UNDERSTAND TO OVERCOME

CONTENTS
Understanding Pain: Exploring It’s Depth…………………………….….. 2

Distinctions In Understanding Pain………………………………………….. 5

Influential Factors: Shaping Our Perception of Pain…………….…… 7

Placebo VS. Nocebo: The Power of Words……………………………… 8

Medical Imaging……………………………………………………………………… 9

Injection…………………………………………………………………………………. 12

Opioid…………………………………………………………………………………….. 13

Surgery.…………………………………………………………………………………. 15

When Should I Get Surgery?…………………………………………………… 19

Misconceptions Unveiled: Dispelling Myths About Pain…………… 21

Understanding Pain: It's All in Your Brain…………………………………. 22

Assessment: The Foundation of Effective Pain Management…… 24

Summary………………………………………………………………………………… 25

Main Takeaways…………………………………………………………………….. 26

References…..………………………………………………………………………… 27
 UNDERSTANDING PAIN

EXPLORING
IT’S DEPTH
We've all experienced pain at some point in our lives, but what exactly
is happening when we feel it? Why does it occur, and what measures
can we take to alleviate it?

Pain is a multifaceted and universally recognized phenomenon. It lacks

a singular definition, yet its presence is unmistakable—we've all
encountered it in some form or another.

However, its complexity can often obscure the truth of what we're
experiencing. What appears evident may not always align with reality,
leading to uncertainty about the appropriate course of action.

The objective here is to gain a fundamental comprehension of pain,

empowering us to navigate its challenges with greater assurance. With
increased knowledge, we enhance our capacity to identify effective,
long-term solutions, fostering confidence and comfort in our
management strategies.

Before delving into solutions, it's imperative to grasp the full scope of
the problem at hand.

2
Chronic pain plagues a significant portion of the American population,
with approximately one-fifth of adults, totaling 50 million individuals,
enduring its relentless grip. Conditions like back and neck pain afflict up
to 85% of adults at some stage in their lives and rank among the
leading causes of doctor and hospital visits.

The economic toll is staggering, with musculoskeletal care costing U.S.

employers over $100 billion annually, and back pain alone contributing
to more than 264 million lost workdays per year. Defined as pain
persisting beyond three months or exceeding the expected duration for
a specific condition, chronic pain poses a formidable treatment
challenge. The National Research Council estimates its annual cost at a
staggering $210 billion, highlighting the urgency of finding effective
solutions. Traditionally, chronic pain has been viewed through two
lenses:

Structural problem. Some doctors attribute it to tissue damage,

such as muscle strain or herniated discs, often resulting in
complex diagnoses that offer little beyond restatement of initial
complaints.

Dismissiveapproach. Others, unable to pinpoint a structural

cause, may prescribe painkillers and rest, offering temporary
relief but failing to address the underlying issue.

However, these approaches fall short, leaving patients with inaccurate

diagnoses and inadequate treatments that fail to address the root
causes of their pain.

Despite the prevalence and impact of chronic pain, current healthcare

practices often offer a one-size-fits-all approach, relying heavily on
imaging, injections, pain medication (including opioids), and surgery.
Unfortunately, these interventions, termed "usual care," often overlook
evidence-based practices, leaving patients without effective solutions.

3
A systematic review revealed alarming statistics: less than 20% of low
back pain patients received evidence-based information and advice,
with a significant portion undergoing unnecessary imaging and opioid
prescriptions.

This stark reality underscores the urgency for change. We must

challenge the status quo, demand better solutions, and advocate for
more effective, evidence-based approaches to chronic pain
management. By driving this conversation forward, we can pave the
way for a future where those in need receive comprehensive,
personalized care that addresses the complex nature of chronic pain.

