providers who are highly trained to treat pain at its source and who provide treatments that are likely to be beneficial, and, at worst, are not harmful. These include:
Physical Therapists for Chronic Pain Treatment
Physical therapists treat people with medical problems that impair their ability to move and to function in their daily lives. After examining the patient, physical therapists develop an individualized treatment plan to increase mobility, reduce pain, improve function, and prevent disability.[i] Physical therapists use a variety of techniques, which include heat, cold, water, ultrasound, electrical stimulation, manual therapy, and exercise.[ii]
Manual therapy is treatment performed primarily with the hands. Manual therapy can include massage; mobilization (movement to loosen tight tissue around a joint to improve flexibility and alignment); and manipulation (pressure applied to a joint with hands or a special device).[iii] Exercise can include stretching, core-strengthening exercises, lifting weights, and walking. It may also include instruction in a home-exercise program.[iv]
The use of physical therapy techniques dates back to the days of Hippocrates, who used massage and other manual therapies as well as water therapy to treat people as early as 460 BCE. A physical therapy session usually includes one or more treatment modalities combined with education, advice, and exercise. Effective treatment includes informing the patient about his condition and challenging distorted beliefs about pain and disability,
A review of randomized controlled trials from 1961 to 2009 found strong evidence for the use of manual therapies in the treatment of chronic low-back pain and knee pain for adults with musculoskeletal pain. A recent study of manual therapy for fibromyalgia found improvements in pain, muscle fatigue, tension and anxiety.[v]
Find Physical Therapists Near You
Chiropractors for Chronic Pain Treatment
The chiropractic profession was founded in the United States in 1895. Chiropractors diagnose, treat, and prevent disorders of the musculoskeletal system. More than 90% of patients who seek care from chiropractors are seeking relief from pain, including back and neck pain and headaches.[vi]
Chiropractic treatment has been shown to be much safer than any conventional pain treatments. The estimated risk for serious complications for cervical (neck) manipulation is 6.39 per 10 million manipulations; for lumbar (low-back) manipulation, the estimate is 1 serious complication for every 100 million manipulations, according to a 1998 study sponsored by nonpartisan nonprofit research institute the RAND Corporation. Compare this to the 156,000 serious complications per 10 million cervical spine surgeries and 32,000 serious complications per 10 million patients using nonsteroidal anti-inflammatory drugs (NSAIDs). The same literature review found that spinal manipulation was more effective for both acute and subacute low-back pain without sciatica than comparison treatments, and that cervical manipulation was effective for neck pain and muscle tension-type headaches.[vii]
In 1997, the Agency for Health Care Policy and Research reported that chiropractic spinal manipulation was one of the few evidence-based treatments recommended for the treatment of low-back pain.[viii] The World Health Organization (WHO) admitted the World Federation of Chiropractic, which represents national chiropractic associations from more than 70 countries, into official relations as a nongovernmental organization in 1997. This indicates that WHO considers chiropractic an accepted healing modality.
Most studies have shown that chiropractic treatment saves money compared to conventional treatment for these conditions.[ix] Despite all this, chiropractic treatment is still considered alternative medicine, and its use is actively discouraged by the US health care system.
Massage Therapy for Chronic Pain Treatment
Therapeutic massage and bodywork include a wide variety of techniques that involve manipulation of soft tissue or subtle energy to alleviate pain or resolve structural imbalances so that health and well-being are improved.[x]
Physical therapists, chiropractors, and other types of health care providers may incorporate massage as one of the treatment modalities used during a session. Massage is also used as a stand-alone treatment, in which case the massage is usually of longer duration and more intensive.
There are many different types of massage and bodywork. These can be classified into four types of approaches:
- Gentle bodywork includes light application of touch, as in Swedish massage, craniosacral therapy, and lomi lomi massage. These techniques help the body relax and return to its natural state of balance. For treatment of pain, gentle bodywork techniques are best suited to patients in significant pain, at least initially, as they are less likely to aggravate the condition than forms of massage that use more pressure.
- Structural bodywork includes Rolfing, Hellerwork, and other schools of structural integration. The goal of this bodywork is to change structure by creating a direct change in muscles, tendons, ligaments, and other soft tissues to restore structural balance and reduce strain. The pressure applied with these techniques can create short-term pain.
- Deep tissue bodywork, which focuses on the alleviation of pain and discomfort, includes, in addition to deep tissue massage, neuromuscular therapy, Trager psychophysical integration, and myofascial release.
- Movement therapy, or reeducation, includes the Feldenkrais method, the Alexander technique, and Rolf movement work. Movement therapy aims to alter the person’s habitual body usage to reduce muscle strain. Movement therapy also helps maintain the results of structural bodywork.[xi]
Numerous studies have been done to evaluate the effectiveness of massage therapy for chronic pain. A series of 8-10 massage therapy sessions over a period of 5-10 weeks seems to have significant benefit for a wide range of pain conditions, including back and neck pain and fibromyalgia. Results are better than usual care or pharmaceutical treatment and persist for at least months beyond the treatment period.
