One in every five Canadian suffers from some form of chronic pain, a condition that often — though not always —starts with an injury or illness and lasts more than three months or beyond the normal recovery period. With so many Canadians suffering from chronic pain, one would assume its treatment would be well understood in the medical community; unfortunately, it’s not.
Typically, physicians will try to treat chronic pain medically, believing it is caused by tissue that hasn’t properly healed or some other abnormality, such as joint or disk degeneration. However, if degeneration and other physiological abnormalities were the cause of chronic pain then why does the rate of chronic back pain drop off after age 50 as our bodies are deteriorating? The prescription for chronic pain sufferers often involves pain medication and/or referral to a specialist, the former of which has contributed to the current opioid crisis.
There’s mounting evidence that once tissue or bones are fully healed in the body there’s no longer a physiological explanation for pain, which means that any persistent pain is largely a psychological issue and should be treated as such. Many patients may be insulted to learn that the pain is “in their head.” I’m not suggesting that chronic pain isn’t real — it’s very real and can be debilitating. I know this from experience battling my own issues with chronic pain for more than a year now.
When the pain started I underwent a battery of tests, which didn’t reveal any abnormalities or obvious explanation for my pain. I went from doctor to doctor, each one focusing largely on treatment with pharmaceuticals and physical therapy, but none of these made a dent in the pain level. With no improvement, I went on a self-directed journey of healing focusing on alternative therapists who claimed they could help me. One of these treatment programs included a full week pain clinic in California. Two U.S.-based medical doctors were also patients, struggling with the very same chronic pain issues, despite access to excellent medical care. After spending thousands of dollars of my own money and hundreds of hours of in-office and at-home treatment, my pain was actually getting worse. For many chronic pain sufferers, this journey is all too familiar.
It wasn’t until I started to become educated about the mind-body connection, the brain’s role in persistent pain and cognitive behavioural therapy, that I started to improve.
Physicians will often increase the dosage of pain medication and recommend reduction of normal activities and bedrest for chronic back pain and other similar musculoskeletal conditions. While this treatment plan may have merit for the acute care of patients who have suffered a recent injury, it’s likely to only make matters worse for someone with chronic pain. The gold standard of treatment for chronic pain is actually to continue normal activities and reduce, not increase, dosage and dependence on pharmaceuticals.
Employers looking to reduce incidences and duration of disabilities need to work in tandem with disability managers and insurers to ensure claimants suffering with chronic pain have access to treatment from a psychological perspective.
Thankfully, the benefits community is also reaching this conclusion.
Green Shield Canada has recently partnered with Toronto-based startup ManagingLife Inc. to offer plan members a mobile app that tracks chronic pain, analyzes it and shares the data with their health-care providers. Several providers, including Morneau Shepell Ltd., are now offering internet-based cognitive behavioural therapy, which is one of several types of therapy that can be effective in the treatment of chronic pain. Cognitive behavioural therapy targets negative thinking and emotional responses to pain and depression in order to help form new neurological pathways in the brain and reduce or eliminate the impact of these conditions.
For some chronic pain sufferers, the simple understanding that there’s nothing physically wrong with the body can be the catalyst for a full recovery after years of misery. Just ask radio personality Howard Stern, who rapidly recovered without drugs or surgery from more than 15 years of often unbearable back pain, sometimes so bad that he would lie on the floor of his studio during his radio show.
While I haven’t had a miraculous recovery like Howard Stern, my condition has improved significantly from a year ago. I’m proud to say that I no longer need any prescription medications to manage my pain. I believe most of my healing has been achieved through the resumption of normal activities, cognitive behavioural therapy, mindfulness meditation, regular exercise and sheer perseverance.
For most chronic pain sufferers, recovery can take many months or even years and often requires a multifaceted approach. Just knowing, however, that improvement and recovery is possible can have a significant psychological impact on suffers and can mean the difference between a life of disability, drugs and suffering or a full and pain-free productive employee.