A What Can I Do About My Pain?
Personal injuries can arise from many sources, such as car accidents, falls or a work injury. One thing these injury victims usually share is pain. The location and type of pain may vary, but everyone wants to know how they can better handle pain after an accident. September is Pain Awareness Month, and there are many excellent resources if you suffer from acute or chronic pain.
This article supplements our prior writings about pain and inflammation, traumatic brain injury, and memory loss after a car accident. We attempt to explain the mechanics behind pain and why relief can be so hard to come by. We then finish with a few suggestions to help reduce and handle your pain.
What is Pain?
Everyone knows pain when they feel it, but what exactly is “pain”? It is not just that uncomfortable feeling that tells you something may be wrong. Pain is a signal in your nervous system that is usually associated with tissue damage. Think of it as the body’s fire alarm. Your body is sending out an alert to get you to safety now and to teach you to avoid the injury-causing issue later.
Pain can be an unpleasant feeling, such as pin prick, sting, or ache. It can be dull or sharp. Pain may come and go, or it may be constant. It might affect one area of your body, like your back or neck, or you might feel it all over. Everyone experiences pain differently. You might suffer the same injury as your sibling, but one of you will describe the pain as a dull ache while the other one cries in agony. The International Association for the Study of Pain says “pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.” Remember this because it will be important later.
Like most biochemical systems, it is great when it works properly, but problematic when it does not. An improperly functioning nervous system can take short-term pain and transform it into a long-lasting nightmare known as chronic pain.
The History of Chronic Pain
In the personal injury industry, insurance companies, defense lawyers, and the so-called experts they hire have caused the term “chronic pain” to become a dirty word. At its bare essence, chronic pain is pain that is ongoing and lasts longer than 3 months according to the NIH. If you go back through history, humans expressed compassion for those who suffered pain, often turning to the most educated and respected citizens (e.g., priests, sorcerers, doctors) to provide relief. Even though we do not full understand the mechanism of pain, efforts over the centuries have led to great developments in medicine.
Medical scientists of the 19th Century discovered that opium, morphine, codeine, and cocaine could be used to treat pain. Aspirin was developed. Around the 1900s, doctors began debating the use of such pain relievers because patients were becoming vulnerable to addiction. The development of aspirin-like non-steroidal anti-inflammatory drugs, such as ibuprofen and Naproxen, were introduced for mild to moderate pain. In the 1980s, several prominent pain specialists published questionable reports that there was minimal potential for addictive behavior when using opioids to treat long-term, non-cancer pain. Purdue Pharma further spread and amplified this myth. The pharmaceutical industry financed a “prescription culture” that would become an opioid epidemic in Arizona and across the U.S..
Today, many long-term personal injury pain sufferers are labeled “drug seekers” or “pill poppers”. Opioids have become many health care providers’ first treatment method, ultimately making the pain sufferer become reliant on, and addicted to, pain pills. I am not saying the opioid epidemic caused “chronic pain” to become a scarlet letter to be hoist upon injury victims, but it did not help.
Chronic Pain in Personal Injury Cases
Another thing that does not help is the fact that people can suffer from chronic pain long after the original injury is healed. Doctors do not know exactly why these people suffer from chronic pain—some believe signals get rewired in the brain to perpetuate the experience of pain, while others believe low-grade pain signals continue to travel to your spinal cord and brain where they are amplified. This makes it difficult to treat effectively.
Those defending personal injury cases take advantage of these uncertainties to suggest to a jury the injury victim is lying about their pain. They say there is no objective evidence of injury that should cause the pain, so the pain is either fake or from something else. The doctors they hire disingenuously ignore the fact that an injury caused the victim pain, the victim’s nervous system unintentionally malfunctioned, thereby causing the victim to experience pain long after their injuries have healed. It is not something the injury victim can control.
Depression and Chronic Pain
A study from NESDA reported that chronic pain is common in up to 70% of patients with depressive and anxiety disorders. Unsurprisingly, pain is a predictor of the persistence of depression and depression is a predictor of persistent pain. The study proposes a possible explanation is that impaired functioning caused by pain can lead to social isolation, which in turn can lead to a negative effect on depressive symptoms, and vice versa.
We know the same is true about anxiety. Simply put, people suffering with pain have difficulty moving, working, sleeping, taking care of themselves or others, and completing seemingly simple physical tasks. This adds to their stress and anxiety, and depression. Furthermore, different brain areas, such as the amygdala and hypothalamus, play a role in both depression and pain. Also, when depression and chronic pain are co-morbid, recognition and treatment of depression are less effective, as patients mostly only present their physical complaints and receive treatment accordingly. This further compounds issues for injury victims.
