Acute Pain Management: A Guide to Complementary Therapies

Complementary Medicine

Acute Pain Management: A Guide to Complementary Therapies

Increasing number of patients do not wish to take any pain medication when they develop acute pain from fear of side effect.  There is an ongoing battle and numerous initiatives to fight the opioid crisis around the world. It is also true that every medication carries a risk of side effects.

 

Complementary medicine such as acupuncture, massage, yoga and meditation has been used to ease the pain and treat acute and chronic injuries long before contemporary medicine became the standard of care. The question arises, should we shy away from conventional pain medication for controlling acute pain and focus primarily on complementary modalities, because they are generally safer and mostly free of side effects?

 

In this post I will try to present unbiased view of  both sides and attempt to come up with the answer that I have found in my practice most successful.

Conventional medicine and acute pain

Conventional pain medication maintains a bad rap in minds of many people. This is especially true for those who are more in tuned with their body and look for complementary medicine as the primary treatment option for their daily maladies.

 

While managing daily aches and pains with stretching, massage, yoga or acupuncture is definitely very reasonable and preferred option, situation slightly changes in case of intense acute pain.

 

It is important to understand that there is a role for pain medication when it comes to severe pain. Getting your pain under control as soon as possible will prevent altering the way your brain deals with pain.

 

Any uncontrolled pain lasting longer than several days can sensitize your brain to pain and lower your pain threshold. This ultimately translates to experiencing pain from similar injury in the future at much lower level than before.

Complementary medicine and acute pain

Complementary medical modalities have been used successfully for management of pain and injuries for hundreds of years. Many of them have been extensively studied and their effectiveness proven in rigorous trials.

 

Despite their popularity, however, their primary role is generally seen in management of chronic conditions. This is largely because their main mechanism of action, by which they help to promote recovery, is through stimulating body’s own healing processes and pain control.

 

In other words, their primary role is to restore the body homeostasis. The subtle changes they produce over time are sufficient to create a noticeable difference when treating chronic pain or injuries.

 

It is, however, usually not enough to promote lasting pain relief in severe acute pain. But that doesn’t mean these modalities cannot be used successfully even in cases of significantly severe pain.

 

There are many practitioners who are quite skillful and capable to accomplish “miraculous” results. This author has treated successfully many patients with significant amount of acute pain in his own private practice with acupuncture and herbal medicine.

 

The problem with using modalities such as acupuncture for treatment of severe acute pain, becomes with the access to these skillful practitioners and the associated cost. In case of acupuncture, it takes years of experience, and additional training in treatment of musculoskeletal injuries to treat patients with severe acute pain, to achieve reliable results.

 

When seeing an acupuncturist for treatment of chronic conditions, weekly sessions are generally sufficient to achieve great results. This is, however, not true in case of significant acute pain.

 

To successfully treat an acute pain, the practitioner will need to see the patient generally up to three times a week for the first two weeks and usually will also prescribe an herbal formula. At the average cost of $70 -$100 per office visit, this can easily add up to $300 - $400 a week x 2.

 

This also does not account for the travel time to and from the office and lost work. Compared to a small co-pay for an office visit with a primary care provider and pain medication if the patient has a medical insurance, this becomes a significant financial burden that majority of patients cannot afford. Just because it is possible, doesn’t therefore mean that it is always feasible and the right thing to do.

Conventional medicine and acute pain

Conventional pain medication works in completely different way. When taking pain medication, the goal is not to restore the body’s homeostasis, or to support the body in its own ability to take care of the pain. The pain medications are designed for one and only purpose. To suppress the pain as fast as possible and as much as possible.

 

There are many different classes of pain medication and they all work in slightly different way. Some of them can be purchased over the counter to suppress mild to moderate pain, but for the severe pain, it is usually necessary to see a medical provider who can write a prescription.

 

While opioid medications are the most powerful tools that we have in our pain arsenal, there are other options which are not classified as opioids, and which your provider can prescribe to control your acute pain.

