Non-Drug Ways to Treat Chronic Pain
May 16, 2022
There is increasing evidence that, with time, almost all chronic pain develops a central brain/spinal cord/neurotransmitter component.
For some types of chronic pain, like Crohn’s disease, pain may start from an inflammatory process in the intestinal tract. With treatment to get rid of the inflammation, the pain should resolve. But for some individuals, even with healthy looking intestines following treatment and with no inflammatory markers, the abdominal pain lingers. Why is this?
What about irritable bowel syndrome (IBS), where symptoms might start with an acute viral gastroenteritis (or out of nowhere) but then abdominal pain continues onward, often with nausea, diarrhea, and/or constipation? In this case, multiple GI testing and blood tests might not reveal any pathology, but the symptoms are still present and distressing. For teens, these symptoms may prevent attendance at school.
Other chronic pains include persistent musculoskeletal pain and widespread pain (with multiple tender points at ligament insertions), often called juvenile fibromyalgia. Complex regional pain syndrome (CRPS) is a condition where a focal body part (not in a nerve root distribution) becomes painful, especially with use, and the area becomes tender to even light touch. Even continual headaches which do not respond to preventive or abortive migraine medication can create stress and impede a teen’s life.
These are the types of pains that medication alone -- sometimes even with physical therapy -- cannot easily resolve. The longer the pain continues, the more “baggage” it brings along, like fatigue, insomnia, anxiety, and depression, as well as eating restrictions for GI symptoms, and pain in other parts of the body.
Chronic pain is a complex, multi-layered condition that requires a deep look at factors that might have contributed to its emergence (developmental sensory sensitivity, premature birth, history of multiple injuries, past history of depression and/or anxiety, etc.) and at factors that keep the pain going, and even enhance it, creating more pain-related disability.
Medication Alone Is Not Enough
Modern pain science has contributed to a new understanding of chronic pain and the best ways to treat it. We now have new tools to look at brain pathways and brain inflammatory cells called microglia. We have increased knowledge of neural signaling throughout the body -- from body upward and from brain downward -- and the neural impact of different emotions on pain signaling. We have learned that for many, medication alone -- even with the addition of physical therapy -- is not enough to resolve many types of chronic pain.
The University of Michigan Adult Chronic Pain and Fatigue Research Center directed by physician and pain researcher Dr. Dan Clauw has reported that “there isn’t any drug in any chronic-pain state that works in better than one out of three people…and nonpharmacological therapy should instead be front and center in managing chronic pain — rather than opioids, or for that matter, any of our drugs.”
Mind-Body Therapies for Chronic Pain
In other words, modern pain science suggests that for most people, especially teens with chronic pain of any type, non-drug brain and body therapies carried out consistently over time work far better -- and the effects are far more long-lasting -- than medication alone, even with the addition of routine physical therapy.
What are some of the mind-body therapies for chronic pain? Well-established therapies, with good brain research, include cognitive behavioral therapy (CBT), dialectic behavioral therapy (DBT), hypnotherapy, biofeedback, mindfulness/meditation, yoga, acupuncture, aquatherapy, and physical therapy with a therapist trained in pain treatment.
Newer therapies, with gradually increasing evidence, include martial arts, Chinese healing practices like Qi Gong and Tai Chi, Sophrology, craniosacral therapy, art and music therapy, aromatherapy, pet therapy (including hippotherapy, or working with horses), and other forms of creative arts immersion (involvement in art, music, dance, theater, cooking, gardening, etc.).
Looking For “The Answer”
Too often we see child and teen patients whose parents have brought them to specialist after specialist. They’ve already undergone numerous blood, urine, stool, and radiographic tests and procedures looking for “the answer” to their chronic pain.
These multiple searches, while well-meaning, delay “putting the puzzle together.” Thus, they can delay a mind-body-developmental treatment approach that can improve the teen’s pain and disability, and enhance the teen’s ability to re-engage with school, friends, and fun activities.
While medications, for some teens, can increase “bandwidth” that can help them engage in the mind-body therapies, they alone are not the answer. Parents can become desperate and look for “quick solutions” -- and there are many such “solutions” offered on the internet.
With some, like Calmare Scrambler therapy, there is interesting early scientific research, but the findings don’t yet guide the practice. It is also expensive (insurance typically doesn’t cover the costs) and time intensive.
The problem is that while many teens will say that their pain is gone and they feel great, the pain typically returns, leading to increased frustration and discouragement for them. The research doesn’t yet provide answers on how to carry out lasting effects with scrambler therapy.
Beware of other types of treatments and “programs” with testimonials that offer “amazing results.” Often these treatments are not based in science and have good marketing for their business model.
They are different than pediatric chronic pain rehabilitation treatment programs offered by academic universities and children’s hospitals.
Creative Healing for Youth in Pain
Once I retired from my 30-plus years heading the pediatric pain and palliative care clinical, teaching, and research programs at UCLA, I launched my efforts into our non-profit Creative Healing for Youth in Pain (CHYP): www.mychyp.org.
CHYP is all online and serves teens with any type of pain -- even primary emotional pain -- providing online information about the modern science of pain, tools to cope with pain, social support, and arts opportunities to stimulate the creative aspects of their brains and bodies. CHYP is based in science and will always be coming out with information about new therapies for pain and new programs to heal teens, young adults, and their families.