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How might pain practitioners best offer patients relief without relying only on pharmacology?

In this Ask the Expert Q&A, the founder of Health AtLast offers alternative treatment options for pain care.
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Pain comes in all forms, and yet, it remains subjective with variable tolerances, perceptions, and methods of management. Given physician shortages, rushed patient scheduling, and a desire among patients to achieve instant results with little to no long-term lifestyle changes, pills are often the preferred choice for handling pain – fast-forward to the current drug epidemic.1 This problem has grown to such an extreme that the US Surgeon General sent 23 million letters to physicians across the country warning of an opioid dependency in which 91 people a day are dying as the result of drug misuse and abuse.2

As physicians, one of our biggest calls to duty is to accurately diagnose the origin of the patient’s pain so that measures may be taken to adequately and sufficiently address the root cause; otherwise, we are simply putting duct tape over a “check engine” light and ignoring the underlying problem. If the underlying cause is not addressed, chronic pain may become a life-long condition. Once the actual cause is found, however, I believe it is important whenever possible to try various non-pharmacologic therapies to treat the pain.

We need to take the time to listen and observe the patient. For example, fibromyalgia may flare following long durations of sustained poor posture from a sedentary job that fatigues muscles and causes aches and pains. The correction for this muscle tenderness may be improved posture and exercise, and for some, may eliminate tender points and fatigue. Massage, acupuncture, and trigger-point injections may, in many cases, eliminate tender points, while improved diet and nutrition may also prove beneficial.

In other cases, the practitioner might ask the patient about day-to-day activities. For instance, how heavy is the bag she is carrying; what is his position when he walks, sits, sleeps; and which outside activities does she do? What a patient does during the day with their body may help to clarify the whole picture. If an ergonomic or lifestyle root cause is identified, the practitioner may choose to focus on preventing recurrence of pain.

Use Patient Education as Part of Treatment

Pain is real, whether mental, physical, emotional, or otherwise, and patients come to doctors for solutions. Patients should be educated, however, to understand that pain may be a signal—an indication that something is awry, or needs to be altered to prevent permanent damage. Once the patient appreciates that the pain is a warning, they may start paying attention to it and work toward treatment.

With regard to prescribing, I try to explain to patients in my practice that, in certain cases, taking pain medications that “makes you feel good” may inadvertently mask the underlying problem. In turn, “living with the pain” but changing daily activities with regard to rest, posture, etc., may allow the body to heal faster.

Advanced, nonpharmacologic treatment for pain may be innovative, creative, and provide results to patients with little to no side effects (see “Range of Pain Relief Approaches”).

Find the Right Therapeutic Balance

Clearly, there are many conditions for which lifestyle adjustments may not prove sufficient for long-term treatment. There remains a place for pain medication, particularly after surgery or accidents, for instance. Finding the right balance between pharmacological and nonpharmacological solutions, whenever and often as possible, is our responsibility as practitioners.

Consider Range of Pain Relief Approaches

The following methods may be used to relieve pain depending on the patient and condition.

Last updated on: November 9, 2017
Continue Reading:
Can Physiological Profiles Affect Pain Treatment?
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