Movement, distraction, and meditation provide some of the best relief from chronic pain. Combined with brief, goal oriented cognitive behavioral therapy or other similar strategies, these are by far the best and least expensive treatments for injured workers with chronic pain.
While physicians are starting to get the message that prescribing copious amounts of opioids for ailments such as low back pain is not the answer, they often don’t understand how to provide relief for their patients. Many continue to prescribe them even in the face of the national opioid epidemic. Gaining insight into chronic pain can put them in a position to significantly improve functioning for injured workers and save money for payers.
Congenital insensitivity to pain is a condition that inhibits the ability to perceive physical pain. People who have this often have multiple wounds, bruises, broken bones and other health issues, along with shortened life spans. It is a horrific condition, and it underscores the point that pain is good. It can save your life. That is, until it becomes chronic.
If you put your hand on a hot stove, you should feel pain. That’s acute pain and it’s a good thing. The pain signal causes you to remove your hand from the stove as quickly as possible so your hand will suffer little if any tissue damage.
This ‘good pain’ is a response to threats to our bodies and even our lives. Chronic pain, on the other hand is not symptomatic of a threatening stimulus, but is its own disease and must be treated differently from acute pain.
Acute and Chronic
Acute pain activates the brain’s fight/flight/freeze response. It’s a warning that something needs immediate attention. With the hand on the stove, there would likely be some treatment needed, whether putting it under cold weather or more intensive treatment, depending on the damage. Once treated, the pain should dissipate and eventually disappear altogether.
Chronic pain is different. While acute pain may eventually lead to chronic pain, it is much more complex. Unless there is an underlying physical cause — which there usually is not — chronic pain cannot be cured. But it can be managed. And that’s important to understand in order to help injured workers with chronic pain.
Chronic pain is a perception based largely on psychosocial factors and environmental stimuli. People who suffer from it need to learn how to control it. There are a variety of successful techniques that teach people how to change their negative thoughts and behaviors, enabling them to cope with their pain and get on with their lives.
Treating Acute vs. Chronic Pain
There are several major differences in terms of treating acute vs. chronic pain. For example, with acute pain we are often instructed to protect the affected area to avoid causing further harm. The exact opposite is true with chronic pain. In fact, movement of any kind is one of the best ways to manage chronic pain.
Mindfulness is yet another technique that helps injured workers with chronic pain. It is a form of meditation in which the person becomes a detached witness to the pain sensations, and is able to control the physiological effects of his pain. Through brain imaging, we can see how mindfulness actually changes the structure of the brain.
Another difference is that we can be distracted from chronic pain, which also helps the injured worker function better. Using acute pain to distract the person from his chronic pain is a technique we often employ to help the injured worker better engage in his own recovery. Biting the lip, for example, distracts the brain’s attention away from the chronic pain. Essentially, the brain interprets the lip pain as a threat to the body (acute pain), and is focused on that. Suddenly the chronic pain disappears for a while.
Opioids also serve as a distraction for chronic pain; however, the disadvantages of them far outweigh the advantages in nearly all cases. Opioids do not give the person control over his own body. Instead, the drugs take control so he doesn’t care about the pain, but he is always at the mercy of the next pill. As we also know, some people are vulnerable to dependency and/or addiction. Even those who don’t become addicted typically experience overwhelming side effects, and require additional medication.
Once injured workers begin seeing the benefits of natural distractions combined with CBT-type therapies, they embrace the treatments. Instead of reaching for an opioid, they will go for a walk. They understand that physical therapy and other forms of exercise are so much more effective than a medication. We often see injured workers in our programs request extra PT after a session. Pushing through the pain releases certain chemicals in the body that mitigate the experience of pain and gives them a sense of self that allows them to return to function, and work.
Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.
Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.