Living with Chronic Pain: Research Supports a Different Approach to Treatment

By John Fiore

Chronic pain is defined as a painful condition affecting one or more areas of the body lasting for more than twelve weeks. In contrast to acute pain, which is induced by tissue damage, injury, or disease, chronic pain may be linked more to familiar sensory pain patterns or previous pain experiences. The complexity of chronic pain leads to costly and often ineffective treatments. Health economists from Johns Hopkins University estimated the annual cost of chronic pain is as high as $635 billion per year, which is more than the annual related costs for cancer, heart disease, and diabetes.

Treating a person with chronic pain must include treating the person as a whole. Rather than treating the chronic pain symptoms, a comprehensive evaluation of movement, limitation, medical history, surgical history, and current medications must be performed. Historically, traditional treatments for chronic pain have included prescription medication and surgical intervention.

Physical therapy can improve quality of life for those with chronic pain.

Physical therapy can improve quality of life for those with chronic pain.

Applying treatments for acute pain or injury to chronic pain conditions, however, leads to poor results and frustration for all involved. Focusing treatment on restoring movement and function will not only improve quality of life, but it will also address the underlying cause of chronic pain.

A recent article in the New York Times highlighted the need to change our treatment approach when working with individuals with chronic pain. The article cited a July 20, 2014, study published in The British Medical Journal which compared the results of surgery for knee meniscus tears with a physical therapy exercise. The results showed no greater improvement in the surgical group.

Furthermore, knee MRI scans of pain-free individuals often revealed meniscus tears which were not symptomatic. Similar studies have looked at the outcomes of individuals following lumbar fusion which is a common surgical intervention for chronic low back pain due to degenerative disc disease. Again, no long-term benefit was shown between the fusion group and the physical therapy exercise group.

While it should be noted that both knee meniscus and lumbar fusion surgical procedures may be the only option given certain clinical cases, surgical procedures should not be equated with a quick fix. In most cases, proper conservative, function-based treatments and lifestyle modifications are a more effective and economical option.

In 23 years of practice as a physical therapist, I have learned that beneath the surface of every individual suffering from chronic pain are one or more compensatory movement patterns which collectively contribute to chronic pain symptoms.

Much like a detective following clues to solve a mystery or crime, a physical therapist must possess the knowledge and understanding of the human body to piece together the movement limitations and/or dysfunctions contributing to an individual’s chronic pain symptoms.

Once the underlying causes are identified, realistic, short-term mobility and exercise goals can be established. Short-term goal success represents progress towards freedom from the familiar chronic pain pattern. Good physical therapists will take the time to thoroughly evaluate movement patterns, joint mobility, and formulate an individualized treatment plan aimed at successfully returning an individual to the quality of life enjoyed before the onset of chronic pain. Neurosci Biohehav Rev.2013 Dec: 37(10 0 2): 2597-2607

Darrel J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13(8): 715 DOI: 10.1016/j.pain.2012.03.009

www.nytimes.com2016/08/04/upshot/the-right-to-koe-thatan- operation-is-nest-to-useless.html

John Fiore is a physical therapist and can be reached at

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