For fibromyalgia, studies indicate that myofascial release and shiatsu massage resulted in large reductions in pain and moderate reductions in anxiety, depression, fatigue, stiffness and quality of life. Swedish massage did not benefit fibromyalgia patients.[xii]
Find Massage Therapists Near You
Acupuncturists for Chronic Pain Treatment
Acupuncture is a treatment system that involves inserting thin needles into specific points on the body in order to positively affect a patient’s health. Acupuncture is a therapy that has been developed and refined over thousands of years and is part of traditional Chinese medicine (TCM). Treatment is focused on the individual, not the diagnosis, and the goal is to treat the root cause of the problem and the reasons why the individual cannot heal.[xiii]
TCM is based on the principle that the universe is balanced between two opposing forces, yin and yang. Yin is soft, dark, cold, lower, passive, nourishing, and still. Yang, its opposite, is hard, bright, hot, upper, dominant, consuming, and active. The interaction of these two forces is believed to create qi (pronounced “chee”), the vital energy that is life itself. Qi flows through the body along energy pathways known as meridians. The meridians are believed to be related to different organs. Along each meridian are many points that are stimulated through the insertion and manipulation of the acupuncture needles to regulate the flow of qi. There are 361 acupuncture points in classic Chinese medicine. Over time, many different styles of acupuncture have been developed, with more than 2,000 acupoints currently identified.[xiv]
Traditionally, needles are manipulated by pecking, twirling, and flicking until the patient feels sensations of soreness, heaviness and/or tingling. More recently developed applications of acupuncture include electroacupuncture (stimulating the inserted needles with small electric currents) and laser acupuncture (stimulating the acupoints with light). Points are also traditionally stimulated with moxibustion (burning a small amount of an herb) and cupping (using a special glass cup to create a vacuum in order to move stagnant blood and qi).[xv]
Acupuncture has been the subject of significant research, including research into its underlying mechanisms and its effect on clinical conditions, including pain. Studies have shown that acupuncture affects the supply of neurochemicals, including levels of endorphins, cortisol, serotonin, and dopamine.[xvi] Other studies have shown changes in levels of brain activity with needling of acupuncture points.[xvii]
There has been significant research on acupuncture. In a 2012 review that included individual patient data from 29 controlled studies with a total of 17,922 patients, researchers concluded that acupuncture is an effective treatment for chronic back and neck pain, osteoarthritis, and chronic headaches.[xviii]
The World Health Organization states that acupuncture is safe if it is properly performed by a well-trained practitioner. WHO reported that acupuncture is nontoxic and that adverse reactions are minimal. Effects on pain were found to be comparable to morphine without the side effects and risks.[xix]
Acupuncture modestly improved pain and stiffness in fibromyalgia sufferers in a 2013 Cochrane review. Sham acupuncture seemed to reduce pain and fatigue and improve sleep and overall well-being as well as real acupuncture. The review also found that electroacupuncture was better than the manual variety for reducing pain, stiffness, and fatigue and for improving sleep and global well-being in fibromyalgia sufferers. Acupuncture also seemed to enhance the effects of medication and exercise in reducing fibromyalgia symptoms. Improvements lasted at least 1 month but were not generally still present at 6 months. The review also concluded that acupuncture appeared to be a safe treatment for fibromyalgia.[xx]
Nutritionists and Chronic Pain Treatment
Decades of research have shown that diet plays an important role in chronic pain. The human body constantly makes new cells to replace aging or damaged cells. These cells, the building blocks of our tissues and organs, require certain foods and nutrients for healthy development; other foods and substances are detrimental to cell development. In addition, the nutrients we ingest are the raw ingredients for our hormones, neurotransmitters, digestive enzymes, and other essential substances that keep our bodies healthy and in balance. Changing what you eat can have a significant impact on your pain levels.
A whole-foods diet that emphasizes fresh fruits and vegetables, whole grains, and lean meats reduces pain and inflammation. Processed foods and sugars and unhealthy fats increase pain and inflammation.[xxi] In addition, certain nutritional supplements—including omega-3 fatty acids, B vitamins, vitamin D, magnesium, and antioxidants—also have pain-reducing properties. There is considerable scientific evidence that certain foods are as effective at reducing pain as medications.[xxii]
Find Healthcare Providers Who Practice Nutritional Medicine Near You
Pain Psychologists (and other mental health providers trained in mind/body medicine) and Chronic Pain Treatment
According to the International Association for the Study of Pain, pain is both a sensory and an emotional experience. The way you think and feel impacts how you process pain in the brain and affects how much pain you feel. Psychologists, Clinical Social Workers and other mental health providers trained in mind/body medicine teach techniques for regulating thoughts and emotions, which improves coping with pain and reduces pain intensity.