4
DISTINCTIONS IN
UNDERSTANDING PAIN
Experiencing pain and
comprehending its intricacies
diverge significantly. Even
amid excruciating discomfort,
one may possess limited
insight into the underlying
mechanisms.
However, acquiring a basic
understanding of pain greatly
facilitates the journey toward
alleviation.
Before delving further into
pain, it's essential to grasp
another concept: irritation.
Irritation signifies the
conscious reception of stimuli,
manifesting as sensory input.
Subsequently, our brains
interpret this data, discerning
whether it constitutes pain.
In the realm of research, pain
is defined diversely
An unpleasant sensory
experience associated
with actual or potential
damage, encompassing
sensory, emotional,
cognitive, and social
components.
A survival mechanism,
evolutionarily favored for
expression.
An experience contingent
upon subjective
perception, learned
response, and observable
expression.
5
Initially, categorizing pain as an
emotion might seem perplexing.
However, this characterization
does not diminish the significance
of pain; rather, it unveils its
intricate nature.
Dr. Lorimer Moseley, a luminary
in pain research, recounts an
illuminating anecdote regarding
his encounter with a venomous
snake. When bitten, he initially
mistook the sensation for
innocuous contact. Yet,
subsequent agony and physical
evidence revealed the gravity of
the situation. Intriguingly, a
benign encounter with a stick
later elicited a similar response of
fear and pain, underscoring the
emotional component of pain
perception.
Understanding pain as an
emotional response yields
profound insights:
It divorces pain from
inherent tissue damage,
elucidating that not all
discomfort equates to
harm.
It underscores the
importance of emotions in
signaling potential threats,
prompting necessary
action.
Embracing this perspective
liberates individuals from
perpetual suffering, offering
avenues for progression and
resolution. Moreover, it
underscores the multifaceted
nature of pain, encompassing
emotional dimensions that
warrant acknowledgment and
management.
Indeed, navigating pain entails
contending with an array of
emotions, including sadness,
fear, and uncertainty. Effectively
addressing these emotional
facets is pivotal for reclaiming a
fulfilling life unencumbered by
persistent discomfort.
6
 INFLUENTIAL FACTORS

SHAPING OUR
PERCEPTION OF PAIN
Consider the last instance when you encountered physical pain,
perhaps from cutting your finger or stubbing your toe. Such moments
transcend mere physical sensations; they intertwine with our thoughts,
emotions, and memories. We recollect not only the source and severity
of the pain but also the circumstances surrounding it—such as the time
of day or weather conditions.

These experiences are profoundly influenced by our senses, beliefs,

and past encounters.

In the context of the biopsychosocial model, our perception of pain is

intricately intertwined with various factors, including the context in
which the experience occurs. For example, a construction worker
accustomed to minor cuts may dismiss a new injury, whereas a violinist
may perceive the same injury as threatening, given its potential impact
on their livelihood. Each individual's perception of pain is inherently
unique, shaped by their life experiences and situational context.

The overarching lesson here is the significance of context. The same

event can elicit disparate responses from different individuals or even
from the same person at different stages of their life. Our perception
fundamentally shapes our experience of pain, underscoring the
importance of cultivating mindfulness in our approach to pain
management.

This underscores the imperative for the medical community to elevate

its communication practices.
7
 THE POWER OF WORDS

PLACEBO VS. NOCEBO

Irrespective of one's credentials, words wield immense influence,
impacting both oneself and those around them. Research on patients
with lower back pain highlights the considerable influence of healthcare
professionals on attitudes and beliefs, potentially shaping patients'
perspectives for years to come. Consequently, individuals often harbor
preconceived notions about their conditions, which can significantly
influence their outlook.

However, the influence of language extends beyond the realm of

healthcare. Trainers and coaches within the fitness industry frequently
propagate narratives that may inadvertently instill fear and negativity.
Statements such as "Don't arch your back" or "Your core is weak" not
only perpetuate falsehoods but also foster a sense of disempowerment
and apprehension, hindering individuals' progress.

This phenomenon can be likened to the "nocebo" effect—a counterpart

to the placebo effect. While placebos engender optimism and positive
outcomes, nocebos evoke pessimism and negative outcomes. The
nocebo effect manifests as detrimental health effects stemming from
negative expectations of treatment or prognosis.

Becoming cognizant of the nocebo effect reveals its pervasive

influence across various domains, from medical consultations to fitness
coaching. Negative encounters or dismissive attitudes can instill fear
and erect psychological barriers to exercise, impeding individuals' well-
being and inhibiting their potential for growth. Awareness of the
nocebo effect prompts a reevaluation of language and communication
strategies, emphasizing the importance of fostering optimism,
empowerment, and resilience in our interactions.

8
Research has shown that imaging findings, such as bulging discs or
arthritis, are prevalent even in individuals without pain, particularly as
they age. This discrepancy between imaging results and pain
experience underscores the limited utility of imaging in determining the
cause of pain.

Moreover, the overemphasis on structural abnormalities in imaging

reports can instill unwarranted fear in patients and prompt unnecessary
interventions like surgery. Pain is poorly correlated with structural
damage, emphasizing the need to focus on treating patients rather than
images and prioritizing tissue health over tissue shape.