Personal injury pain sufferers, like yourself, may try anything to get relief. Read further for potential treatment options.
Future Pain Management
Opioids are not going away and, for some people, that’s a good thing. Certain long-term pain patients, like those suffering from certain types of cancers and systemic diseases, need opioids to control the significant levels of pain they experience. Additionally, those who have found themselves addicted to opioids will need the medication to help wean them off the drugs.
Since 1999, more than a million people died from opioid overdoses. This public health crisis, and the shady methods used to market and prescribe opioids, has led to increasing efforts to develop and promote alternative therapies.
Researchers are developing innovative treatments to disrupt the improperly functioning nervous system and modify nerve activity to minimize the sensation of pain reaching the brain. Electric stimulation devices, like spinal cord stimulators and transcutaneous electrical nerve stimulators, are being used to treat a wider variety of chronic long-term conditions, including complex regional pain syndrome. Along those lines, BioElectronics Corporation developed a patch that uses electromagnetic fields to dampen the brain’s perception of pain. Soundwaves are now being used to help control certain types of pain. Another non-invasive, non-opioid treatment method, which is near and dear to my heart, is virtual reality (i.e., exploring a digital world distracted pain sufferers enough that even those with cervical spine pain reported significant pain relief).
The medical profession still loves medications, despite the opioid epidemic. As our understanding of neurochemical mediators and biochemical pathways increases, researchers are experimenting with medications to address different contributors. For instance, sodium and calcium channels play a huge role in neuro-messaging, so researchers are looking into augmenting these channels to stop the pain signals from reaching the brain.
Treatment of Underlying Conditions
The most important aspect of pain management is to treat the underlying injury. If your chronic pain is caused by a chronic health condition, such as arthritis, cancer, or chronic migraine, your health care provider might prescribe medication, surgery, or other therapies to help treat it. Once your injury or condition has been treated or resolved, if you still have pain, you should talk to a health care provider to determine if any of the treatment options discussed above are right for you.
Traditional Pain Management
Even though the future of pain management is here, many health care providers still employ traditional treatment methods. You can expect most non-pain-management doctors to suggest over-the-counter pain relievers (e.g., acetaminophen, aspirin, ibuprofen, naproxen), prescription anti-inflammatory drugs (e.g., corticosteroids, Celebrex), opioids, antidepressants, or anti-seizure medications (e.g., gabapentin, Lyrica).
Pain management will continue to include injection therapy and intrathecal drug delivery systems. Pain management medications can be used a for a host of different conditions. They also have fewer adverse side-effects. Additionally, traditional pain management is the most cost effective way to control pain.
Alternative Pain Management
In addition to traditional pain management, and upcoming therapies, there are alternative therapies that may help lessen your pain. The term “alternative therapy” has received flack and criticism for being some hippie, non-scientifically proven therapy—which is not true. When used in conjunction with traditional pain management, alternative therapy has been shown to be very effective.
We will discuss a few in detail, below, but alternative therapies typically include: physical therapy, massage, chiropractic treatment, acupuncture, yoga, hypnosis, meditation, guided imagery, biofeedback, aromatherapy, counseling, and herbal remedies. In all instances, you should discuss these potential complementary therapies with your health care provider(s). These are all methods that can help you handle both your immediate and chronic pain after a car accident.
Physical Therapy ( PT ) and Massage
Physical therapy aims to ease pain and help you function, move, and live better through movement-based exercises. The therapist measures your ability to move and complete certain tasks while assessing your needs. The therapist then creates a treatment plan and guides you through specific exercises to help reduce your pain. Starting physical therapy soon after an injury leads to greater improvement in functioning and reduced use of medications.
Massage is frequently helps to reduce stress and relieve tension by enhancing blood flow. A massage therapist rubs and kneads the soft tissues of your body with varying degrees of pressure and tempo. This reduces muscle tension and increases relaxation. This treatment also can reduce the presence of “toxins” that may cause inflammation and pain. As a result of all the benefits of massage, massage therapy holds considerable promise for managing pain.
Chiropractic treatment is the most common treatment for neck and back pain after an injurious event. Chiropractors believe proper alignment of the body’s musculoskeletal structure will enable the body to heal, so the chiropractor performs manipulations to restore mobility to joints. People undergo chiropractic manipulations primarily for personal injury pain relief in muscles, joints, bones, cartilage, ligaments, and tendons. Like physical therapists, the chiropractor conducts and examination and develops a treatment plan that usually includes controlled, sudden force and exercises.
