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Alina Freiberger

Prof. Loudermilk

English Composition II

April 21,2021

Managing Chronic Pain

One of the best ways the human body protects itself is using pain. The body uses pain as

a warning system, this system alerts the brain that something is wrong and immediate action

needs to take place. Whether that action is to take pain medication to relieve a headache or to

quickly move from the hot stove that was touched. Pain makes it so that the body won’t get hurt

or die. Pain can usually be categorized into two types, acute and chronic. Acute pain is the pain

felt right after stubbing a toe or falling down on the sidewalk and will last a few hours or maybe

a few days if the fall was hard enough. Chronic pain is consistent pain for twelve weeks or more.

Chronic pain can develop from an injury that never heals right or an accident that causes nerve

damage. It can also come from illnesses such as Arthritis, Fibromyalgia, Lyme disease, or

Shingles. Unlike acute pain, which can be fixed with rest or simple over the counter remedies,

chronic pain usually doesn’t have a cure and takes constant treatment using medications or other

methods to lower the pain to a manageable level. Prescription medications such as opioids,

whilst they can be helpful with taking away the pain, they are highly addictive and can be

harmful to those with chronic pain. Instead of using opioids, there are several other options to

manage chronic pain than with prescription medications such as opioids.

To understand the advocacy of using natural pain management tools, one must

understand the history of pain management/medication. For as long as the human race has
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existed, pain has always followed. Treating pain has always been one of greatest mysteries

throughout history.

Collier (2018) states doctors in the early 1600’s would give opium to patients to soothe

pain, by the 1800’s doctors had developed ether and chloroform to let patients fall asleep in

surgery, and in the 1900’s morphine and heroin became used as pain medications (p.E26). By the

1900’s doctors didn’t take into consideration people who suffer from chronic pain. Doctors

treated all pain as if it was acute pain, so when people who would come in with “chronic pain

they were often regarded as deluded or condemned as malingers or drug abusers” (Collier E26 ).

By the 1960’s and 1970’s real science started to go into pain studies particularly into opioid

medication.

By the 1980’s scientist began saying that opioids had a very low-to no chance of

becoming addictive. They were easy to prescribe and they helped treat pain with little to no other

side effects. Doctors began prescribing anyone with pain an opioid to help relieve it. This

massive over prescription of opioids from doctors is what started the opioid epidemic. Once

people have realized how addictive opioids can be, they began looking for alternatives to pain

management that doesn’t lead to addiction. After a long time of research, scientists and doctors

have found several different alternatives to pain management.

One of the healthiest ways to manage pain is with exercise. When most people think of

exercise they usually think of the activity that causes soreness and exhaustion. While that is

correct, for patients with chronic pain exercise is extremely beneficial. Exercise allows people to

strengthen both their pain tolerance and helps when it comes to preparing your body for a future

injury. These are both really beneficial to those with chronic pain, having a higher pain tolerance
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makes it easier to live with chronic pain. It also allows them to be able to sustain a future injury

without too much pain, have better posture, and to not go into a pain cycle from inactivity.

Fig. 1 shows the cycle of pain in people with chronic pain when exercise is not implemented into

daily activity.(The Betty Irene School of Nursing).

A study done in 2015 took a group of 30 people split into two groups. These groups were

determined by how long they have suffered with chronic pain. “Group-A patients complain about

pain duration for more than twelve months and Group B complains about pain duration from

three to twelve months” (Kumar 699). This separation was intentional to see which group got

better faster. The scientists on this team believed that the group with the “short duration group

would improve faster than the long duration” (Kumar 700). The scientists set up an agenda of

workouts that both groups would perform three times a week for six weeks. These exercises

would include “Ten minute warm-up by bicycle or normal walk, flexibility exercises included
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knee to chest in supine, cat camel, trunk side flexion in standing, trunk rotation in crook lying”

(Kumar 701). These exercises over the course of 6 weeks improved the patients pain regardless

of how long they have had their pain for.