 

It should be therefore clear, that prescribing pain medication for severe pain, does not necessarily equal prescription for opioids, if that is something that the patient does not feel comfortable with. It is however noteworthy, that taking seven to ten day course of opioid medication is usually sufficient to get even the most severe pain under better control. Different class of pain medication can be prescribed after the initial seven to ten day course of opioid medication, to provide sufficient pain relief.

 

This short course of opioid pain medication is rarely causing any more side effects then some drowsiness and sleepiness. Most individuals with acute severe pain prefer to take this medication only at night when pain becomes more intense, because all the daily distractions are taken away by the silent night.

 

Opioid pain medication is therefore particularly helpful to take before sleep to ease the severe pain and allow for better sleep. To keep the dose of the strong opioid medication as low as possible, the provider usually prescribes one or two other pain medication that work through different mechanism and add to the total pain relieving effect.

Eclectic Approach

An eclectic approach to pain management is in this author’s opinion the best. In the eclectic approach, the patient uses combination of several modalities which complement each other to achieve the best result.

 

Combining one or several complementary modalities such as acupuncture, acupressure, massage, yoga, breathing exercises and meditation along with pain medication, will have much greater effectiveness than using any of them as a standalone modality.

 

This combined approach takes the best from both worlds so to speak. The complementary medical modalities slowly work on helping the body recover faster, while pain medication helps to control the acute pain and allows the patient to focus on the recovery process.

 

Getting sufficient amount of sleep, staying physically active and following an anti-inflammatory diet will further maximize the healing. For more details on how to optimize your recovery process follow this link.

 

To learn more about complementary therapies, visit National Center for Complementary and Integrative Health

by Dr. Michal Domeny DNP, L.Ac, CD/N

Trigger Points: The Shocking Culprits Behind Your Pain

Complementary Medicine

What are Trigger Points ?

In the mid-1960s doctor Travel introduced the term myofascial pain.  Over the years, many publications and clinical experience have shown that nearly 80% of local muscular pain can be attributed to myofascial pain. The term myofascial pain has been associated with muscle tenderness that arises from hyperirritable areas in the muscles called trigger points. Muscular pain caused by trigger points has been known to mimic symptoms of a very long list of common maladies. Pain resembling sciatica, herniated discs, joint problems, kidney stones, and even headaches can be caused by the presence of trigger points in the associated muscle groups. Dismissing the concept of trigger points when evaluating common daily pains and aches, can result in incorrect diagnosis and failure to formulate an effective treatment plan to resolve the painful condition.

Back Pain and Trigger PointsWhich Muscles Are Involved?Treatment optionsOptimize Your Recivery

What is a Trigger Point?

A trigger point is usually defined in textbooks as a painful point that can be felt as a hard nodule in the muscle. Clinically, however, a trigger point is more of an area of the muscle, not necessarily a precise point. There may be a palpable nodule, but that is not always the case. A better definition of a trigger point is an area of muscle that feels tight and ropy and usually is tender on palpation. Not every tender area within a muscle, however, is a trigger point. Several other characteristics have to be present for a tender area of the muscle to meet the criteria for the definition of a trigger point. Trigger points are therefore usually defined as areas that are tender on palpation, but also display twitch response when strumming the tight muscle band in a perpendicular direction.  Compression of the trigger point also needs to reproduce the patient’s familiar pain. In some cases, when pressure is applied to the trigger point, the pain can be felt in a distant area of the body. This phenomenon is known as referred pain. The typical example of referred pain secondary to trigger points is pain at the base of the spine or the buttock, caused by trigger points in the mid-back muscles, at the area of the lowest ribs. A new definition of trigger points, however, suggests that referral of the pain to the distal area of the body does not need to be present in order to make the diagnosis of a trigger point.