Acupuncture, or acupressure, involves stimulating certain pressure points on your body to help relieve chronic pain and stress. This is performed inserting very thin needles into strategic points on your body. Traditional Chinese medicine believes this balances the flow of energy or life force that flows through pathways (meridians) in your body.
Western practitioners believe the needles activate new nerve endings, taking your attention away from the original pain and telling your brain it was a false signal. The theory is that the stimulated muscle and nerves send a message to your brain causing the release of endorphins. Our bodies produce Endorphins, which are morphine-like chemicals. Endorphins, along with other neurotransmitters, block the pain signals.
Yoga is a mind and boy practice that combines the benefits of movement with the perks of a mindfulness. There are different styles of yoga that all combine physical posture, gentle movement, breathing techniques, and meditation to stretch and stimulate muscles. The theory is that yoga helps with chronic personal injury pain by improving flexibility, reducing inflammation, easing tension, and reducing stress.
Mind-body therapies are treatments intended to help the mind improve the body’s functions and symptoms. This includes a wide range of therapies, including relaxation techniques, meditation, guided imagery, biofeedback, and hypnosis. Essentially, you use techniques to focus your mind in ways to relieve stress and tension.
Biofeedback uses electronic devices to help you learn how to consciously control body functions to lessen pain. Some of these functions include breathing and heart rate. Biofeedback alerts you to the ways in which muscle tension is contributing to your pain. Being aware of pain triggers can help stop future pain from occurring.
At its core, visualization or guided visualization, has you visualize calming images. In pain management, the technique involves closing your eyes and creating a visual image of the pain. Creating a visual image means to give the pain a shape, color, size, or a motion. And then slowly start altering the image to transform it into one that is more pleasing.
As discussed above, some aspects of chronic pain “are in your head”. Counseling therapy can improve your emotional well-being. The theory is that counseling gives you the mental tools to recognize pain and learn to cope with it. Many people, once they understand why they are feeling pain and how relaxation techniques can help, find their pain less problematic. It also helps you to be mindful of pain triggers so you can avoid them.
Dietary Approaches to Manage Pain
Pain management through diet means reducing consumption of foods that cause inflammation. It is equally as important to simultaneously increase consumption of anti-inflammatory foods, such as fruits and vegetables. Typically this means reducing dietary fat while increasing plant foods. The evidence is thin, but some fibromyalgia sufferers report decreased symptoms when consuming a mostly raw vegetarian diet. Similarly, some women with premenstrual symptoms reported a low-fat vegetarian diet decreased their pain intensity and duration.
Most people understand that your body needs certain vitamins and minerals to function. A healthy and balanced diet is necessary to meet the body’s nutritional needs. However, there is a billion-dollar industry that tells us we will benefit from increased intake of certain supplements. For example, fish oils help improve anti-inflammatory symptoms. Medicine is slowing uncovering the benefits of other supplements like turmeric, quercetin, zinc, and vitamins C and D3. Cannabidiol (CBD), is increasing in popularity as a non-addictive option for treatment of pain, inflammation, seizures, and anxiety.
Lifestyle Changes to Manage Pain
As discussed above, there are certain lifestyle changes that may have a positive impact on pain management. The changes focus on creating healthy habits and wean out unhealthy habits. For instance, if you smoke, talk to your doctor about stopping—this might require a smoking cessation plan or pharmacological treatments. There are many negative health effects of smoking (e.g., cancer, heart disease, stroke, lung disease, circulation problems, and immune system compromise).
If you have trouble sleeping, talk to your doctor about options that might help you fall asleep and stay asleep longer. Sleep is vital as it gives your body a chance to recover and heal.
Also, some of the therapies discussed above work to ease the effects of stress with professional guidance. Check with your providers to see if it is safe for you to engage in self-directed stretching and exercise. Both stretching and exercise are a great way to deal with stress.
Finally, for minor injuries that do not require medical attention, follow the general rule of RICE:
- Rest the injured area;
- Ice the injured area, by applying a towel-wrapped cold pack or ice pack for 10-20 minutes at a time;
- Compress the injured area, by wrapping it in an elastic bandage tightly enough to provide support, but not so tightly that it causes numbness; and
- Elevate the injured area above your heart.
Additionally, heating pads and warm baths are helpful to ease muscles stiffness, soreness, or cramps.
Ultimately, there is a lot you can do to reduce the impact of pain. A holistic approach that treats the underlying injury, and addresses mind and body, will go a long way to improving your quality of life.