To optimize the use of imaging, healthcare providers should assess the

necessity of scans on a case-by-case basis, considering factors like
patient history and the presence of red flags. Additionally, adopting a
"wait and watch" approach may be prudent in some cases, allowing
symptoms to evolve before resorting to imaging.

Ultimately, while imaging is a valuable diagnostic tool, its interpretation

and utilization should be approached with caution, ensuring that
patients receive appropriate care based on comprehensive
assessments rather than routine procedures.

10
Medical imaging plays a crucial role in
diagnosing, monitoring, and treating
medical conditions, providing valuable
information about the body's internal
structures. Technologies like X-rays,
MRIs, CT scans, and ultrasounds offer
different perspectives on possible
diseases, injuries, or treatment
effectiveness.

The primary goal of imaging is to

augment medical knowledge and ensure
thorough examination, sometimes
serving as a precautionary measure
against potential legal issues. For
instance, X-rays can help identify
fractures and their severity, aiding
physicians in treatment decisions.

However, there's a common

misconception that imaging is harmless
and always beneficial. Patients often
request X-rays or MRIs to pinpoint the
source of their pain, hoping for a clear
structural explanation. Yet, the reality is
far more complex. Imaging results often
reveal incidental findings that may not
correlate with the patient's symptoms,
causing unnecessary anxiety and
potentially leading to overtreatment.
INJECTION

The use of injections has become increasingly popular in addressing

pain and inflammation, yet many of these treatments lack sufficient
evidence of efficacy and pose potential risks and side effects.
Cortisone injections, a common example, may provide short-term pain
relief but can contribute to long-term tissue damage and degeneration.

Other emerging injection therapies, such as prolotherapy and PRP

injections, claim to offer solutions for chronic pain. However, research
on their effectiveness is inconclusive, with some studies showing no
significant benefit over placebo or sham treatments. Moreover, these
injections often come with substantial costs, both financially and in
terms of potential side effects.

Despite the growing popularity of injection therapies, they lack FDA

approval and are often considered experimental by insurance plans,
leaving patients to bear the financial burden.
Considering the limited evidence supporting the efficacy of injections,
as well as their potential risks and costs, it's essential to explore
alternative approaches to pain management. Embracing a
biopsychosocial model of care, which considers the biological,
psychological, and social factors influencing pain, offers a more
comprehensive and effective approach to addressing chronic pain.

While injections may offer short-term relief for some individuals, they
do not address the underlying complexities of pain and may pose
significant risks and financial burdens. Therefore, it's crucial to
prioritize evidence-based and holistic approaches to pain management
for better long-term outcomes.

11
OPIOID

The use of injections has become increasingly popular in addressing

pain and inflammation, yet many of these treatments lack sufficient
evidence of efficacy and pose potential risks and side effects.
Cortisone injections, a common example, may provide short-term pain
relief but can contribute to long-term tissue damage and degeneration.

Other emerging injection therapies, such as prolotherapy and PRP

injections, claim to offer solutions for chronic pain. However, research
on their effectiveness is inconclusive, with some studies showing no
significant benefit over placebo or sham treatments. Moreover, these
injections often come with substantial costs, both financially and in
terms of potential side effects.

Despite the growing popularity of injection therapies, they lack FDA

approval and are often considered experimental by insurance plans,
leaving patients to bear the financial burden.
Considering the limited evidence supporting the efficacy of injections,
as well as their potential risks and costs, it's essential to explore
alternative approaches to pain management. Embracing a
biopsychosocial model of care, which considers the biological,
psychological, and social factors influencing pain, offers a more
comprehensive and effective approach to addressing chronic pain.

While injections may offer short-term relief for some individuals, they
do not address the underlying complexities of pain and may pose
significant risks and financial burdens. Therefore, it's crucial to
prioritize evidence-based and holistic approaches to pain management
for better long-term outcomes.

12
Moreover, the risks associated with opioids extend beyond immediate
use, as long-term opioid use following surgery is common among
patients, highlighting the need for careful consideration before opting
for surgical interventions.

However, the widespread prescription of opioids persists due to

various factors, including financial interests and corruption within the
healthcare system. Meaningful change requires increased awareness,
open conversation, and a shift towards safer and more effective pain
management strategies that prioritize patient well-being over profit.
Addressing the opioid crisis requires a multifaceted approach that
involves educating healthcare providers and patients about the risks of
opioids, promoting alternative pain management strategies, and
advocating for policy changes to combat the influence of
pharmaceutical companies.