Another study that used exercise as a treatment for chronic pain done in 2019 took one

hundred and fourteen patients with chronic pain. In this experiment they did different exercises

that would also strengthen core muscles, they did the experiment for “twelve weeks, three times

a week” (Jiyoon 4). Jiuoon explains that these exercises included rolling, folding knees and

raising legs while face down, bending knees to 90° bringing toes to the floor, then lifting them

(p.5). After the experiment was over the results showed that over the course of twelve weeks, the

pain of the patients had dropped significantly.

What both of these studies demonstrate is exercise helps extremely well with lessening

the pain for people with chronic pain issues. Exercising often allows the body to stop being in a

cycle of pain from sitting down all day and doing nothing. It allows the body to grow strength

and tolerance to pain to help ease the daily amount and prevent future injury from making it

worse. Exercise is a really good tool for pain management, it is exciting and there are so many

ways to customize it to personal needs. Another tool used in pain management that can be

customized to personal needs is music.

One of the more fun ways to reduce chronic pain is with music. Music has always been

beneficial to people. There is a long list of things that music has helped with, such as studying,

relaxation, emotional trauma, plant growth, several medical conditions, and help with relieving

pain in some situations.

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Music has been known to be a “moderately effective pain reliever”(Painter) So far there

is no explanation as to why music helps with pain. One theory is that it is a really good

distraction from the pain, another is that it releases positive chemicals in the brain that help

reduce pain. Regardless of reason, music helps people feel better emotionally and physically.

Painter (2008) writes in her newspaper article that a study was done where sixty people with

chronic pain not caused by cancer listened to music for one hour and reported significantly less

pain and depression and an increased sense of control (p. 04D). While music isn’t a permanent

solution, it is better than none.

Another study done in 2017 showed the effects of music on female patients with

fibromyalgia; an illness that involves widespread pain and soreness. All of the patients part of

this experiment were first evaluated at “Juntendo University…[and] no patients had any other

critical medical illness”(Usui 1547). Once the patients were evaluated and showed no sign of

other medical illnesses the experiment began with having all patients sit in a quiet room while

they listened to classical music for seventeen minutes. The patients were asked to rate their pain

on a nominal scale before and after listening to music. The results showed “pain scores were

significantly reduced after listening to music. Further, we observed there was a significant

difference in connectivity between the right insular cortex (IC) and posterior cingulate cortex

(PCC)/ precuneus (PCu) before and after listening to music”(Usui 1548). This study showed that

music temporarily helped the symptoms of fibromyalgia and an overall feeling of pain relief.

Music is really relaxing and helps with a lot of issues. Regardless of how it works, music will

always be very helpful, fun, and relaxing when treating patients with different types of illnesses

and allow those to have fun while taking the medicine of melodies.
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While music is a relaxing and fun form of pain management, an even more relaxing form

of pain management is acupuncture and yoga. Acupuncture is a form of alternative medicine and

is a big part of traditional Chinese medicine. In an acupuncture session, tiny needles are stuck

into points on the body that help the flow of energy or Chi through the body (Mayo Clinic). It is

believed that opening these pathways during an acupuncture session is to help with pain relief

and stress management. Yoga is also another technique that helps relieve stress and pain. Yoga is

a spiritual discipline which focuses on bringing harmony to the mind and body. The point of

yoga is “Self-realization, to overcome all kinds of sufferings leading to the state of

liberation”(Basavaraddi). Some of the benefits of yoga is overall improvement in physical and

mental health. Both of these spiritual medicines have been shown to help improve the daily lives

in people living with chronic pain.

A study done in 2017 on the effects of acupuncture on patients suffering from chronic

pain. The study took forty five patients suffering with chronic pain and offered them “4. 7, or 10

sessions of acupuncture”(Liu 1592). All forty five patients were recruited successfully and after a

few weeks of acupuncture treatment the patients came back with “ Over 90% of participants

indicated that they were “very satisfied” and/or “extremely satisfied” with the acupuncture

treatment.”(Liu 1592). Whilst it wasn’t a permanent solution for the pain. The participants felt

much better afterward and enjoyed their time getting the acupuncture treatment.

