The Ideal Medical Configuration for Chronic Pain Treatment

Image with four medical care workers:white female with long curly hair and glasses in blue scrub is front, then white female with white doctor coat and straight brown hair, then black male with glasses wearing white lab coat, backed by a white male with gray short hair wearing blue scrubs. The dark blue font says THE IDEA MEDIAL CONFIGURATION FOR CHRONIC PAIN TREATMENT
Teal colored clip-art of a waterlily flower.

Did you know that there is such a thing as an International Association for the Study of Pain (IASP)? They recently worked on revising the definition of pain that has been in place and guided the training of doctors and the treatment of those with pain for the last 40 years.

 “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

PaiN -The Journal of IASP

While the change is subtle, it opens for more multidisciplinary treatment of those living with chronic pain which had been largely ignored in the previous definition. The new definition adds the words “or resembling that associated with” and eliminates the phrase “or described in terms of such damage.” So the new definition reads as:

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and that the accompanying notes be updated to a bulleted list that included the etymology.

Pain-The Journal of IASP

I learned of this change after being contacted for an interview with Jackie Rocheleau, a healthcare contributor to Forbes.com who was writing an article about the definition change. This change was precipitated by the research of the past few decades that show that pain is much more complicated than just tissue damage. The research shows that those living with chronic pain have an over-amplification of the nervous system and have actually dropped the threshold for which the brain interprets a sensation as pain causing pain to happen even though there is no tissue damage.

Mayo Clinic’s Christopher Sletten, Ph.D., ABPP discussing Central Sensitization Syndrome, which is the prevailing theory of the cause of chronic pain & other chronic symptoms.
A patient and/or provider understanding of this process can lead to seeking appropriate treatments including the Pain Rehab Center (PRC) at Mayo Clinic’s Florida campus.
13 minutes long but really worth the viewing.

Hope for New Treatments for Chronic Pain

In her article “After 40 Years, Updated Pain Definition Aims To Include Those Once Left Out”, I had the opportunity to share what I hoped this change in definition would mean for chronic pain patients like me. I explained that while my pain is everywhere all the time, it isn’t of the level where the pain stops me from functioning too much. (I know that I am very fortunate.) My pain, I usually explain, is the pain you’d feel if you worked out all over really hard one day after doing nothing for three months. It’s deep muscle ache for the most part (with some joint pain). However, the symptoms of chronic pain that tend to stop me from being able to function well (like not being able to commit to a job or a friend get-together) are brain fog and utter fatigue that seems then to lead to deep sadness. This isn’t generally the chronic pain symptoms that are acknowledged by pain scales, pain evaluations, or treatment.

“I’ve been fortunate to have doctors that mostly believe the pain I feel is real,” she said. But even then, “They don’t fully understand that it affects you emotionally, physically, your energy level, your ability to think straight. That is difficult to communicate to doctors.”

After After 40 Years, Updated Pain Definition Aims To Include Those Once Left Out

I was heartened to read that the change in definition is to invigorate multifaceted treatment of patients with chronic pain by the addition of how it affects every aspect of the pain patient’s life physical, mental, emotional, spiritual, and social. In addition, writes Rocheleau, “Working with insurance carriers is another way to address those needs. Insurance typically covers drug interventions for pain, but in recent years some have started covering other pain treatments, too. If insurance carriers adopt the language in the new definition, a multifaceted approach might be more accessible to people with pain.” As I explained to her when we interviewed over Zoom, many of the alternative protocols that have proven to help with chronic pain such as meditation, yoga, Tai Chi, massage, myofascial release, Low Dose Naltrexone, and others are not covered by insurance.

My Vision for Ideal Chronic Pain Health Care

A square grid graphic with five sections: 2 on tope and 3 on bottom. On top: woman on her yoga mat and an image of two hands massaging a bare back. On bottom, two women practicing Tai chi, a group of different kinds of pills, a cream, and a syringe, and lastly and image of two hands putting acupuncture needles into a bare back.
This is in no way all inclusive of the types of treatments that would exist in my ideal chronic pain wellness center.

I feel the key to having the ideal set up for treating chronic pain (besides having open-minded, kind doctors who have chronic pain education) is that all the doctors in your life have communication. Having a team of doctors (much like I used to be a part of a team of students/teachers) can bring the missing piece of collaboration to address the whole of the person. In my 6th-grade team, the four teachers (math/sci, soc st/learning connections, reading/writing workshop, and special education teachers) would come together and discuss each student to figure out the best way to help them; we were all on the same page and gave the same plan from each of our students. I had that when I went through the 10-week pain management program, and it was WONDERFUL! I believe it’s a HUGE part of why I’m doing so much better as quickly as I have than when I first went on long-term leave from teaching.

Pain is a whole systems issue; it does not just reside in the body but in the mind as well. Thus, it impacts the psychosocial life of not only the chronic pain survivor but their loved ones. As we come together to understand and treat chronic pain more effectively, we cannot lose sight of the holistic approaches needed to support not only the one coping with pain but those systemically connected to them.

