No Pain No Gain

Pain is more complicated than you probably realise. The good news: That means there are more ways to treat it.

According to research published in the journal Pain earlier this year, more than a quarter of the world’s population is suffering from chronic pain. That’s more than two billion people, struggling through life;
however, the solution is not as simple as popping a pill.

You’d think that something as primal and ubiquitous as pain would have a straightforward, simple explanation. That is not the case. In fact, the current definition of pain was only published by the International Association for the Study of Pain (IASP) in 2020. It defines pain as, “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. It then goes on to explain that how we perceive pain is entirely personal, and influenced by biological, psychological and social factors. And that “through their life experiences, individuals learn the concept of pain”.
There are also different types of pain. “Acute pain is pain that’s been present for a few days to about six weeks; when the pain’s been present from six weeks to about four months, it’s in the sub-acute category and anything longer than three to four months it becomes chronic,” explains Dr Nadah Karriem, who works at The Pain Collective, a facility that specialises in the treatment of chronic pain.
Acute and sub-acute pain is generally linked to an obvious tissue injury. “With chronic pain, most times the tissue injury has already improved, but the pain signalling pathway is still signalling pain even without a tissue injury.” Functioning correctly, pain is the body’s warning system that there’s a threat to its well being. When pain becomes chronic, the warning system is malfunctioning – like a house alarm that keeps going off when no one is trying to break in.

Felicia Rubin, pharmacist and integrative health practitioner, practices functional medicine and believes in homing in on the underlying cause. “I do not treat symptoms – I treat the cause,” she says. “Because if you just treat with painkillers, you might be masking the diagnosis. You need to understand what sort of pain you’re treating.”
Rubin typically looks at three things when she works with patients – inflammation, diet and lifestyle. “Pain is caused by inflammation,” she says. So by treating the inflammation, you eliminate the symptom, which is the pain. She says following a healthy diet can go a long way towards fighting inflammation. While that will look different for everyone, she finds many people respond well to eliminating sugar, heavily processed foods, gluten and sometimes dairy.
“Lifestyle is important because sometimes pain is triggered by stress,” says Rubin. While pain may leave you tempted to curl up in bed all day, she says that’s the worst thing you can do. Instead, she recommends practising mindfulness, yoga,Pilates or going for walks in nature.

Naturopath Felicia Rubin’s supplement recipe for fighting inflammation:
Omega 3 + Curcumin with Boswellia + Magnesium

Other Alternative Pain Treatments
TENS machine: A mild electric current is applied to the area through electrode pads attached to the skin, reducing pain signals to the brain and stimulating endorphins, the body’s natural painkillers.
Acupuncture: Thin needles are inserted at different “acupoints” on the body, stimulating nerves and relieving pain. Despite the use of needles, it usually doesn’t hurt.
Chiropractic: Body manipulation and mobilisation adjust your alignment, taking pressure off nerves and relieving pain.

Dr Karriem’s first step is also to treat the underlying cause. “With acute pain, you treat the underlying issue – whether it’s a cut on your hand or an infection – and once the tissue has healed, the pain will subside.”
With chronic pain, things become more complex. Dr Karriem and her colleagues work as part of an interdisciplinary team and adopt a bio psycho social approach to treating chronic pain. “You look at the person as a whole – what are the chronic conditions influencing the pain? You take into account his/her age and the context from which he/she comes. In that way, you can use a combination of medication, therapy, and pain procedures to desensitise the system and treat the pain.”
Again, lifestyle plays an important role. An occupational therapist will consult on factors such as stress management, sleep hygiene and ergonomics. There is also a dietician on the team, who helps patients follow an anti-inflammatory, Mediterranean-style diet. “There’s been a lot of research recently about the effect of the foods that we eat and how they can increase inflammation in the body,” says Dr Karriem. Again, movement is encouraged – in the form of yoga, Pilates and daily walks.
If these interventions don’t work, a patient may be a candidate for the next tier of treatment – a pain-blocking procedure. “We do pulsed radio frequency rhizotomies – using electrical stimulation to block the pain signalling pathways in the body.” Essentially, it involves stimulating the nerves with electricity that send pain signals from the tissue to the brain, confusing them and disrupting the signals, she explains. This reduces the intensity of the pain, allowing the patient to function. It takes around six to ten weeks to take effect and typically lasts 12-18 months. It can be repeated. In addition, they also do pharmacological blocks – using
medication to block the pain pathways.
Here the effect is immediate, but it wears off after about a week. There’s no surgery involved in these procedures, but there are needles, so they’re usually performed under sedation in a day theatre facility. “With these procedures, we’re not treating the underlying problem, we’re treating pain,” says Dr Karriem.
The important thing to remember is that pain is complex and if one treatment hasn’t worked for you, that
doesn’t necessarily mean you’re out of options.

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