13
SURGERY

One thing to remember about surgery is that it can’t be undone. As

soon as the first incision is made, it will forever permanently impact
your body.

Therefore, when considering all the options available to relieve pain, we

should always consider conservative care before surgery.

Loading Before Cutting

In too many cases, surgery is performed without consideration that

research shows dismal success rates of around 25 percent (Nguyen et
al.,2011).

Why rely on such an ineffective tool?

14
Before a drug or medication can be marketed, it must undergo rigorous
testing to show it is safe and effective. Surgery, though, is different.

The Food and Drug Administration does not

regulate surgical procedures. So what happens
when an operation is subjected to and fails the
ultimate test — a clinical trial in which patients are
randomly assigned to have it or not?

The expectation is that medical practice will change if it turns out that a
certain procedure or surgery has no efficacy. If only. These low-
evidence procedures are still performed thousands of times daily, with
billions of dollars being thrown around and little to no evidence to
support them.

It looks as if the onus is on patients to ask what evidence, if any, shows

that surgery is better than other options.

Take what happened with spinal fusion, an operation that welds

together adjacent vertebrae to relieve back pain from worn-out discs.
Unlike most operations, it actually was tested in four clinical trials. The
conclusion: Surgery was no better than alternative nonsurgical
treatments, like supervised exercise and therapy to help patients deal
with their fear of back pain. In both groups, the pain usually diminished
or went away (Mirza & Deyo, 2007).

The studies were completed by the early 2000s and should have been
enough to greatly limit or stop the surgery, says Dr. Richard Deyo,
professor of evidence-based medicine at the Oregon Health and
Sciences University. But that did not happen, according to a recent
report. Instead, spinal fusion rates increased — the clinical trials had
little effect (Yoshihara & Yoneoka, 2014).

15
When you think about it, it makes sense, right? When we’re looking at
surgery and pain, it’s not rational to believe that something as simple as
surgery can solve a problem as complex as pain.

"We can't point to one anatomical structure and

say, 'Ah, that's the cause,” said Dr. Richard Deyo,
professor of evidence-based medicine at Oregon
Health Sciences University in Portland. "There are
many anatomical structures involved, and it's a
mind-body issue as well. We need to understand
how the brain handles chronic pain."

We simply cannot slice open our bodies and cut pain out. It’s too
complex, and we need a more holistic, person-focused approach.

Let’s look at lumbar fusions again, for example. This procedure involves
permanently connecting two or more vertebrae in the spine to improve
stability, correct a deformity or reduce pain. More simply, it’s basically
slicing through someone’s back and cementing their bones together
with rods. Lumbar fusions are one of the most commonly performed
surgeries for low back pain, despite very little evidence that they
actually work.

This meta-analysis from World Neurosurgery found that "Lumbar fusion

is not necessary for chronic LBP associated with degenerative disc
disease given the pain and disability outcomes were no better than the
nonoperative treatment represented by cognitive interventions” (Xu et
al., 2021).

So despite all this evidence saying no, why do physicians continue to

say yes?

16
Long after research contradicts common medical practices, patients
continue to demand them and physicians continue to deliver. The result
is an epidemic of unnecessary and unhelpful treatments. When we visit
physicians, we assume the treatment we receive is backed by evidence
from medical research. Unfortunately, that’s simply not the case.

It’s not to say that surgery is useless, but rather that it is performed on
a huge number of people who are unlikely to get any benefit (Lyu,
2015). Meniscal tears, for example, are as diverse as the human beings
they belong to, and even large studies will never capture all the
variation that surgeons see.

There are compelling real-world results that show that surgery helps
certain patients. “I think it’s an extremely helpful intervention in cases
where a patient does not suffer from the constant ache of arthritis but
has sharp, intermittent pain and a blockage of motion,” says John
Christoforetti, a prominent orthopedic surgeon in Pittsburgh. “But when
you’re talking about the average inactive American, who suffers
gradual-onset knee pain and has full motion, many of them have a
meniscal tear on an MRI, and they should not have surgery as initial
treatment.”

Instead, we should exhaust conservative care first, using movement as

medicine.

Only when our daily functioning is impaired, the chronic pain becomes a
constant strain on our happiness and well-being, and we’ve tried all
other options should we consider going under the knife and doing what
can’t be undone.

