I want to tell you a brief story...

John (name is changed for confidentiality) came to see me with chronic neck and back pain. He had been in pain for several years and the other treatment options he tried hadn’t worked to help him feel better. He was frustrated, depressed, unmotivated, at the end of his will, and quite frankly had a pretty crappy attitude about his entire situation. John had pain all day and it woke him up several times a night. He couldn’t exercise anymore because the pain had gotten so bad. He felt his pain during all his daily activities so doing things started to become more of a hassle or a chore. He lost the desire to go and do fun thing because his pain would flare up and he thought he would ruin fun for others. John’s friend told him to come and try acupuncture, but he was skeptical and thought it was some woo woo medicine. At this point, I couldn’t tell you how many people have come to see me with pain that has not been resolved through other treatment options. One of my favorite things about being an acupuncturist is seeing the smile on people’s faces, hearing about how much better they feel, and how they are now a believer in acupuncture. This is exactly what happened with John. In treating John, we did acupuncture, but we also took a functional approach to treating his pain. In this article we’ll explore some information about pain and the functional approach to treating pain.

First, let me ask you…

How many people do you know that suffer from chronic pain or a pain condition? Several I imagine, you could probably recount conversations you’ve had in the last week with people you know and at the very least a few have told you about some kind of pain issue they’re having. More than 1 in 5 adults experience chronic pain, 20.4% of adults in the US had chronic pain in 2016  (James Dahlhamer, 2018). Pain has a high impact on people’s lives, both physically and emotionally. Not only are people unable to work or do daily activities, but they also become depressed and unmotivated. It becomes a circular game of the chicken or the egg. 

Here are some interesting statistics regarding pain

• Chronic pain sufferers are four times more likely to have comorbid anxiety or depression
• Sleep complaints are present in 67-88% of chronic pain conditions
• 70% of all deaths in the United States result from chronic preventable diseases that are attributed to diet and lifestyle. 
• 50 million adults in the United States are dealing with chronic pain resulting in 80 billion dollars in lost wages every year. 
• Chronic pain is 68-254% higher in the obese population 
• Women who are overweight have a 60-70% greater chance of developing fibromyalgia 
• 57% of people with a neurological dysfunction have a gluten sensitivity 
   (Diana Noland, 2020) (Reno, 2021)

The different processes by which pain is experienced are nociceptive, neuropathic, psychological, and central sensitization. Some people experience a mixture of the four. Below are the characteristics of each one. 

Nociceptive Pain: 

• Relates to the perception or sensation of pain
• Often occurs as acute pain
• Noxious (harmful) stimuli activate nociceptors in the peripheral nervous system
• Occurs as a protective function
• Can result in chronic pain
• Examples of conditions--acute pain due to injury, osteoarthritis, rheumatoid arthritis, cancer-related pain, post-operative pain

Neuropathic Pain: 

• Caused by a lesion, injury or dysfunction of the peripheral nervous system or the central nervous system
• Complex chronic pain 
• Tissue damage or injury of the nerve fibers occurs
• The nerve fibers misfire and send incorrect signals to various pain centers
• Generally experienced as spontaneous pain
• Central pain processing may be altered
• Neurons continually fire 
• Manifests as shooting, burning, tingling, or numbness
• Examples of conditions--diabetic neuropathic pain, post herpetic neuralgia, trigeminal neuralgia, phantom limb pain, complex regional pain syndrome. 

Psychological Pain: 

• Non-physical origin
• The central nervous system may be altered by emotional states and traumatic events
• Often pain occurs in the absence of an injury or physiological cause
• History of trauma or adverse childhood experiences co-exist with many pain conditions
• Chronic pain develops due to unresolved emotional issues

Central Sensitization: 

• Condition of the nervous system that is associated with the development and maintenance of chronic pain
• The central nervous system is hyperactive or magnifies sensory input in multiple organ systems
• Localized pain can become generalized pain that is felt in joints or muscles
• It’s a complex mixture of nociceptive, neuropathic, and psychological factors with central sensitization being the dominant piece
• It’s the underlying pathophysiology associated with fibromyalgia, irritable bowel syndrome, tension headaches, migraines, sleep disturbances, restless leg syndrome, chronic neck and back pain, osteoarthritis, rheumatoid arthritis, interstitial cystitis, and TMJ with implications in anxiety, depression and PTSD.

Sleep, emotional imbalances, obesity, inflammation, gut microbiome, and food sensitivities can all have an impact on pain and chronic pain. Depression and anxiety share similar pathways with pain in the central nervous system, which leads to pain having a greater emotional impact on us. 

We’ve all probably been told at some point in our lives how important sleep is to our health. While we sleep our bodies are given time to rest and repair. What happens when we have pain or some other ailment that is keeping us from sleeping? Loss of sleep increases inflammation, alters metabolism, depresses immunity, and doesn’t allow the body time to rest and repair. Insomnia can cause increased pain sensitivity. 