In 2020 there was a study done with older women suffering with chronic pain to see if

doing yoga would help relieve chronic pain. Thirty-eight patients were taken in to participate in a

yoga program. This program was a class “held twice weekly for 1 hour a day and led by a

certified yoga instructor”(Seguin-Fowler 1). These sessions were done for twelve weeks and

participants were given materials so they could participate in extra at home yoga. As the sessions
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went on participation kept at a very high rate. Seguin-Fowler(2020) states By the end of the

experiment all participants would suggest these sessions to others along with a reduction in pain

on a daily basis and it improved their social interactions.(p.1). Yoga is an extremely calming

practice that helps with not only physical health but mental health as well. Yoga and acupuncture

are calming, relaxing spiritual elements that add to the help of managing chronic pain.

One final type of pain management is the use of physical therapy. Physical therapy is a

well known treatment for pain. When most people think of physical therapy they think of

someone who was in an accident and is trying to regain function of a lost limb again. However,

there are several different types of physical therapy such as manual physical therapy, massage

therapy, the use of cold and heat, and ultrasound treatment. All aspects of physical therapy are

great tools for helping with chronic pain.

Manual physical therapy is one of the ways to help patients with chronic pain. Manual

physical therapy takes a hands on approach instead of using machines or devices (Daul). This

involves the physical therapist to put pressure on the muscle, tissue, or joint that is causing pain

and adjusting it in an attempt to lower the pain in that area. There are a lot of factors that play

into the work of manual physical therapy such as “patient education is an important component

of a manual physical therapy interaction and the manner and content of education, specifically

related to pain, can greatly influence treatment effectiveness”(Coronado 116). It is also just part

of the total intervention which can take several sessions to show any sort of improvement. While

it isn’t the perfect form of physical therapy, if the patient is willing to put time and effort into it

there are great results that lead to less constant pain.

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Another part of physical therapy is message and the use of heat or ice. A message is

always relaxing and helps with the aches and pains that everyone has. Messages for chronic pain

patients are extremely helpful due to the fact that they “improve muscular blood flow and relieve

tightness”(Sears). It relaxes the constantly tight muscles that can cause a lot of pain within the

body of someone with chronic pain. Heat and ice while only temporary measures can also help

alleviate some of that pain as well. Both of them help “ decrease pain and inflammation”(Sears)

and while they aren't a permanent solution for chronic pain, they are used to help treatments go

along with less pain during a physical therapy session and can help in the cases where the pain

becomes severe in one particular place.

One final physical therapy that helps with the managing of chronic pain is the use of

focused ultrasound treatments. When most people think of ultrasound they think of the machine

used to see the inside of a person without cutting into them, this technique is usually used for

expecting mothers to see their baby. The way that ultrasound waves can help see inside a person

is being tried to help with chronic pain patients. “Focused ultrasound (FUS) is an emerging

technology that has great potential to be added to the set of medical devices used in the treatment

of chronic pain” (Todd 238 ). Ultrasound is non-invasive and has three great functions, “(1)

thermal ablation of tissue; (2) transient disruption of the blood-brain barrier; or (3)

excitation/inhibition of neuronal activity” (Todd 238). These functions can help with non

invasive neurosurgical procedures and trials have begun with drug delivery though the disrupted

blood-brain barriers. While focused ultrasound technology is still in testing phases and research

is still being done with it, it can be an extremely helpful tool as a non addictive and non-invasive

way to help treating patients living with chronic pain.

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In today's world there are several people advocating for more research on natural ways

for pain management to avoid the usage of addictive prescription medications, however there are

people who advocate for prescription drugs such as opioids. To understand why opioids seem

like the better option, one must underrate why opioids work and how they work in the brain.

Opioids can be made in two different ways. They can be made naturally from the opium

poppy plant or they can be made in a lab using the same chemical structure from the poppy plant.