17
WHEN SHOULD
I GET SURGERY?
The “Surgical Seven” Model is a good framework for understanding
when surgery may be an option. Chronic pain can be debilitating, and
for some, surgery may actually be the best option for relief. However,
the decision to undergo surgery is never easy. The fear of the unknown
and the possibility of complications can be overwhelming.

If you’re experiencing all 7 of the items in the “Surgical Seven” Model,

then surgery may be right for you.

Scans and tests show contributing pathology.

1 One of the first things to consider is whether there is a clear
contributing pathology. X-rays and MRIs can provide valuable
information about the extent of the damage, such as
advanced osteoarthritis. However, it's important not to rely
solely on imaging results, as there may be other factors to
consider.

Activities of Daily Living (ADLs) are limited.

2 Next, consider if the pain is limiting your ability to perform
daily tasks, such as grooming, bathing, walking, squatting, or
bending over. If it is, surgery may be a necessary option to
improve your quality of life.

Symptoms are worsening and increasing in intensity,

3 frequency, and duration.
The Irritability Index is a good indicator of whether or not the
symptoms are worsening and increasing in intensity,
frequency, and duration. If the symptoms continue to worsen
despite other interventions, surgery may be necessary.

18
 Consistent exercise/therapy/coaching of 6+ months has
4 been tried.
Before considering surgery, it’s essential to try other
interventions such as exercise, therapy, and coaching for at
least six months. This timeframe is sufficient to determine if
there has been any improvement in the symptoms.

Other functional lifestyle factors have been considered and

5 addressed.
It's crucial to consider other factors that may be contributing
to the pain, such as inflammation, sleep, diet, and stress.
These factors may need to be addressed before surgery is
considered.

Other less invasive measures are ineffective.

6 Other interventions such as injections and pharmaceuticals
should be attempted before surgery. However, if these
interventions are ineffective, surgery may be the next option.

There’s belief and optimism that it will help.

7 Perhaps the most important factor on the list is the belief and
optimism from you, the patient, that surgery will help. If there
is fear or doubt, the likelihood of a successful outcome is low.
The power of education is that it will help you gain awareness
and understanding of the risks involved and the options
available, leading to an informed decision.

The “Surgical Seven” Model is an excellent tool to help determine

whether surgery is the right choice for chronic pain. While surgery is
not always the first option, it may be necessary in some situations to
improve quality of life. It’s crucial to have a clear understanding of the
risks and benefits of surgery and to have a good relationship with your
team, including your healthcare professional, to make an informed
decision.

19
MISCONCEPTIONS
UNVEILED: DISPELLING
MYTHS ABOUT PAIN
HURT ≠ HARM

The notion that "hurt doesn't necessarily equal harm" underscores a

fundamental truth about pain: its role as a protective mechanism. In
everyday scenarios, pain serves as an alarm, alerting us to potential
danger and prompting swift action. However, in cases of persistent
pain, this alarm system becomes overprotective, often exaggerating
the perceived threat relative to the actual tissue damage.
Consequently, individuals may experience heightened pain sensations
even during harmless movements. Understanding this distinction is
crucial, as it enables individuals to engage in activities without
unnecessary fear or distress, ultimately facilitating a more constructive
approach to pain management.

THE PERFECT POSTURE DOESN'T EXIST.

Contrary to popular belief, poor posture is not necessarily a direct

cause of tissue damage and pain. Despite pervasive cultural narratives
suggesting otherwise, research fails to establish a definitive link
between posture and pain. Consequently, attributing discomfort solely
to posture overlooks the myriad other factors contributing to pain
perception. Rather than fixating on achieving an elusive "ideal" posture,
it is more productive to address individualized factors and engage in a
holistic approach to pain management.

20
YOU ARE NOT YOUR SCAN!

As mentioned before, the reliance on diagnostic scans, such as X-rays

or MRIs, to pinpoint the source of pain is often misguided. While these
imaging techniques can offer valuable insights, they do not invariably
correlate with an individual's pain experience. Research demonstrates
that many individuals without pain exhibit similar abnormalities on
scans as those experiencing pain.

Therefore, interpreting scan results in isolation can lead to

misconceptions and unnecessary alarm. Instead, healthcare
professionals advocate for a comprehensive assessment, considering
clinical history, symptoms, and imaging findings in conjunction to
formulate an accurate diagnosis and tailored treatment plan.

