Did you know that chronic pain affects more Americans than any other disease³? On top of that, pain is historically under treated. Not only is pain a physical and emotional burden, but a huge financial burden. In 2010 it was estimated that pain related health care costs totaled $560-635 billion¹! What can we do to better manage pain?

Unfortunately, many health care providers receive insufficient pain management training, averaging about 9 hours total. One study even found that only 4 US medical schools have mandatory pain management training.⁵ There is a clear education gap and knowledge is key.

Pain is a complex topic that I will simplify for this post’s sake. Below you will find a broad overview of pain, types of pain, and different non-pharmacologic treatment strategies. Let’s get to it.

What is Pain

“Pain is an unpleasant sensory and emotional experience.”² You may have heard pain is the 5th vital sign. However, pain is subjective, meaning pain is perceived differently. This is not because one person is weak and another is strong. But rather a difference in pain receptor sensitivities. A lot of this is genetic or epigenetic. There is emerging research evaluating pain differences in relation to social status. There will be more to come on this.

When treating pain it is important to first identify the cause and type. Diagnostics may include physical exam, blood work, and/or imaging.

Types of Pain

Acute	Chronic
Inciting event	Underlying condition/improper healing
<3 months	>/= 3 months
Physical factor	Physical + mental and social factors

Nociceptive	Neuropathic
Musculoskeletal (muscles, bones) or visceral organs (i.e. GI)	Nerve related
Achy, dull, throbbing	Tingling, shooting, burning
Localized or diffuse	Follows nerve path or poorly diffuse

Non-Pharmacologic Methods

• Heat Therapy
  • Improve mobility and relieve stiff joints (i.e. arthritis)
  • Alleviate muscle spasms (i.e. neck or back)
• Cold Therapy
  • Helps reduce inflammation
  • Beneficial immediately post injury
• Physical Therapy
  • Maintain and improve range of motion
  • Strengthen muscle groups
• Exercise
  • Prevent injury
  • Improve mobility
  • Reduce stress
• Stretch
  • Prevent injury
  • Improve mobility
  • Reduce stress
• Massage
  • Regular massage may reduce inflammation
  • May prevent injury
• Acupuncture
  • May reduce inflammation
  • Reduce stress
• Diet
  • There are anti-inflammatory diets which have limited evidence
  • A well-balanced diet is key
  • Incorporate anti-inflammatory foods
  • Eliminate/minimize pro-inflammatory foods
  • Check out my post on this topic for more info https://lrxwellness.com/how-to-combat-inflammation-with-diet/
• Meditation
  • Relieve stress
  • Relieve tension
  • Prevent injury
• Cognitive Therapy
  • Pain can be emotional as much as physical
  • Talking about pain, identifying triggers, developing coping skills and routines can all help alleviate pain

In Conclusion

Pain is the most common health condition. It is often under treated or treated inappropriately. There are effective medications based on indication and mechanism of action. But that’s not enough! Many non-pharmacologic methods help improve and prevent pain. Without implementing these treatment strategies, pain management is a slippery slope.

**A proper diagnosis from a health care provider is key in starting appropriate treatment.

As always reach out with questions, comments, or for further discussion.

Lindsey, PharmD, BCPS

References

¹Gaskin DJ, Richard P. The Economic Costs of Pain in the United States. In: Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. Appendix C. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92521/

²NIH. (2024, July 22). Pain | National Institute of Neurological Disorders and stroke. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/pain

³NPAC. (n.d.). Fast facts about pain. National Pain Advocacy Center. https://nationalpain.org/fast-facts-about-pain

⁴Standford Medicine. (2017, September 12). Management of pain without medications. Stanford Health Care. https://stanfordhealthcare.org/medical-conditions/pain/pain/treatments/non-pharmacological-pain-management.html

⁵Stroud C, Posey Norris SM, Bain L, editors. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington (DC): National Academies Press (US); 2019 Apr 12. 6, Education and Training of Health Professionals in Pain Management.

⁶Thomas MA. Pain management – the challenge. Ochsner J. 2003 Spring;5(2):15-21. PMID: 22826679; PMCID: PMC3399329.

⁷U.S. National Library of Medicine. (2023, May 23). “ouch, that hurts!” The science of pain | nih medlineplus magazine. MedlinePlus. https://magazine.medlineplus.gov/article/ouch-that-hurts-the-science-of-pain/