New paradigm of chronic pain treatment

Chronic musculoskeletal pain treatment is ready for a paradigm shift. 

For decades chronic musculoskeletal pain treatment has focused on management of pain symptoms. 

I believe the way we do this has lowered the bar of expectation for patients and doctors so much that we forgot what our initial goal was. The goal is to be pain free and return to living a full life. This means being able to do the job we want, participate in the recreational activities we want, and enjoy our favorite leisure activities all while being pain free. 

Whether we work in construction or landscaping, as a truck diver or police officer, sitting at a computer 10 hours a day, or as a professional athlete, we should be able to enjoy our work pain free. 

We want to be able to enjoy our free time playing recreational sports; running, hiking or biking; gardening; playing golf or poker; or watching movies or playing video games without pain or limitation. 

"Management of pain symptoms" is not turning out to be what we believed it would be. 

Our pain symptoms are being diagnosed as "degenerative disc disease", "stenosis", "osteoarthritis", "osteoporosis", "spondylolisthesis", "spondylosis", "spondylolysis", "thoracic outlet syndrome", "fibromyalgia", "piriformis syndrome", "carpal tunnel syndrome" and "failed back surgery syndrome". 

The problem with our current paradigm of chronic musculoskeletal pain treatment starts with the diagnoses themselves. 

1. Big words are scary. Being told you have a strained muscle is one thing and being told you have degenerative disc disease is another thing!
   
2. Disease is defined by Merriam-Webster as "an illness that affects a person...: a condition that prevents they body or mind from working normally" and "a problem that a person...has and cannot stop" [emphasis added]. Wikipedia points out: "Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one's perspective on life, and one's personality" [emphasis added]. I don't think we want to be doing this to people who have mild low back pain!
   
3. Syndrome is defined by Merriam-Webster as: "a disease or disorder that involves a particular group of signs and symptoms" [emphasis added]. Again we are scaring people into thinking they caught a disease when they simply have some wrist pain. 
   
4. Most of these diagnoses are presented as something that will worsen over time or with age, and maybe even worse, as a normal part of aging! I'm sorry, but none of the above conditions or symptoms are "normal"!!

The problem then is compounded by how we treat chronic musculoskeletal pain.

1. Management implies a long term relationship. Yes, pain that has become chronic has been there for longer than 12 weeks, but that should not imply that it will still be around in another 12 weeks. Treatments often try to decrease the sensation of pain and not eliminate the cause of pain, which implies the pain is here to stay. Ignoring the cause of pain actually encourages more wear and tear which will lead to increased pain and disability in the future. 
2. Treatment of chronic musculoskeletal pain includes: pharmacological drugs, epidural steroid injections, facet joint injections, nerve blocks, spinal cord stimulators, and intrathecal drug delivery system implants. Every single one of these "treatments" is only at best going to help with the pain symptoms and do nothing about the cause of the pain. 
3. Surgery for chronic musculoskeletal pain is another treatment option. Degenerative disc disease has over 15 different surgery options including: facetectomy, foraminotomy, laminectomy, laminotomy, discectomy, corpectomy, intervertebral disc annuloplasty (IDET), percutaneous laser disc-decompression (PLDD), artificial disc replacement (ARD), dynamic stabilization, and spinal fusion. The problem with surgery is the surgery treats the symptoms of disc degeneration, but does nothing about the cause of the disc degeneration.

I think it's time for a paradigm shift in the way we treat chronic musculoskeletal pain. 

It's time to stop treating chronic pain like a disease.
It's time to stop treating chronic pain like a syndrome.
It's time to stop managing chronic pain.
It's time to stop treating chronic pain symptoms.
It's time to stop accepting chronic pain as part of aging.
It's time to stop accepting chronic pain as normal.

It's time to start treating chronic pain for what it is: a message from the body.
It's time to start listening to the body.
It's time to start trusting the body.
It's time to start looking at the body as a whole.
It's time to start treating the underlying causes of chronic pain.
It's time to start believing in the amazing ability of the body to recover and heal.
It's time to start believing that it is our birthright to live a pain free and active life. 

What do we do now? I think a good place to start is by asking more and better questions.

• What does spondylolisthesis mean?
• What caused the vertebrae in my lumbar spine to slide forward?
• What caused the osteoarthritis?
  
• What caused the discs in my back to degenerate?
• Why do I have compression at my superior thoracic outlet?
• What allowed my bones to lose density?
• What caused the mineral deposits by my spinal cord?

These types of questions often lead to learning things like this:

• The human body is dynamic and responding to its environment. Everything is caused by something. Change the environment you live in and your body responds (negatively or positively).
• Bones respond to impact. Lack of impact causes the bones to lose density, increased impact leads to increased bone density. The forces bones feel depends on the postural position they are in. (i.e. a slouched and rounded thoracic spine does not respond to loading forces the same as a vertically aligned spinal column)
• Each vertebra in the spine is supposed to have a certain amount of movement in flexion/extension, lateral flexion, and rotation. If one or more vertebra are limited in range of motion the adjacent vertebra will make up for the lost range of motion. For example, if someone has lost their lumbar curve and have limited movement and flexibility in the upper lumbar spine, this can cause the body to create excessive movement and extension at the lowest lumbar vertebra, L5. This excessive extension pressure can cause L5 to slide forward which would then be diagnosed as spondylolisthesis.
• The spinal column sits on top of and responds to the pelvis and is affected from above my the shoulder blades and shoulder position and function. Lack of pelvic function and movement will cause increased movement and stress in the lumbar and/or thoracic spine leading to wear and tear of the structures including facet joints, intervertebral discs, ligaments, and vertebral bones.
• Since valgus stress increases wear and tear on the medial meniscus, correcting my valgus knee stress will decrease my pain and help eliminate the cause of the wear and tear. 
• The body creates bone spurs or osteophytes for a reason, often to protect against wear and tear stress between two bones. Restoring the joints to their normal postural position is the only way to stop the body from forming more bone spurs and give the body a chance to heal.

What's fun about what I do at Oregon Exercise Therapy is I get to help people who have been suffering with chronic musculoskeletal pain for months or years figure out what questions to ask, how to find the answers to those questions, and how to put together an posture exercise program (Egoscue e-cise menu) that will correct their posture, restore proper joint position, and balance muscular strength and function so they can eliminate their pain for good and return to living a pain free and active life without limitations. By restoring their postural alignment they have addressed the underlying cause of their chronic pain, often eliminating the need for drugs or surgery.

Contact us today to join the OET family and live, play, be...pain free!