In summary, debunking these misconceptions surrounding pain

empowers individuals to adopt a more nuanced understanding of their
symptoms. By embracing the complexity of pain and recognizing its
multifaceted nature, individuals can navigate their pain journey with
greater clarity and resilience, ultimately paving the way for effective
management and improved well-being.

21
UNDERSTANDING
PAIN: IT'S ALL IN YOUR
BRAIN
Contrary to common belief, the pain you
feel in your arm isn't localized to that
specific area; rather, all pain originates
in the brain. This phenomenon is
evidenced by conditions like phantom
limb pain, where individuals experience
sensations of pain in limbs that are no
longer present. Pain is a complex
neurological process, devoid of a
singular "pain center" in the brain.

Your nervous system employs two

mechanisms to modulate pain signals:
endorphins and gating. Endorphins, the
body's natural opiates, provide relief
from acute, severe pain, such as that
experienced by athletes or soldiers.
However, they prove less effective
against chronic pain. Gating, on the
other hand, operates on the principle of
prioritizing sensations, blocking or
"gating" less urgent signals to alleviate
pain. This explains why actions like
rubbing a cramped leg or applying ice
packs can offer relief from discomfort.

22
Psychology also plays a significant role in pain perception. Emotions,
beliefs, expectations, and thoughts influence our experience of pain,
often amplifying or attenuating its intensity. The biopsychosocial model
of pain acknowledges the intricate interplay between biological,
neurological, cognitive, emotional, social, and behavioral factors.
Notably, stress, anxiety, and mood disturbances can exacerbate pain,
while positive emotions and a sense of safety can mitigate it.

Understanding the psychological aspect of pain opens avenues for pain

management strategies that go beyond pharmacological interventions.
By reducing stress, anxiety, and negative emotions, and promoting
positive mood and attentional shifts, individuals can effectively
modulate their pain perception. While this approach isn't a panacea, it
offers valuable insights into the multifaceted nature of pain and
empowers individuals to take an active role in managing their
discomfort.

23
 ASSESSMENT

THE FOUNDATION OF
EFFECTIVE PAIN MANAGEMENT
The oft-quoted adage, "If you're not assessing, you're guessing," rings
particularly true in the realm of pain and injury management.
Unfortunately, the fitness industry often falls into the trap of making
assumptions about the interplay between dysfunctions and postural
patterns, potentially failing to address individual needs effectively.

While there may be discernible trends and patterns in people's

movements, treating them as immutable truths can lead to oversights
and suboptimal outcomes for clients. Therefore, the cornerstone of any
effective pain and injury management strategy is a robust, function-
based assessment process.

Chronic issues persist precisely because they are approached from a

symptom-centric standpoint. It's simple to identify the location of pain,
but the real challenge lies in uncovering the underlying causes. Often,
the root of the problem extends beyond the affected joint,
necessitating a comprehensive assessment that considers the entire
kinetic chain. By examining both proximal and distal factors, we can
discern the multifaceted origins of pain and tailor interventions
accordingly.

Ultimately, the key to effective pain management lies in rigorous testing

and analysis, eschewing assumptions in favor of empirical evidence. By
adopting a systematic approach to assessment, we empower ourselves
to accurately diagnose and address the complexities of pain and
dysfunction, fostering improved outcomes and enhanced well-being for
our clients.

24
 SUMMARY
The prevailing treatments often fall short in effectively addressing pain
issues, leading to dependency on the medical system. Reimagining
healthcare with patient-centered approaches is imperative. Patients
should be empowered to make informed decisions, understand
available options, associated risks, and access evidence-based care.

In the midst of pain, it's easy to feel overwhelmed, as if pain has

become our sole identity, overshadowing everything else in our lives.
Yet, it's crucial not to succumb to this self-betrayal, for research
suggests that identifying with our pain only perpetuates its grip on us.
Instead, it's essential to broaden our perspective, to remind ourselves
of the richness of our lives beyond pain's confines. Reflecting on our
passions, interests, and strengths can help restore a sense of self that
transcends pain, allowing it to become a mere footnote rather than the
defining narrative of our existence.

Remember, you are more than your pain.

While pain presents challenges, it also offers opportunities for growth

and resilience. By understanding its complexities and embracing a
positive vision of ourselves, we can navigate its tumultuous waters with
greater fortitude and grace.