There are several types of opioids that are made. Some of the most common ones that get

prescribed by a doctor are “hydrocodone (Vicodin), oxycodone (OxyContin and Percocet),

oxymorphone (Opana), morphine (Kadian and Avinza), codeine, and fentanyl” (NIDA). Opioids

are used mostly to treat moderate to severe pain. The way they work is they attach to active

opioid receptors in the brain, spine, and organs where pain or pleasure is usually felt. From there

they block signals from the brain to the body and flood the body with dopamine. (NIDA)

Dopamine is a chemical that our body naturally produces. It is created in the brain and travels

throughout the nervous system sending messages throughout the body. It is an important part of

how people feel pleasure along with how people think and plan. This rush of dopamine from

opioids blocks out the pain and replaces it with feelings of pleasure making people feel very

relaxed and feel ‘high’. (NIDA).

One of the good things about opioids is how quickly it takes away pain. There is a reason

that doctors in hospitals use opioids and other strong medications and it's because they are really

good at blocking out pain and bringing in the pleasure from the dopamine rush. This effect is

really great for anyone who has been in an accident that caused lots of injury or for someone who

just got out of surgery. It is a good solution for moderate to severe acute pain. However when it

comes to chronic pain, these kinds of medications can lead to big problems.
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The relaxed and ‘high’ feeling from taking opioids is extremely addictive. The want to

gain this high again can be immense. “Prescription opioids and heroin are chemically similar and

can produce a similar high” (NIDA). Misusing opioids can quickly lead to the use of heroin due

to the fact that it can be cheaper than obtaining a prescription. When a person with chronic pain

is given a prescription for opioids it does the same pain blocking and rush of dopamine as it

would to a patient getting the prescription for acute pain. While both people suffering from acute

pain and people suffering from chronic pain can become addicted to prescription opioids, there is

a higher chance of becoming addicted to the drugs for people suffering with chronic pain. When

people with acute pain take the drug, it helps them through the pain as they are healing from

surgery or an injury. By the time they are out of the prescription, the healing process is done and

there is no longer pain and no longer a need to continue taking the medication. When it comes to

people with chronic pain, opioids help the pain stop as it would with acute pain. The only

difference is that people with chronic pain will still be in pain when the medicine wears off and

the prescription runs out. Wanting to not be in pain is also addictive and just like wanting to feel

pleasure from opioids making it easier for people suffering with chronic pain to become addicted

to opioid medication.

Another positive that opioids have is there is a one hundred percent chance that they will

take the pain away. Opioids have been used to treat pain since the 1600’s and there is a good

reason for that. They are effective. They block pain and replace it with pleasure, and it works for

all types of injuries. In the past opioids were really easy to prescribe and “ in 2014 and 2015,

opioid manufacturers paid hundreds of doctors sums in the six figures, while thousands more

were paid over $25,000” (Harvard). While this is good for doctors and patients in pain. This over

prescription of opioids has had big consequences.

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These big consequences come from the 1980’s when doctors and scientists claimed

there was a low chance of addiction to opioids, there was a push for usage of the drugs. Collier

(2018) notes in his article that this low addiction claim made it easy for doctors to prescribe the

highly addictive drug to patients with chronic pain without feeling guilty. (p.E27) This over

prescription of opioid drugs “turned out to be a driver of the current opioid crisis” (Collier E27).

The opioid crisis leads to hundreds of patients addicted to opioids. This crisis still affects people

today along with the corrupt over prescription of opioids today.

While opioids are really good at treating pain, they can become highly addictive and can

be dangerous for people suffering with chronic pain. To avoid the threat of addiction, there are

several ways to help manage chronic pain in a natural way such as, exercise, music, acupuncture,

yoga, and different types of physical therapy. There have been too many people in this world

who have suffered from addiction. The consequences from these mass amounts of addiction from

the 1970’s and 1980’s still affect today's world. Hopefully as more research is done on natural

non addictive pain management systems, there will be less need for the use of addictive

prescription medication.
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