Cracking down on chronic pain

HANCOCK – Charleen Ahola has been in pain caused by degenerative disc disease and fibromyalgia for 15 years, but she’s recently been getting some relief with physical therapy at Portage Health.

According to a 2011 report from the Institute of Medicine, about 100 million Americans experience chronic pain, which according to the website of the National Institutes of Health, is any pain lasting more than 12 weeks.

Ahola, who is 68 years old, said in 2005, she had spinal fusion to help reduce the pain of degenerative disc disease, which provided only temporary relief.

“It helped for a couple years,” she said. “The pain is actually worse, now.”

Her experience with fibromyalgia has lasted much longer than the degenerative disc disease, Ahola said.

“I’ve had that since I was in my 20s,” she said.

Ahola said she’s been coming to Portage Health Rehab for about four months, and the treatments she’s been getting have helped ease the pain of fibromyalgia.

“My pain has decreased from an eight to a six,” she said. “I’m finding I have more energy.”

When a patient presents with pain to a doctor or therapist, the patient is asked to rate the pain from one to 10.

Ahola’s physical therapist is Mark Kargela, who said doctors and therapists are looking at chronic pain differently than in the past.

“We used to blame pain on tissues,” he said.

Recent research is showing that three months after an injury, tissues are healed, Kargela said. However, during an injury the nervous system floods the damaged area with chemicals, and may continue to do so after the injury has healed, and the pain lingers.

“That nervous system protection stays there,” he said.

Kargela said part of his treatment involves teaching patients exactly what pain is, and that it’s sometimes important to move even though doing so hurts.

“It depends on what the movement is,” he said. “You have to find ways you can work into that movement.”

Kargela said some movement exercises can help to ease the pain of fibromyalgia. It’s also possible to ease the “phantom” pain of amputation with physical therapy.

“It’s brain training,” he said.

Kargela said fear and depression can actually make pain last longer. Focusing on pain can delay relief, also.

Ahola said making psychological adjustments to deal with pain is an important part of healing.

“It’s easier to sit in a chair when you’re in pain than it is to keep moving,” she said.

Dr. Michael Luoma, medical director at Aspirus Keweenaw Hospital in Laurium, said in the United States, about 20 percent of routine office visits and 12 percent of drug prescriptions are for chronic pain. Direct and indirect expenses related to chronic pain amount to $100 billion.

Luoma said there are four characteristics of pain, including neuropathic (nerves), musculoskeletal (muscles, bones, tendons and ligaments), inflammatory, and mechanical, such as tumors or kidney stones.

There are some pains for which a source may not be found, Luoma said. At one time that included fibromyalgia.

“Fifteen years ago that diagnosis didn’t exist,” he said. “There are still a fair number of doctors who don’t really believe in it.”

Luoma said surgery can sometimes ease chronic pain by removing the source, such as a tumor or a pinched nerve. Some surgeries are done to kill a problematic nerve, but that could result in permanent localized numbness. Artificial joints can relieve chronic joint pain.

Drugs are used to relieve pain, but Luoma said that can lead to drug dependency, so they must be used with care. There are non-narcotic drugs, which can be useful for pain relief.

“Especially for fibromyalgia, you want to stay away from the narcotics,” he said. “A lot of fibromyalgia patients also have other issues involved. They tend to have addictive personalities.”

Losing weight and getting regular exercise are helpful in relieving the pain of fibromyalgia, Luoma said.

There are other non-surgical and non-drug treatments helpful in treating chronic pain, Luoma said. Physical therapy is very effective.

Alternative treatments once considered to be on the fringe have been found to be helpful, Luoma said. Massage therapy, reflexology and even acupuncture have been successful in easing pain.

“All of those have been shown to provide some benefit,” he said. “I’ve had some patients get phenomenal success with acupuncture.”

Long lasting pain can lead to some psychological problems, Luoma said.

“Pain affects everything in your life,” he said. “Typically pain triggers depression or depressed feelings. It tends to be completely encompassing.”