In closing, let us not define success as the absence of pain or problems

but rather as the ability to confront and overcome them, emerging
stronger and more resilient than before.

And with these insights in mind, may we embark on our journey

towards healing and well-being, armed with the wisdom to navigate
pain's complexities with courage and compassion.

25
 MAIN TAKEAWAYS
Pain remains a pervasive issue, yet conventional medical solutions
frequently fail to provide effective relief.

Patients are often relegated to passive roles, reliant on medicine,

rather than being active participants in their own well-being.

There are diverse treatment modalities beyond those discussed

here, highlighting the inadequacy of current approaches.

Addressing pain requires a holistic, personalized approach that

empowers patients and acknowledges the complexity of pain.

Pain is multifaceted, influenced by emotions and beliefs.

It's not solely about physical damage but often involves

sensitization and irritation.

Awareness and understanding are crucial for managing chronic

pain effectively.

Success lies in our ability to cope with challenges, not in their

absence.

26
 REFERENCES
1. Apkarian, A. V., Baliki, M. N., & Geha, P. Y. (2009). Towards a theory of
chronic pain.

2. Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic

literature review of imaging features of spinal degeneration in asymptomatic
populations.

3. Court, E. (2020). Health-records company pushed opioids to doctors in

secret deal with drugmaker.

4. Deyo, R. A., Mirza, S. K., & Martin, B. I. (2006). Back pain prevalence and
visit rates: estimates from U.S. national surveys, 2002.

5. Feldman, D. E., Carlesso, L. C., & Nahin, R. L. (2020). Management of

patients with a musculoskeletal pain condition that is likely chronic: Results
from a national cross-sectional survey.

6. Garland, E.L., Hanley, A.W., Nakamura, Y., et al. (2022). Mindfulness-

oriented recovery enhancement vs supportive group therapy for co-
occurring opioid misuse and chronic pain in primary care: A randomized
clinical trial.

7. Gazendam, A., Ekhtiari, S., Bozzo, A., et al. (2021). Intra-articular saline
injection is as effective as corticosteroids, platelet-rich plasma and
hyaluronic acid for hip osteoarthritis pain: a systematic review and network
meta-analysis of randomised controlled trials.

8. Hart, L. G., Deyo, R. A., & Cherkin, D. C. (1995). Physician office visits for
low back pain.

9. Karjalainen, T.V., Silagy, M., O'Bryan, E., Johnston, R.V., Cyril, S.,
Buchbinder, R. (2021). Autologous blood and platelet-rich plasma injection
therapy for lateral elbow pain.

10. Kearney, R.S., Ji, C., Warwick, J., et al. (2021). Effect of platelet-rich
plasma injection vs sham injection on tendon dysfunction in patients with
chronic midportion Achilles tendinopathy: A randomized clinical trial.

27
11. Kamper, S. J., Logan, G., Copsey, B., et al. (2020). What is usual care for
low back pain? A systematic review of health care provided to patients with
low back pain in family practice and emergency departments.

12. Lyu, S. R. (2015). Why arthroscopic partial meniscectomy?.

13. Mathieson, S., Lin, C.C., Underwood, M., & Eldabe, S. (2020). Pregabalin
and gabapentin for pain.

14. Mirza, S.K. & Deyo, R.A. (2007). Systematic review of randomized trials
comparing lumbar fusion surgery to nonoperative care for treatment of
chronic back pain.

15. Nguyen, T. H., Randolph, D. C., Talmage, J., et al. (2011). Long-term
outcomes of lumbar fusion among workers' compensation subjects: a
historical cohort study.

16. Opioid epidemic: Addiction statistics. (2023).

17. Thorlund, J.B., Simic, M., Pihl, K., et al. (2022). Similar effects of exercise
therapy, nonsteroidal anti-inflammatory drugs, and opioids for knee
osteoarthritis pain: A systematic review with network meta-analysis.

18. Vraa, M. L., Myers, C. A., Young, J. L., & Rhon, D. I. (2021). More than 1 in
3 patients with chronic low back pain continue to use opioids long-term after
spinal fusion: A systematic review.

19. Xu, W., Ran, B., Luo, W., et al. (2021). Is lumbar fusion necessary for
chronic low back pain associated with degenerative disk disease? A meta-
analysis.

20. Yoshihara, H. & Yoneoka, D. (2014). National trends in the surgical

treatment for lumbar degenerative disc disease: United States, 2000 to
2009.

28