DOVER –– Chronic pain is a condition more than 100 million Americans are living with and September is Pain Awareness Month, a time to spread the word about how pain effects the lives of millions and pain management options available to them.

Chronic pain is defined by the American Chronic Pain Association as, “pain that continues a month or more beyond the usual recovery period for an injury or illness or that goes on for months or years due to a chronic condition.” Chronic pain may not be constant but is severe enough interfere with daily life at all levels.

Dr. Ganesh Balu, of Comprehensive Spine Center in Dover, said that chronic pain can involve almost any part of the body and causes can greatly vary from fractures, accidents, but most likely, untreated injuries.

He said chronic pains can arise from small, treatable injuries that were not treated properly or at all.

“You may have a construction worker with a lower back injury that could be healed with a few days off and some therapy but they are supporting their family and can’t afford to take off or can’t get time off to get therapy,” he said.

Many therapists’ offices are open only 9 to 5 which is when many pain sufferers are at work and treatment could take up to two hours per session, much longer than a lunch break.

So simple injuries can easily turn into chronic pain conditions after continuous aggravation. Dr. Balu said the most common chronic pain injuries he sees are in the lower back.

“It’s unfortunate, but chronic pain disproportionately effects those with a lower socioeconomic status,” Dr. Balu said.

Multidisciplinary treatment

Once pain becomes chronic, patients used to undergo multidisciplinary treatment, which involves multiple doctors all trying to treat the same condition.

“Patients may see a chiropractor, their primary care physician, a pain management doctor and a surgeon, all which may suggest different courses of treatment,” Dr. Balu said.

The courses of action could include realignment, over-the-counter medications, injections or surgery.

“The problem with multidisciplinary treatment is that none of the treatment is happening in real time,” Dr. Balu said. “Patients are getting treatment from different doctors at different times.”

More recently, physicians have been practicing integrated treatment which requires doctors to work together simultaneously to treat patients.

“Multiple doctors and specialists are working together with a common goal in real time,” Dr. Balu said. “It can be complicated sometimes but it produces the best results for the patients and prevents doctors from shuffling through a lot of paperwork.”

Doctors can test treatment options in the office such as injections or physical therapies and patients can describe how the treatment is affecting them and if it seems to be a successful option.

In most circumstances, patients are put on prescription drugs for pain, but Dr. Balu said prescription drugs are only prescribed after all over-the-counter options have been exhausted.

But not all prescription drugs work the same on every individual, even if they have the same pain caused by the same condition. The reason comes down to how each individual’s body digests the medication.

“We now can do genetic testing, which can prevent a patient from being on too high a dose of one drug by determining another drug they can take a low dose of, while effectively treating their pain,” Dr. Balu said.

After pain becomes managed or reduced with the use of medication, many physicians including Dr. Balu suggest alternative or supplemental treatment options to improve patients’ quality of life.

Supplemental treatment options

For the past 18 years, Cheyenne Luzader has been a champion of alternative medicine at Beebe Healthcare’s Department of Integrative Health.

The department which specializes in the integration of conventional medicine and alternative health practices gives patients ways to relieve stress and pain outside the traditional method of prescription drugs.

All patients start off with a consultation with Ms. Luzader, the program coordinator, that can last anywhere between 15 minutes and an hour. In the consultation, the patient’s pain and stress are assessed using the Subjective Units of Discomfort Scale.

Patients share their level of pain and stress, how often and how severely it interferes with daily life in terms of movement, sleep, eating and regular activities.

From the consultation, Ms. Luzader or another nurse in the department will help the patient outline a plan of action to best address their particular needs, and there are many options.

The most popular, but also most expensive therapies for pain are acupuncture, chiropractic and massage therapies.

“Acupuncture is a difficult therapy for most westerners to understand because it focuses on the flow of the life force, chi, and although it may be difficult to understand, many patients find that it improves muscle pain and pain caused by arthritis,” Ms. Luzader said.

Chiropractic therapy helps with nerve problems, usually in the neck and back and massage therapy can alleviate muscle pain. Beebe usually suggests alternative physical therapies to be done about once a week, although the frequency fluctuates based on the patient’s needs.

Although these therapies can be successful for many pain patients, they do come with a cost and both Dr. Balu and Ms. Luzader said income does play a part in the accessibility of alternative therapy. Those with either a low or fixed income will have fewer opportunities to take advantage of existing resources.

Alternative medicine also takes into account the interconnectivity of stress and chronic pain.

“Pain causes shallow breathing and tightened muscles which actually increases pain,” Ms. Luzader said. “Stress does a very similar thing and a lot of times people are stressed because they are in pain, so it creates a continuous pain cycle.”

One of the most common causes of stress in chronic pain patients comes from their inability to conduct daily life as usual due to their pain so activities like yoga, meditation, tai chi and qi gong are good options because they are both mind and body exercises. After a little practice, these exercises can be done outside a structured group setting.

“Our hope is that pain relief will lead to reduced intake of medication, but that’s up to the patient to discuss with their doctor,” Ms. Luzader said. “All the therapies we suggest do not interfere with any medications and we never advise anyone to quit taking their medicine.”

Beebe’s Integrative Health Department may also include counseling or support groups for its pain patients’ plan of action if talking about their condition could also contribute to stress reduction and pain relief.

If you have questions about alternative therapy for pain relief, visit the integrative health page on beebehealthcare.org or call 645-3528.