2 minute read
Chronic Pain Management
Chronic Pain Management
By Dr. Asha Bajaj, Resident Since 1986
www.BlackhawkLivingCA.com
Pain serves a very important function in the body protecting us from potential harm and acting as an alarm to impending danger. However sometimes the pain continues to persist, even when the offending stimulus is removed and there is no active disease process. This is often the result of incomplete treatment after an acute injury such as an auto accident causing neck whiplash and/ or back problems.
“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage” as described by the International Association of Pain management.
Early theories suggested pain was caused “by evil spirits,” but once neurons were discovered a theory called the Gate control theory of pain was proposed in the early 1960’s by Melzack and Wall. They suggested that there was a gating mechanism that either allowed the perception of pain or blocked it depending on which nerve fibers carried the message. Later in 1968 Ronald Melzack and Kenneth Casey described pain in terms of its three dimensions: “sensorydiscriminative” (sense of the intensity, location, quality and duration of the pain), “affective-motivational” (unpleasantness and urge to escape the unpleasantness), and “cognitive-evaluative” (cognitions such as appraisal, cultural values, distraction and hypnotic suggestion). They theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus, but “higher” cognitive activities can influence perceived intensity and unpleasantness. “Pain can be treated not only by trying to cut down the sensory input by anesthetic block, surgical intervention and the like, but also by influencing the motivational-affective and cognitive factors as well.”
There are many treatment approaches to chronic pain. These approaches include passive and active therapies, medications, behavioral-psychological treatments, and a host of other modalities, devices, and interventional techniques including surgery and other procedures. Medications, passive treatments, and invasive interventions alone are not always satisfactory without the additional use of other active rehabilitation and educational approaches that treat the whole person with chronic pain.
In fact, rehabilitation through cognitive, behavioral, and physical reactivation treatments (also called functional restoration) often lessens the need for medications and other more invasive procedures. With our current opioid crisis more people are turning to physical therapy, behavior modification and biofeedback to increase their repertoire of pain management tools. Exercise is the best opioid available to us, but the type and intensity of exercise needs to be prescribed by a trained physical therapist.
Please go to apta.org to learn more about pain management and getting your life back in control via non-invasive techniques, and avoid all the complications of relying solely on pain medication. Try and balance medications with other therapies to get the maximum pain relief and better functional ability.
Dr. Asha Bajaj, PT/ DPT has 30+years experience in a variety of settings including the management and operation of an outpatient private practice in Walnut Creek. Asha has served in Bhutan, India, Vietnam and Malawi Africa with Health Volunteers Overseas to train and develop their Physical therapy program. Asha has a special interest in Women’s health and did her doctoral project in the area of Bone health and Osteoporosis. Her goal is to promote health and lifelong wellness.
