By Mel Pohl, MD, FASM
A holistic approach to the healing process.
Unlike other injuries, chronic pain is unrelenting, lasts longer than
six months, and is characterized by decreased function. The desire to avoid feeling more pain or aggravating the pain one does feel leads patients to avoid movement, which, over time, erodes function. The old “use it or lose it” mantra is definitely applicable here.
It’s understandable that patients with chronic pain fear worsening their pain by moving, but what most people don’t realize is that maintaining mobility is essential if function is to be preserved for the present and the future. Body parts that go unmoved for any length of time eventually become “frozen.” This can happen with the back, the abdomen, the joints (e.g., knees and shoulders), etc. Furthermore, with decreased movement, circulation decreases, scar tissue eventually forms, and pain increases.
The consequences of this are not merely limited to decreased mobility and lingering pain. Avoidance of movement ultimately leads to complete non-function. When people are limited, they may become ashamed of their disability and want to hide, want to do nothing. If I can’t get my shirt on by myself in the morning, why would I want to go out in public and expose any other problems I have to friends and strangers alike? This response to pain, this avoidance, leads to feelings of depression and helplessness that only feed into the cycle of immobility and worsening pain until the patient is entirely non-functioning. This is called the Fear Avoidance Cycle.
Now, some people will try to function around all of this by taking drugs. If I go to a physician or a prescriber and I say that my shoulder or back hurts, what will I be prescribed? Painkillers in the form of opioids (narcotics). Many people who take these medications and as a result feel less pain assume that their treatment is working for them. Successful treatment of chronic pain must include improvement of function as well as reduction of the level of pain.
When people whose only treatment has been medication to reduce the pain come to treatment at my center, I notice that their function is deceased and they are sleepy, less active, and cognitively impaired. This lethargy affects all aspects of their life, from digestion to social interactions. We see people medicated for pain, but their function overall has suffered as a consequence. This is not the proper treatment of chronic pain.
The root of this problem is fear. People need to be supported to walk through their fear of pain. Numerous studies that have proven that if someone is afraid of a certain activity, he or she will avoid that activity, and as a consequence won’t progress in his or her treatment. If we expose the person to the activity with support and gentle movement, the fear slowly diminishes. If fear diminishes, pain does as well, and the person regains mobility and confidence. There is a direct correlation between fear, anxiety, and pain. The solution for Fear Avoidance is increased movement, which will cause some discomfort initially. But it is on a temporary basis because at first patients are breaking up the fibrous tissue that has built up as a result of their inactivity. But with increased mobility we get increased function, and improved self-esteem and lower social isolation. The person overall becomes healthier.
When using medications, it is essential to make sure that the function of the patient improves. Simply taking the pain away and putting someone to bed for 20-plus hours a day is bad pain treatment. Unfortunately that is the cycle that people get into. They can’t sleep because of their pain meds, and then they are given sleeping pills. This makes them anxious during the day, so they are given anti-anxiety pills, and then pills to wake up. The result is that they are over-medicated and they are not living life to the fullest. Their quality of life is diminished. The solution is to decrease or eliminate the use of these medications until overall function improves and life gets better even though there is pain present. It is this delicate balance that defines pain recovery.