Patients with rare and serious conditions often face chronic pain, a challenge that affects not only their physical but also their mental well-being. To better understand the science of pain management, we need to start with a basic concept: pain is a signal from the body to the brain that something is not right. However, for those who have experienced serious pain, including chronic pain, it’s clear that nothing about it is simple. Pain is a complex and individualized phenomenon, and describing and understanding it among doctors, researchers, and patients often presents many difficulties.
In a recent webinar hosted by the National Hemophilia Foundation, Kalpna Gupta, a scientist at the University of California, Irvine, emphasized that pain is not just a medical issue but also an economic and social one. According to Gupta, pain costs the United States over $600 billion annually, more than cancer, heart disease, and diabetes combined. Specifically, individuals with bleeding disorders such as hemophilia endure chronic pain due to recurrent bleeding and accumulated damage over time, leading to depression, anxiety, and reduced quality of life. The report also noted that pain can make pain-reducing activities, such as exercise, more challenging.
This article will explore the science of pain and effective therapeutic approaches for managing such pain.
What is the Science of Pain?
Pain science is the study of the biological, psychological, and social factors that contribute to the experience of pain. It involves understanding how the body perceives and processes pain sensations, as well as the factors influencing pain sensitivity and tolerance.
Pain science is the study of the biological, psychological, and social factors that contribute to the experience of pain
Research in pain science has led to a more comprehensive understanding of pain, recognizing that it is not simply a straightforward sensation but a complex experience influenced by factors such as emotions, beliefs, past experiences, and social context.
A key finding in pain science is that pain is not just the result of tissue damage, but a complex interaction involving the nervous system, immune system, and brain. This understanding has shifted from the traditional biomedical model, which focused on treating the root cause of pain, towards a biopsychosocial model. This model acknowledges pain as a multidimensional experience influenced by many factors.
Another important aspect of pain science is understanding that chronic pain is not just a continuation of acute pain but a separate condition requiring different treatment approaches.
Pain science has also contributed to the development of new pain management techniques such as cognitive-behavioral therapy, mindfulness-based stress reduction, and acceptance and commitment therapy, which aim to address the psychological and social factors contributing to pain.
Treatment Methods
Biopsychosocial Approach
The biopsychosocial approach is recognized as the most successful model for understanding pain to date, as it encompasses broad issues related to the interaction between biological, psychological, and social factors that are unique to each individual. This model illustrates that the concept of pain cannot be divided into distinct physical or social factors. Instead, the complexity of pain manifests through psychological, social, and physical factors, which interact to modulate pain perception and the patient’s ability to function. Therefore, the biopsychosocial model utilizes physical, psychological, social, cognitive, emotional, and behavioral measures—along with their interactions—to assess the specific pain condition of each individual.
In the treatment of chronic pain, classifying and providing tailored treatment for each patient is crucial due to the diversity of biological and psychological factors involved. The overarching goal in managing patients with chronic pain is to improve their ability to function, which includes enhancing strength, mobility, emotional state, and self-esteem. Depending on the condition and stage of injury, this approach categorizes care into different levels such as primary, secondary, and tertiary care—specifically designed for patients experiencing pain.
The biopsychosocial approach is recognized as the most successful model for understanding pain to date,
Primary Care focuses on alleviating symptoms related to acute pain conditions while enhancing movement and functionality in the affected area. Psychological factors addressed in primary care include reducing anxiety or fear related to pain occurrences. Educating patients on medication adherence and following prescribed exercise protocols is crucial during this phase to accelerate the healing process.
Secondary Care typically involves patients recovering from injuries who may find it challenging to fully recover with primary care alone, necessitating an extended treatment program known as secondary care. At this level, a multidisciplinary team collaborates to help patients avoid physical decline and minimize psychological barriers that hinder recovery. Most patients who do not achieve satisfactory results from primary care often benefit positively from secondary care.
Tertiary Care is for patients who do not respond well to primary or secondary care due to issues related to physical and psychological recovery, or other factors such as legal issues or work-related stress that contribute to serious emotional strain. Within this scope of treatment, patients receive support from a multidisciplinary team, typically including, but not limited to, a primary care physician, a psychologist or psychiatrist, a physical therapist, an occupational therapist, and a disability case manager. Together, this team develops a comprehensive plan to help patients not only regain mobility and function but also teach them stress management skills and coping strategies necessary to address any lifestyle or work-related issues arising from pain and disability.
