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10 Articles in Volume 17, Issue #10
A Guest Editorial on Counterfeit Pain Medication: The Other Epidemic
A Model to Incorporate Functional Medicine into Chronic Pain Care
Chronic Pain and Substance-Related Disorders
Getting at the Root of Opioid-Induced Constipation (OIC) with an Osteopathic Approach
Inside FDA's Guidance on Generic Abuse-Deterrent Opioids
Neural Pathway Pain — A Call for More Accurate Diagnoses
Pain Care in a Natural Disaster
Pharmacological Interventions in Sport-Related Concussion
The Internet of Medical Things
What Type of Withdrawal Symptoms from Tramadol Might a Patient Experience?

Neural Pathway Pain — A Call for More Accurate Diagnoses

In the treatment of chronic pain, the author argues that a patient’s physical and emotional history may play a more significant role in long-term outcomes than expected.
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  • Group 1: received education only
  • Group 2: underwent cognitive behavioral therapy
  • Group 3: underwent emotional processing therapy.

The therapy utilized by the third group included exercises designed to help patients recognize, experience, express, and process emotions such as anger, guilt, sadness, and compassion that may have been avoided in their lives. The emotional processing group reported significantly higher rates
(> 50%) in pain reduction compared to the first two groups. The emotional therapy group also reported higher rates of improving “very much” or “much” in comparison to the other groups (see Figure 2).20

Discussion and Conclusions

The combination of new research on how pain is generated and processed in the brain, along with data on improved outcomes, suggests that pain care providers may have an opportunity to change the paradigm of pain management and offer hope of recovery to patients living with chronic pain. However, there are several barriers to the widespread recognition of neural pathway pain disorders and the implementation of effective treatments.

First, the concept that pain may be generated by the brain—in the absence of tissue damage—may seem counterintuitive. Medical training focuses on structural abnormalities and many patients have evidence of mild structural anomalies that may actually be normal variants. A great deal of education and repetition, along with significant inquiry into the clinical evidence for neural pathway-generated pain, is necessary for this concept to be fully embraced.

A second barrier is that pain generated by the brain is typically considered to be “not real.” Stigma often surrounds conditions deemed to be psychological, and many patients are understandably sensitive to being told that their pain is “in their head.” It is crucial, therefore, for practitioners to explain to their patients that neural pathway pain is not only real but also common.

When treating neural pathway disorders, pain specialists are also encouraged to consider mental health providers as part of the patients’ treatment team. Providers may ask patients about psychological issues that may be at the root of neural pathway disorders, and, in turn, mental health providers may take patients’ medical histories to determine the causes of physical symptoms. Together, they may find that long-term patient outcomes improve when focusing on eliminating pain, versus coping with pain.

The final barrier to accepting and properly diagnosing brain-induced pain lies in standard practice. Many providers rely on standard medications and procedures for treating chronic pain, as opposed to exploring applying alternative therapies. It has been estimated that more than $600 billion is spent in the United States on pain care annually.21

If the model for diagnosing and treating neural pathway pain were widely adopted, there might be significant economic repercussions in the healthcare system. However, this approach has potential to dramatically reduce the suffering of millions of people living with chronic pain and may substantially reduce medical costs.

Disclosure: Dr. Schubiner reported receiving support from the Multiversity 1440 in Santa Cruz, California, for a scheduled January 2018 teaching seminar.



Training opportunity: Dr. Schubiner and Mr. Alan Gordon will offer a 2-day training for professionals on the diagnosis and treatment of neural pathway pain syndromes at the Multiversity 1440 Retreat Center, January 18-20, 2018 in Santa Cruz, California. 

Last updated on: December 7, 2017
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Pharmacological Interventions in Sport-Related Concussion