Pain is no longer an epidemic that only supplements a medical condition. Pain has become a beast of its own. Crossing social and cultural lines, it has burdened individuals and societies on a large scale. Pain not only has the potential to destroy the quality of life but also has significant direct and indirect economic impacts. National Pain Awareness Month is an effort to spread knowledge of pain and pain management amongst both patients and healthcare providers in hopes to tackle this issue from all angles.

According to The National Awareness Campaign, founded by The National Pain Foundation and the American Academy of Pain Medicine, more than 75 million Americans suffer from chronic debilitating pain and chronic pain accounts for more than 80 percent of all physician visits.

“Although much has been learned, pain is a very complex issue that is a completely personal experience,” says Joseph A. Kleinkort, PT, MA, PhD, CIE. “And since it is both psychological and physical, it is very difficult to objectively access.” Kleinkort is president of the Pain Management Special Interest Group within APTA's Orthopedic section and also a diplomate of the American Academy of Pain Management.

Recent studies released by the International Association for the Study of Pain (IASP) and European Federation of IASP Chapters (EFIC) show that one in five people suffer from moderate to severe chronic pain. Not only is quality of life affected, but there are significant economic costs resulting from healthcare, medication, job absenteeism, loss of income, worker compensation, etc. The IASP and EFIC report also indicates that two-thirds of sufferers were less able or unable to work outside of the home, one in four had changed job or job responsibilities due to their pain and one in five lost their job.

Pain

So what exactly is pain? According to the IASP, pain is “an unpleasant sensory or emotional experience associated with actual or potential tissue damage and described in terms of such damage.” Pain experts have divided the physical causes of pain into two types: nociceptive and neuropathic pain.

Nociceptive pain (bone fractures, burns, bumps, bruises, inflammation, etc.) is caused when the nerves (nociceptors) respond to damaged parts of the body. They signal tissue irritation, impending injury, or actual injury. When activated, they transmit pain signals to the brain.

Neuropathic pain (nerve trauma, components of cancer pain, phantom limb pain, carpal tunnel syndrome, etc.) is caused by damage to, or pathological changes in the peripheral or central nervous systems. The pain may persist for months or years beyond the apparent healing of any damaged tissues.

Helping Patients Manage Pain

The type and severity of the pain determines treatment. This includes prescription and non-prescription drug treatment (Aleve, Motrin or Morphine, Codeine, etc.), nerve blocks, electrical stimulation, surgery, acupuncture, biofeedback, etc. Beyond treatment, healthcare providers are in a critical and influential position to aid individuals in their battle against this “invisible disease.”

Empathizing With Patients
“First and foremost, healthcare providers need to believe the person,” says Mary Pat Aardrup, Executive Director of the National Pain Foundation. “Pain is subjective, so it is what the person says it is.” Many times no obvious physiological explanation can be established, at least not right away. The last thing a patient needs to sense is skepticism from the person they sought help from.

According to the National Pain Foundation, 42 percent of people who visit their doctor for pain feel misunderstood. “They feel abandoned by healthcare providers, friends and even family members and isolated,” says Aardrup.

Aardrup recommends that healthcare providers acknowledge and validate that the patient’s pain is real and deserves their attention. “You can emphasize that they are not alone,” says Aardrup. “You can emphasize that your work together is a partnership requiring commitment on the part of both the healthcare provider and the patient.”

Listen and Pay Attention to Mental Health
Pain takes a toll on a person's emotional health. The stress of constant pain can lead to depression, which only fuels the pain. "Pain and depression are linked in complex ways and people in pain need to address their mental health in addition to their physical health," says Aardrup.

Kleinkort stresses the need for the physical therapist to listen to the person’s complaints and assess both physically and emotionally how the person is taking the process. “With these well-honed listening and understanding skills as well as educational skills,” he says, “the therapist is often able to be the prime person to walk a patient through a complicated pain experience with both understand and action to ameliorate the pain.”

Kleinkort feels that if the therapist listens close enough, patients may confide in the therapist deep seated reasons that may modulate the pain sensation.

Education and Knowledge
Aardrup suggests healthcare providers should encourage patients to educate themselves and become aware of available treatment options. “Empowering themselves through education will help them, with their healthcare provider, determine which options are best for them,” says Aardrup. Finding the right treatment and an understanding and knowledgeable pain specialist is crucial for improving wellness. Health providers should offer useful sources with the latest research, treatments and pain management advice.
 
Offer Self Management Techniques
Self management techniques may give back some of the control patients have lost to pain. "Self-management techniques can help patients stop feeling out of control or anxious and can improve physical functioning," says Aardrup. They may also help patients get through a flare-up that occurs when no healthcare providers are present.

Some self-management techniques Aardrup suggests include biofeedback, meditation, exercise, stretching, avoiding isolation, identifying stressors and avoiding them when possible, guided imagery and more. Different techniques work better for different people, so patients should be encouraged to explore their options.


Future Research

Like most things, there is no magic pill that can cure all pain. However, “one of the new bright areas of research in physical therapy is the use of low level laser therapy to significantly modulate the inflammatory process of pain and heal tissue,” says Kleinkort.

Low-level laser therapy (LLLT), also referred to as cold laser therapy, low-power laser therapy (LPLT) and low-energy last therapy pertains to a wide variety of procedures involving several laser types and treatment methods. It is the use of red-beam or near-infrared lasers with wavelengths between 600-1000nm and a fraction of the wattage that a laser in surgery uses.

Due to the low absorption by human skin, it is hypothesized that the laser light can penetrate deeply into tissues creating a photobiostimulation effect. It inserts bio-photons, which may help the division of neighboring cells, to generate new tissue and bring about healing. Continuing research is underway with low level lasers and other treatment procedures.

Pain is an underestimated healthcare problem that impacts – directly or indirectly –everyone. There are many efforts to create awareness of this issue. September is National Pain Awareness Month, October 17th is International Pain Awareness Day and in February, The National Pain Foundation conducts an awareness program in conjunction with the annual meeting of American Academy of Pain Medicine. For more information on upcoming events, visit www.NationalPainFoundation.com.

Janine Kusza is a New Jersey-based freelancer.