Most patients with chronic pain requiring this level of tertiary care often rely on pain-relieving medications such as opioids. Therefore, functional rehabilitation and addiction management are considered essential components of treatment that are believed to provide positive outcomes throughout the patient’s lifetime.
Chiropractic Practice
Chiropractic practice for treating pain involves using the best available research evidence to guide the assessment, diagnosis, and treatment of pain. This approach emphasizes the use of objective measures and evidence-based interventions to manage pain and improve function.
Chiropractic practice for treating pain involves using the best available research evidence
An important aspect of evidence-based pain management in chiropractic practice is employing thorough assessment processes to identify the underlying causes of pain and develop personalized treatment plans. This may involve using standardized tests and measurements to assess pain intensity, range of motion, strength, and function, as well as outcomes reported by the patient.
Another crucial aspect involves utilizing evidence-based interventions to manage pain. This can include manual therapy techniques such as manipulation and mobilization, exercise-based interventions like stretching and strengthening exercises, as well as modalities such as massage, vibration therapy, acupuncture stimulation, nutritional counseling, and lifestyle advice.
Education and self-management strategies are indispensable components of evidence-based pain management in chiropractic practice. This may include educating patients about pain and its mechanisms, providing them with information on pain management strategies, and helping them develop a pain management plan tailored to their individual needs and goals.
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT), a type of talk therapy, has recently been used for patients suffering from chronic pain. Several studies indicate that whether used alone or alongside medical treatments, CBT has been effective in alleviating pain and related issues. Pain is influenced not only by physical injury but also by individual thoughts, and CBT operates on the principle that dysfunctional thoughts contribute to maintaining emotional distress and behavioral challenges. Previous research has shown CBT’s efficacy in treating depression, anxiety, stress, and chronic pain. Moreover, CBT has been shown to enhance quality of life, daily activities, and manage conditions like chronic headaches, facial pain, joint pain, and fibromyalgia. CBT aims to reduce pain and distress by altering physical sensations, catastrophic thinking, and unhelpful behaviors.
- Assessment: Begin with a comprehensive evaluation of the patient’s pain history, including the intensity, duration, and triggers of pain. Assess emotional responses to pain, thoughts about pain (such as catastrophizing or fear-avoidance beliefs), and how pain impacts daily life and functioning.
- Goal Setting: Collaboratively set specific, achievable goals with the patient. Goals may include reducing pain intensity, improving physical functioning, enhancing mood, or increasing overall quality of life.
- Education: Provide clear and accessible psychoeducation about chronic pain. Explain the biopsychosocial model of pain, emphasizing how thoughts, emotions, behaviors, and physical sensations interact to influence pain perception and management.
- Cognitive Restructuring: Identify and challenge unhelpful thoughts and beliefs about pain. Teach techniques to replace negative, catastrophic thinking (like “I can’t do anything because of my pain”) with more balanced and realistic thoughts (such as “I can manage my pain by pacing myself”).
- Behavioral Techniques: Introduce practical strategies to manage pain and improve functioning. This may include pacing activities (breaking tasks into manageable parts), relaxation techniques (deep breathing, progressive muscle relaxation), and graded exposure to feared activities (gradually facing activities that cause anxiety or pain).
- Skill Building: Teach coping skills that empower the patient to manage pain effectively. Skills may include problem-solving (finding solutions to challenges caused by pain), stress management (techniques to reduce stress that can exacerbate pain), assertiveness (communicating needs effectively), and communication (with healthcare providers and loved ones about pain and its impact).
- Activity Planning: Help the patient structure their daily routines and activities to balance physical activity and rest. Guide them in gradually increasing activity levels based on their tolerance and pacing strategies.
- Relapse Prevention: Develop strategies to maintain progress and prevent setbacks. This includes identifying early warning signs of pain exacerbation, practicing coping strategies proactively, and developing a plan for managing flare-ups or setbacks.
- Integration and Maintenance: Encourage ongoing practice of learned skills in daily life. Schedule regular follow-up sessions to monitor progress, reinforce skills, and make adjustments as needed to support long-term pain management and improved quality of life.
Understanding the science of pain management is crucial for addressing the challenges faced by patients with chronic pain, impacting both their physical health and mental well-being. With these interdisciplinary approaches, healthcare providers can better tailor treatments to individual patients, aiming to improve function, manage pain, and enhance overall quality of life. If you have any concerns, please contact Sun Pain Management for support.
