The Pain Management Crisis

by Mark Whalen

What am I referring to when I mention the pain management crisis?  It’s no secret there is an Opiod epidemic in this country right now. This may be a chicken or the egg type argument, but for there to be an Opiod epidemic, there first has to be a problem with pain management.  Current treatment options don't seem to be effective enough for many.

Today we are going to look into what pain is, how the body identifies pain and how Acupuncture and Chinese herbal medicine can help play a role in combatting this epidemic.

So what is pain?

Pain- specifically acute pain- serves a strong purpose. It is a warning sign of danger. You touch a hot stove and you pull your hand away immediately, thus removing the danger. In an injury, let’s say a sprained ankle, the pain is there to alert you to not put pressure on the ankle so the body can go about healing it. Again, the acute pain serves as an important signal to let you know something isn’t right.

Chronic Pain, which is typically a pain that has lasted longer than three months. This type of pain no longer serves a purpose.

Pain Management Crisis

Why is pain management such a massive problem in this country right now? Check out these statistics relating to Opiods and Heroin taken right from the CDC website:1

Opiod/Heroin Statistics

  • Overdose deaths involving prescription opioids have quadrupled since 1999 (emphasis mine)
  • Sales of Opiod Prescriptions have quadrupled since 1999 (emphasis mine)
  • At least half of all U.S. opioid overdose deaths involve a prescription opioid. (site update May 12, 2016)
  • Four in five new heroin users started out misusing prescription painkillers.2
  • As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013.3
  • 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.” 4

It’s clear that for many patients, the current treatment options for pain do not seem to be working effectively enough. People are suffering all around this issue. Families are being affected and young people are dying. We need more treatment options and better solutions to handling the Pain problem.

How the Body perceives Pain

To understand where we’re going in this article, we need to understand some terminology related to how the body perceives pain.

Key terms to know:

Noxious Stimuli: the painful event that represents a threat of tissue damage, or actual tissue damage. In our example above, the hot stove is the noxious stimuli.

Nociceptor Fibers: sensory nerves that detect the noxious stimuli

Proprioceptor Fibers: Help identify where the pain is. Location, Location, Location

A Delta Fibers are myelinated (covered in a sheath) and carry nerve signals quickly. These fibers are involved in pain that is sharp or burning.

C Fibers are unmyelinated and carry a slower nerve signal. These fibers are involved in pain that is dull, achy or tingling.

The C Fibers are always involved in chronic pain and in some cases, the A Delta fibers may also be involved.

Pain Management Crisis

How the body perceives pain

In response to tissue injury, the nociceptor fibers send a signal along the A and C fibers up through the spinal cord, where they cross over to the other side of the spinal cord and help the body perceive the pain.5

Once these signals reach the brain, the brain takes over to release the body’s own pain killing Opiods (referred to as endogenous Opiods). The main Opiods include enkephalins and endorphins, which bind to receptors in the spinal cord to suppress the transmission of pain signals to the brain.6

Enkaphalins are released when the mid-brain receives a strong enough stimulus from the Proprioceptor fibers. The Gate Control Theory of pain (Melzak, Wall 1965) posits that chronic pain may arise when there is a decrease in the activity of the Proprioceptive fibers. In other words, the threshold signal on the Proprioceptive pathway is too low, causing a decrease in the release of the body’s endogenous Opiods.7

When there is pain, the brain will vasoconstrict blood vessels going into and out of a painful area (known as ischemia). Without proper blood flow, the area cannot heal fully. The blood carries oxygen, nutrients, pain killing chemicals, hormones and everything else we need to be healthy.

__________

What role can Chinese Medicine Play?

When I speak of Chinese Medicine I am referring specifically to the modalities of acupuncture and Chinese Herbs.

Chinese medicine has a long history of treating pain. It’s still the number one condition we’re known for in the US. So how does it help pain?

Acupuncture for Pain Management

Acupuncture works primarily by helping the body improve blood flow through the vascular system. Despite what you may have heard, acupuncture is not an energy medicine. There is no ‘life force’ being worked on. Acupuncture influences the flow of oxygen through the vascular system to help stimulate the body’s self -healing ability and to improve the body’s function.

The insertion of an acupuncture needle stimulates a cascade of events in the body to achieve its results. For the purposes of this article, pain relief.

Acupuncture Needling

There are many different types and styles of acupuncture. To keep it simple, I’m going to discuss two distinct types of needling. Each can treat pain effectively, but they have a different mechanism as to how they accomplish the end result.