Mind/body treatments for chronic pain offered by mental health professionals include psychotherapy, including cognitive behavioral therapy (CBT) and trauma resolution techniques (EMDR, energy psychology); relaxation training; biofeedback; meditation; laughter therapy; hypnosis; and guided visualization. These types of treatments are among the most potent tools for effective pain management. They have the added benefit of being completely safe and low cost. Furthermore, most are available for self-care.
For most people, chronic pain is not a result of pathological tissue changes but rather physiological changes precipitated by chronic stress cause pain. When our minds perceive a threat, this activates certain brain regions, which cause the autonomic nervous system to trigger the fight or-flight response. As a result, the body increases muscle tension, heart rate, and blood pressure and restricts blood flow to the peripheral tissues while suppressing digestion, immunity, and healing. The purpose of these physiological changes is to direct the most energy possible toward saving the person’s life in the moment of danger. These physiological changes, if chronically triggered, can cause changes in nerve-firing patterns and brain-wiring patterns that cause chronic pain and many other disorders.[xxiii]
Another connection between emotional stress and pain is breath—when people are stressed, their breathing is shallower. This deprives the muscles of the oxygen they need for normal functioning and can create or exacerbate pain.[xxiv]
Low-back pain, neck pain, jaw pain, and tension headaches can all occur as a result of muscle tension. Functional magnetic resonance imaging (fMRI) studies have shown that when pain patients have negative thoughts, areas of the brain associated with pain perception are activated and pain sensations intensify.[xxv]
Physiological changes that create pain are reversible with mind/body interventions that decrease activation, increase relaxation, or appropriately discharge or process emotions
Thousands of studies have demonstrated the effectiveness of mind/body treatments in alleviating chronic pain. These studies are too numerous to cite here. Many of these techniques increase relaxation. A multidisciplinary technology assessment panel convened by the National Institutes of Health in 1996 to evaluate the evidence base for behavioral and relaxation approaches in the treatment of chronic pain and insomnia found that the evidence was strong for the use of relaxation techniques in alleviating chronic pain in many medical conditions.[xxvi]
Trauma reduction techniques such as energy psychology go further. Energy psychology techniques combine focused awareness on traumatic memories or physical or emotional distress with stimulation of the human energy field.[xxvii] In EFT, acupuncture energy meridians are tapped at specific points while the client focuses on a disturbing situation or memory. Functional magnetic resonance imaging studies have shown that stimulating these acupuncture points affects the release of brain chemicals in ways that reduce pain and shut off the fight-or-flight response activated by emotional stress.[xxviii]
Find Healthcare Providers Near You Who Practice Mind/Body Medicine
Holistic Physicians and Chronic Pain Treatment
Several types of physicians utilize the above modalities as well as others, such as stem cell therapy and herbal medicine, to treat chronic pain. These include integrative physicians and functional medicine physicians (usually MDs or DOs) and naturopathic physicians, which have their own specialized medical schools. All have training in both conventional and alternative medicine, and combine the best of both into their treatment plans, though they tend to use nonpharmaceutical medicine more than drugs and invasive techniques. Often they work in multidisciplinary clinics where the other specialists mentioned above also practice.
Holistic physicians tend to spend more time with patients than conventional doctors. They are more likely to try to get to the root of the problem so that healing can take place rather than focusing on symptom management exclusively.
Find Integrative/Holistic Physicians Near You
Naturopathic Doctors (NDs) for Chronic Pain Treatment
Naturopaths are healthcare providers who are trained in naturopathic medicine, which is a distinct system of primary healthcare that emphasizes the prevention and treatment of illness through natural, non-invasive methods. Naturopaths approach chronic pain management with a focus on treating the root cause of the pain, rather than just masking the symptoms. They use a combination of natural therapies and lifestyle changes to help patients manage their pain and improve their overall health.
Naturopaths work with patients to develop a personalized treatment plan that addresses their individual needs and may include herbal medicine, nutrition and supplements, physical therapy, massage and mind/body therapies. Some naturopaths may also use acupuncture.
In the United Staes, naturopathic doctors are required to complete a four-year accredited graduate level naturopathic medical program and pass a licensing exam.
Find a Naturopathic Doctor Near You
And There’s Even More
There are homeopathic physicians, health coaches, energy healers, and natural products that can help.
Conclusion
Many safe and effective pain therapies exist that go far beyond pharmaceutical and surgical options. Don’t give up when a conventional doctor tells you there is nothing more that can be done. Start looking elsewhere for help!
Search for All Alternative Pain Treatment Providers Near You
Cindy Perlin is a Licensed Clinical Social Worker, certified biofeedback practitioner, chronic pain survivor, the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free and the founder and CEO of the Alternative Pain Treatment Directory. She has been helping her clients in the Albany, NY area reach their health and wellness goals for over 30 years. See her provider profile HERE.
Related Articles
Suppression of Alternative Medicine is Killing Us
The Faulty Rationale for Most Surgery for Back Pain
Five Reasons Your Pain Meds Might Not Be Helping As Much As You Think
