Pain management is a broad area of healthcare with a multidisciplinary approach to helping individuals living with pain. To suggest that any one healthcare discipline or professional can solely deal with pain is simply not true. Since the causes of pain are so vast, its treatment must also be extensive and diverse. Which treatment is right for your specific pain very much depends on the root cause. As I have previously suggested, finding the root causes means finding a healthcare professional well versed in pain diagnosis and management.
I will often explain to patients of mine that pain management has a 360 degree view (as outlined in Figure 1). The various sub-classes of pain management include: medication and surgeries; different physical and manual therapies; bracing and assistive devices; rehabilitation and exercise; diet and nutrition; psychological intervention; and complementary/ alternative medicines. We’ll now take a closer look at each sub- class of management and which will help with different causes of pain.
Medication and surgery is often used by western medicine to help individuals cope with the pain they are experiencing. This type of management is very important when looking at pain caused by serious pathologies, like cancers and tumours. Opioid medication is often used to provide short to long term relief of pain for those suffering from serious illness. Diseases, such as, tumours that are compressing vital organs can cause extreme amounts of pain and thus require surgery and removal for relief.
Physical and manual therapy, as is often performed by professionals such as Doctors of Chiropractic is often beneficial for pain being caused by the muscles and joints of the body. Pain/ healing modalities such as TENs machines and cold laser therapy are examples of physical therapy tools that can be used to help with various musculoskeletal injuries. Manual therapies like spinal manipulation is suggested by research to be one of the most effective treatments for low back pain that is mechanical in nature.
Serious injuries like fractures can cause significant pain and will often require bracing and other assistive devices for pain management. However, aliments that will respond well to bracing or other assistive devices do not always have to be serious. Take for example, foot pain that is caused because the person has a flat foot. This will respond well to an assistive device such as a custom made orthotic.
Being out of shape with respect to the cardiovascular and muscular systems can also contribute to a person’s pain presentation. Things like angina which is chest pain caused from poor cardiovascular health can have significant improvement with daily moderate walking. Muscles not only cause us to move, but also support the joints in the body and weak muscle can contribute to joint pain. Thus rehabilitative exercise is important to strengthen those areas and decrease pain.
The foods we eat and supplements we use can also help us to manage pain levels. Chronic inflammation in the body can cause wide spread pain and certain pro- inflammatory foods will worsen this, while anti-inflammatory foods will help. Broadly speaking fruits and vegetables help fight inflammation and meats and grains can contribute to pain. Supplements, like omega 3 fatty acids, are also anti- inflammatory in nature and will help with pain management.
Cognitive behaviour therapy (CBT) is physiological approach to pain management. This therapy allows patients to understand how their physical pain is related to their thoughts, emotions and behaviours. A great example is phantom limb pain. CBT helps to change patterns that contribute to the pain presentation of a person. Psychologists and social workers are examples of healthcare professional that are proficient in this type of intervention.
The categories of pain management that have been discussed so far are all examples of modern western medicine. However, in a true multidisciplinary approach we cannot discount the value of traditional eastern medicines for pain management. Approaches such as traditional Chinese medicine and acupuncture have been used for thousands of years and continue to this day for treatment of pain.
Dr. Luigi Nalli is a fully licensed and board certified Chiropractor with special interest in pain diagnosis and management. His clinics and rehabilitation centres are comprised of a team of multidisciplinary healthcare professionals treating and managing pain and overall wellness. For more information about him or his team please call 416-744-7900 or visit www.humber-family.com.
By: Dr. Luigi Nalli