Local Needling

Local needling involves needling directly into the area of pain. If your shoulder hurts, we needle your shoulder.  The local events include:

  • Mast cells in the dermis of the skin rupture releasing Prostaglandins
  • Prostaglandins cause the small capillaries to open up- local vasodilation- i.e. improved blood flow
  • White Blood cells (macrophages) leak out and start to scavenge and repair any inflammation

By vasodilating the capillaries, blood flow improves, immune cells are activated and the nociceptive sensory fibers are eventually inhibited.8

Distal Needling

Distal needling involves the use of points away from the pain. For instance, using points on the arm to treat the leg; points on the shoulder to treat the hip. With distal needling, acupuncture helps to amplify the signal strength on the Proprioceptive fibers.

Acupuncture stimulates the pathways up to the brain,triggering a release of endogenous Opiods to lower the pain response.  The secondary effect of needling is vasodilation. By lower the pain signals to the brain, vasodilation occurs, which allows for more blood flow to the injured area. More blood flow = better chance to heal.9

What you need to know:

Acupuncture works via the same pathways the body uses to recognize and treat pain on it's own.  Acupuncture amplify's this effect to help the body restore homeostasis.  Acupuncture affects the same areas of the brain as the opiod medications, without the side effects of dependence or addiction.

CHINESE HERBS

There are thousands of individual Chinese herbs to choose from when treating various ailments. Far too many to get into much detail here. For example, in the book Chinese Medical Herbology and Pharmacology, there are 64 individual herbs listed as Analgesics (pain killers)!

Here, I just want to offer a brief summary overview of how the herbs involved in treating pain work.

The main category of herbs used for relieving pain fall under the Chinese Medical Category of Blood Invigorating Herbs. Physiologically speaking, these herbs have the following effects:

Physiology of Chinese Herbs

  • Analgesic- pain killing through action in the Central Nervous System (brain and spinal cord)
  • Anti-inflammatory- reduce permeability of the capillaries
  • Dilate blood vessels
  • Anti-coagulant properties- prevents blood clots in the veins
  • Anti-platelet effects- prevent blood clot in the arteries
  • Increase blood perfusion to smaller blood vessels
  • Lower plasma cholesterol levels
  • Immunologic: some enhance and some inhibit the immune system10

Similar to acupuncture, the herbs help to improve blood flow, reduce inflammation and signal the brain/spinal cord to reduce pain signals11.

SUMMARY

I want to be clear. In no way am I suggesting that Acupuncture and Chinese herbs are not the answer to the chronic pain issues affecting this country, but they certainly deserve a seat at the table to be part of the discussion.

The discussion is happening now.

This is clearly an issue of national importance, as evidenced by two recent House Resolutions passed in May.

May 11, 2016: H.R. 4641 (vote 184) provides for the establishment of an inter-agency task force to review, modify and update best practices for pain management and prescribing pain medications.

May 12, 2016: HR 5046 (vote 187) the Comprehensive Opioid Abuse Reduction Act of 2016 and also S524 (vote 193) the Comprehensive Addiction and Recovery Act of 2016.

Acupuncture and Chinese herbal medicine offer a time tested, safe, non addictive approach to pain management.

If you are a supporter of Chinese Medicine, speak up! Contact your representatives, and let your voice be heard.

Thank you!

-Mark

 

Sources:

  1. (source; CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016
  1. Hedegaard MD MSPH, Chen MS PhD, Warner PhD. Drug-Poisoning Deaths Involving Heroin: United States, 2000-2013. National Center for Health Statistics Data Brief. 2015:190:1-8
  1. Ibid
  1. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826
  1. http://www.ebmconsult.com/articles/opioid-agonist-pain-mechanism-cns
  1. . http://www.the-scientist.com/?articles.view/articleNo/37538/title/Natural-Opioids-Linked-to-Chronic-Pain/_. Online article by Jef Akst. Original source: G. Corder et al., “Constitutive ?-opioid receptor activity leads to long-term endogenous analgesia and dependence,” Science, 341:1394-99, 2013
  1. Latash, Mark. Neurophysical Basis of Movement. Penn State University. 2008 Pg 264
  1. Ma, Yun Tao, Ma, Mila; Zang Hee Cho. Biomedical Acupuncture for Pain Management. Elsvier       Press. 2005. Pg 106
  2. Kendall, Donald.Dao of Chinese Medicine. Oxford University Press. 2002. Pg 257
  3. Chen, John; Chen, Tina. Chinese Medical Herbology and Pharmacology. Art of Medicine Press. City of Industry, CA 2004 Pgs: 611-613
  1. Ibid.
  2. British Medical Acupuncture Society Physiology Day in December 2013.
    http://www.medical-acupuncture.co.uk/

 

 

Mark Whalen is a Licensed Acupuncturist and Board Certified Herbalist and the founder of Five Points Acupuncture & Wellness in Reading, MA.

Mark Whalen – who has written posts on Acupuncture Reading MA - Five Points Acupuncture & Wellness.


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