Pain management and aging loved ones

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Pain hurts anyone, anytime. Pain hurts even more for older people whose resilience is lower and who are thinner, frailer, and more sensitive.

It’s rather interesting to see how we deal with pain management today, compared to even two decades ago. For when a while back physician’s ruled the pain management universe and were driven by evidence-based data, today there are more players offering more options.

Sure, there are still quacks offering instant relief and cure. But there are also more physicians willing to explore alternatives to tried and proven prescription drugs. There are chiropractors, and naturopaths who study long and hard to earn their medical designations.

Learning more about pain management options

I recently spent a lot of time learning more about pain management, mainly from  Dr. Andrea Kuzmiski, an naturopath at the Halton Family Health Centre near Toronto.

She patiently explained that there are more options now, and they are under the umbrella of Complementary Alternative Medicine (CAM). CAM, though, in the management of pain is still a very new and controversial topic.  The scientific community is just starting to explore the role of modalities such as acupuncture, biofeedback , Cognitive Behavioural Therapy and meditation as part of a pain management regime for patients.

Dr. Kuzmiski said that the link between science and CAM can be bridged when we remember that physical pain also has an emotional component, and that to varying degrees patients may have the ability to control their pain levels. With this in mind, pain management’s strategies are moving toward a more unified and holistic mind-body approach.

Currently, the frequency of CAM therapy use for chronic pain is widely reported, with an estimated 34.7 per cent of patients using one or more CAM treatments for pain management. The most often used therapies are chiropractic treatment (54 per cent) and massage therapy (38 per cent).  In addition, 8.3 per cent of CAM users rely on acupuncture and 13.0 per cent on biofeedback/relaxation.

Acupuncture is probably the most studied area of CAM therapies for pain. Neurobiological mechanisms invoking the release of endogenous opioids and depression of stress hormone release are believed to be the basis of acupuncture analgesia.  Patients treated with acupuncture in addition to routine medical care have demonstrated significant improvements in symptoms and quality of life compared with patients who received routine medical care alone.  More specifically, acupuncture can decrease pain levels in osteoarthritis sufferers compared to no treatment at all.  However, this decrease in pain may only be temporary.

The impact of diet

If we look at the most important areas on CAM in pain management, Dr. Kuzmiski maintains that diet and nutritional supplementation can play a significant role.  The Standard North American Diet (SAD) is high in Arachidonic Acid (AA), derived mostly from animal proteins, and this can cause a pro-inflammatory effect.  A diet low in AA has been shown to help reduce clinical signs of inflammation in pain, especially in those with rheumatoid arthritis.

‘Omega-3 fats from fish oils can increase the synthesis of anti-inflammatory cytokines and block a pro-inflammatory response’ she says.  ‘Clinical trials have concluded that arthritis suffers who took fish oils (4 grams/day) could eliminate or sharply reduce their use of NSAIDs and other arthritis drugs’.

Vitamin D is another “hot topic” in pain management.  22 clinical investigations of vitamin D in patients with chronic musculoskeletal-related pain were conducted in various countries and included approximately 3,670 patients representing diverse populations and age groups.  The percentage of patients with pain having inadequate vitamin D concentrations ranged from 48 to 100 per cent depending on patient selection and the definition of Vitamin D “deficiency”.  There is no recommended or established dosage for Vitamin D in pain management; however, it can be safely administered at 2000 IU/day. Studies have shown that 4000 IU/day can be safely administered with more favorable outcomes.

Yet other options, but not much conclusive proof

Still other research in the area of CAM is interesting to examine. I a 2011 article in the journal PAIN, two clinical researchers in the Division of Pain Management, Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University briefly examined other techniques such are using mirrors, magnets, and electromagnetic fields in the process of pain management and test results which look interesting.

The authors conclude that there are now a growing number of options to use in dealing with chronic pain management. However, they note that ‘only a few CAM therapies have shown high quality of scientific evidence…’

What that means for the elderly in pain

I watched my mother become weaker and in more discomfort over the course of a number of years. By the time she was in palliative care near her death exactly two years ago, she was being given morphine on a regular basis and in ever increasing amounts in order to help her cope with her pain: a pain she couldn’t articulate but that was obvious by her body movements.

Prior, she used to be on various prescription drugs at different times to help deal with an assortment of localized pains. And many people looking after aging loved ones who have shared with me the myriad ways they dealt with pain. Many used various acupuncture treatments. Still others tried hypnosis, various herbal treatments, and even music and gently pulsing lights.

It seems that right now there are so many options to explore and try as needed. But the fact seems to be that various treatments and therapies can work in different ways on different people. The mind and body are amazing things and stunningly personal. What can work for one person can be a total failure for another who may be similar in appearance but totally different in every other way.

All in all, it’s important to keep and open mind and be willing to step outside the box when striving to find pain management options.

Sources:

CAM use of frequency – Self-management of chronic pain: A population-based study.

Blyth, Fiona M.;March, Lyn M.;Nicholas, Michael K.;Cousins, Michael J.

Pain, Vol 113(3), Feb 2005, 285-292. doi: 10.1016/j.pain.2004.12.004

Arachidonic Acid – Rheumatol Int. 2003 Jan;23(1):27-36. Epub 2002 Sep 6.

Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis.

Adam O, Beringer C, Kless T, Lemmen C, Adam A, Wiseman M, Adam P, Klimmek R, Forth W.

Fasting followed by vegetarian diet in patients with rheumatoid

arthritis: a systematic review

H. Mu¨ ller1, F. Wilhelmi de Toledo2, and K.-L. Resch1 Scand J Rheumatol 2001;30:1± 10

Vitamin D – Prevalence of Severe Hypovitaminosis D in Patients

With Persistent, Nonspecific Musculoskeletal Pain

GREGORY A. PLOTNIKOFF, MD, MTS, AND JOANNA M. QUIGLEY, BA 2003 Mayo Foundation for Medical Education and Research

Prevalence and Clinical Correlates of Vitamin D Inadequacy among Patients with Chronic Pain

Michael K. Turner MD1, et al. Pain Med. 2008 Mar 11

Fish Oil Use – Kosuwom et al. J Med Assoc Thai 2010