Formation of Trigger Points

When a muscle or a group of muscles is subject to repetitive overuse or sudden strain, a contraction will form in a small number of muscle fibers within the affected muscle. We refer to these small contractions as trigger points. The presence of trigger points in the muscle, shortens the length of the muscle, much like making series of knots on a piece of a string. The more knots on the string, the shorter and tighter the string becomes. This analogy can be applied to muscles that become tight due to the presence of trigger points. The shorter the muscle becomes, the more distinct ropy feeling can be appreciated when strumming perpendicularly across the affected muscle.  When a muscle becomes shorter because of the trigger points, it will start to generate greater pull on the tendons and ligaments that attach the muscle to the joints and other structures. In the case of the knee joint for example, if trigger points are present in the quad muscles, they will shorten the quad muscles. The quad muscles attach below the knee through a tendon that runs over the kneecap (patella). The shortness in the quad muscles will therefore cause the kneecap (patella) to be compressed over the underlying cartilage whenever the knee is flexed. Greater friction between the patella and the underlying cartilage will over time result in faster loss of the underlying cartilage or formation of inflammation. This condition is called a chondromalacia patella and is experienced by the individual as a deep achy pain underneath the kneecap.

What causes trigger points?

In general, trigger points tend to form in the muscle that is subject to a higher load than the muscle can tolerate. There are a variety of factors that have been noted as potential causes for the development of trigger points. The most significant of these include acute or chronic muscle overload due to poor posture or over-exercising. Direct trauma to the muscle, as well as trauma due to a car accident which leads to a whiplash, are another common cause for developing trigger points. Additionally, psychological distress, homeostatic imbalances, and certain lifestyle habits such as smoking, have been identified as important contributors to the formation of trigger points. When an area of muscle is constantly overloaded, the resulting muscle tightness in that area will compress the surrounding blood vessels. This leads to poor local blood circulation with subsequent accumulation of various metabolic by-products and chemicals which sensitize the surrounding nerve endings. The impaired metabolism and blood circulation in the muscle further impair the muscle’s ability to fully relax. Eventually, the muscle develops sustained contraction leading to the development of palpable tight and ropy areas of the muscle defined as trigger points.

Consequences of Trigger points

There are many implications of having trigger points in the skeletal muscles. The most well-known include pain, stiffness, and decreased range of motion of the affected muscles. Decreased athletic performance and pain radiation to other parts of the body are two less known facts about trigger points. Understanding how trigger points affect athletic performance is particularly important for anybody interested in maximizing the benefits of their workout routines. Many top athletes pay large sums of money to experts in myofascial release to keep their muscles free from trigger points.

 

Decreased athletic performance   

When muscles develop trigger points, their overall capacity to do their job is impaired.  Physiologically, the basic function of the muscle is to expand and contract. The presence of the trigger points causes the muscle to assume a constant shortened and contracted state, hindering the muscle’s ability to fully flex and contract. This will manifest as overall muscle weakness, decreased range of motion, feeling of stiffness, earlier fatigue, and intolerance to high-intensity workload. Muscles that have trigger points also recover much slower. The combination of all these factors interferes with athletic performance and leads to suboptimal results despite adequate training and preparation.

Pain radiation to other parts of the body

The characteristic feature of trigger points is their ability to refer pain to distal areas of the body, which makes the correct diagnosis of the true origin of the pain challenge.  Detailed pain referral pathways have been described for individual muscles and their trigger points. These referral pathways sometimes overlap, therefore a detailed search of all muscles which can refer pain to a particular area, should be conducted, to identify all the sources of the pain. An example of referred pain to the same area from a different muscle is a pain in a pinky and along the inner aspect of the hand. This referral pattern is typical for trigger points in the Latissimus dorsi. In some cases, however, the pain in the pinky and along the inner aspect of the hand can result also from the presence of trigger points in the Infraspinatus muscle.

 

Several non invasive treatment options are available to address and treat trigger points. Some of the most popular include acupuncture, dry needling and acupressure modalities. Follow these links to learn more about each one of the them.

 

To learn more about complementary therapies. Visit National Center for Complementary and Integrative Health

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by Dr. Michal Domeny DNP, L.Ac, CD/N