Chronic Pain: how to Approach a loved one without pushing them away

Five-months after my diagnosis with Fibromyalgia (15 years after my Interstitial Cystitis diagnosis), I lucked into finding and getting into a ten-week pain management course through our local rehabilitation hospital, Mary Freebed of Grand Rapids, MI. I know what good care for chronic pain can be like. While the program has room for improvement, it went a long way into meeting my ideal dream care. I learned a lot from the pain medical doctor, pain psychologist, physical therapist, and occupational therapist I worked with 2-3 days a week at 3-4 hours each visit. One wonderful thing was that they worked as a team with each patient, meaning they met once a week to discuss each of their shared patients, deciding on the next program to use or issues to focus on. After the ten-week program, I felt like not only did I have the tools to go forth in developing my pain management plan but also the knowledge and support. I’m able to get a reboot at any time. In fact, they told me that it is very normal to hit a slump and need to come back for in-person guidance.

My Recommendations for the Perfect Chronic Pain Management Center

(If Anyone is Asking)

  • A self-contained facility that holds all the services like that of Mary Free Bed or The Frida Center
  • Patients would be given an overall evaluation to determine how chronic pain is affecting them, giving focus to the whole person. Part of this evaluation would be an in-person interview of at least an hour.
  • Patients would be assigned to the team that best fits the needs based on the evaluation.
  • The patient would undergo an involved, pain management “boot-camp” of sorts, consisting of 20-30 hours of treatment, training, therapy, and education about pain management.
  • The team would meet regularly to adjust the program as needed, but the pain patient would have major input into the process. (Control is important for those with chronic pain because they can feel like they have none).
  • A variety of offerings would be available as no set treatment plan has been found to work for every chronic pain patient.
  • These offerings would be covered by insurance (because the doctors deem they are needed for treatment) much like any other wellness checkup or treatment is currently covered.
  • These offerings would adjust based on best practices and research into their efficacy.
  • These pain facilities would be located all over much like you find urgent care facilities.

What We have is not Working

Our current treatment for chronic pain is not working. Since my 10-week training (an hour drive from my home), I have been doing this largely on my own. While my general practitioner is caring and supportive (he prescribed me Low Dose Naltrexone based on me providing the research that backs its use with those living with Fibromyalgia), he cannot really guide me as to how to adjust its dose. He, and my other doctors, give me something to treat this or send me to that specialist to treat that. It’s a whack-a-mole mentality that just doesn’t fit the chronic pain patient’s actual experience.

As the info graphic explains, pain is a personal experience that affects the whole person, so the whack-a-mole treatment doesn’t work for those living with chronic pain.

Places to Use as Models for this Ideal Configuration

What would be in your ideal set of treatment protocols? For me, I would choose LDN, massage, MBSR meditation, physical therapy, EMDR or CBT counseling, Tai Chi, therapy pool swim classes, diet, and yoga.




Teal line drawing of a waterlily with teal text that says  Pain FULLY Living Living FULLY Despite Pain

6 thoughts on “The Ideal Medical Configuration for Chronic Pain Treatment

  • September 26, 2020 at 4:31 am
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    Excellent article, Katie! I am so glad you had the opportunity to speak to Jackie. I think you’ve hit everything here that a patient could hope or wish for. Now to bring it to fruition! Somehow I think it’s going to take a lot longer. In the past decade, I haven’t seen things grow much in the way of education for pain management with medical professionals. It’s all over the place. Perhaps we’ll see some changes soon.

    Now that GET has been removed from treatment plans (FINALLY!), perhaps we’ll move forward a bit. Open Medicine Foundation and MEAction Net are working overtime this year because of COVID long-haulers. I’m hoping/wishing for better understanding so doctors can finally recognize MECFS and come up with better treatment plans for patients like me.

    Reply
  • September 26, 2020 at 4:05 pm
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    CSS also appears to be a prevailing explanation for a good percentage of FND symptoms! Generally speaking, they need to be treated in a similar manner.
    I love this post because you are recognizing this key portion of pain management: there doesn’t have to be measurable damage for the symptoms to be real!
    Most of the treatments you mentioned line up with suggestions for FND. I have been meditating, getting massages, and exercising regularly for years. I think you are offering excellent guidance on this: finding or creating a team of supportive professionals isn’t easy, but can be super helpful when you manage to!

    Reply
  • September 27, 2020 at 9:24 pm
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    Excellent article! Pain does indeed affect every system, and acknowledging that it needs to be addressed from a multi-disciplinary perspective is the first step.

    Reply
  • September 28, 2020 at 9:24 am
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    I think for me, the most precious thing is when you mention doctors communicating with one another. You feel like you’re being heard, and are being treated by a team of people who are working together to give you the best possible treatment by understanding all aspects of your symptoms. I hope this post opens up all these perspectives for those in the medical profession.

    Reply
    • September 28, 2020 at 10:12 am
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      Yes, while I see most doctors through the same health network, and they use the same computer filing system, they really don’t review the reports from the others, so they aren’t really in sync about the whole situation, even though they have the information.

      Reply
  • October 1, 2020 at 5:28 am
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    Congrats on Forbes… achievement unlocked! 😉 That aside gosh this list is huge isn’t it? I think your perspectives are very sound and reasonable and should already be implemented, really.

    Reply

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