Obesity is a contributing factor to many health problems, including pain. Generally, as one’s body mass index (BMI) increases so does their pain level. Obesity has reciprocal effects with pain. People who have pain will often decrease their physical activity, have trouble sleeping, and may use food as a coping mechanism for the emotional distress they’re in, which all contribute to gaining weight, which then in turn contributes to having more pain. Being overweight puts more stress on our joints, which causes more pain over time. For each pound of weight lost we get a four-pound reduction of stress to our knee joints. 

Have you heard the term inflammation? It’s something we’re hearing about more and more. Inflammation is the body’s immune response to pathogens, injury or contamination. All types of pain are associated with inflammation in the body. Inflammatory mediators, a messenger that acts on blood vessels or cells, can either exacerbate or inhibit pain. Inflammation contributing to pain can be either local or neural, relating to the nervous system. 

The microbiome of your gut can also have an impact on your pain. We need a healthy gut to have a normal inflammatory pain response. Our gut helps to regulate our immune system. The enteric, our intestines, nervous system has its own pain receptors, nerves, and neurotransmitters, which are often identical to those in the central nervous system. Our gut bacteria can be altered by anxiety or stress and altered bacteria in our gut can cause stress and anxiety. In recent years food sensitivities have increased in the United States, which can also have an impact on our gut microbiome. What we put in our bodies can be either harmful or helpful to our gut microbiome. Below are lists of what can be harmful or helpful to our gut microbiome. 

Harmful:

• Refined sugars
• Processed foods
• Hydrogenated vegetable oil
• Additives
• Preservatives
• Artificial sweetener
• High fructose corn syrup
• Alcohol
• Smoking
• Pharmaceuticals; NSAIDS, antibiotics, etc. 
• Acid blockers
• Chronic stress
• Cesarian sections
• Widespread use of antiseptics and sanitizers

Helpful:

• Fibrous whole foods
• Fruit 
• Vegetables
• Nuts
• Quality protein (especially if you favor a Keto diet)
• Whole grains (if non-reactive)
• Healthy fats 
• Fermented foods
• Proper hydration with water
• Prebiotics
• Probiotics

Is there one approach to treating pain? Think about all of the different things you’ve done to help yourself feel better when you’ve been in pain. You’ve probably found relief in different ways, depending on what pain it is you’re having and what you have available at the time. There are several approaches to treating pain. Sometimes we have to try different things or use combinations of therapies to help. Below is a basic overview of different ways we can approach treating pain.  

The standard western medical approach to treating pain consists of: 

• Taking medications (pharmaceuticals or over the counter)-NSAIDS, opioids, antidepressants, anticonvulsants
• Procedures such as injections, ablations, and implants
• Surgery
• Physical therapy 
• Exercise
• Heat and cold therapy
• Cognitive behavioral therapy
• Massage
  (Diana Noland, 2020)

The functional medical approach to treating pain consists of:

• Lifestyle changes
• Correcting nutritional deficiencies
• Removing food allergens
• Creating individualized diet plans: anti-inflammatory, vegan, Fodmap, paleo, etc. 
• Nutrient supplementation: omega-3’s, magnesium, vitamin D, etc. 
• Using plant compounds and herbal remedies: turmeric, boswella, cannabinoids, etc. (Diana Noland, 2020)

Complementary therapies that you can use in the treatment of pain: 

• Acupuncture
• Yoga, tai chi, qi gong
• Meditation
• Essential oils
• Biofeedback
• Hypnosis
• Electrotherapy
• Energy medicine: reiki, etc. 
• Emotional freedom technique (aka tapping)
• Brain integration
• Guided imagery
• Chiropractic
  (Diana Noland, 2020)

Now back to John…

What did we do to help him feel better? We used acupuncture and incorporated a functional approach to treat his pain. When John came in for his first appointment, we went over all of his body systems to assess his symptoms and what his underlying constitution is, from an East Asian medical standpoint. We administered acupuncture and at the end of the appointment we discussed our next steps and gave him some homework and exercises he could do at home to help with the pain. 

We determined the blood tests for him to get to assess his overall health and recommended a food sensitivity with complement test, that he keep a food journal for two to four weeks so we can look further into his habits around food and what he’s eating and drinking daily. To start addressing dietary concerns immediately we recommended that he cut down or eliminate soda intake as a small step to start and to replace it with water. We addressed mindset and gave him the homework of starting a gratitude journal. The other recommendations we gave him after the first visit included purchasing a new pillow, some exercises/stretches for him to do at home to relax his neck and back, to start walking for 15 minutes a day, and to do a self-guided meditation or hypnosis at night to help him get into a restful sleep. 

After receiving the results from his blood tests and a food sensitivity test, we were able to see some areas in his health that needed to be addressed further. Throughout his initial course of treatment with acupuncture we continued to make small changes to his diet, that he could live with and would be sustainable for him and got him an appropriate supplement regimen. He continued with the recommendations previously given to him. I am happy to report that John has had significant reduction in his pain, it is now manageable. His weight is down 20 pounds, he is sleeping better, and he is feeling healthier overall. 

It truly is a blessing to work in a profession where I get to empower people to make positive changes in their lives and I get to watch as the sparkle in their eyes come back. 

Written by Katrina McLaughlin