By John McElligott, MD
with Jeffrey Heinrich, Ed.D., PA-C
It’s one thing to be injured and receive successful treatment for the resulting pain. But what about the pain that just appears and won’t go away? What really causes chronic pain, and what is the best treatment? Just as beauty is in the eye of the beholder, so is pain to the person perceiving it.
What is chronic pain? In life, as we all know, everyone has to deal with chronic aches and pains. Most people have six to eight, or even more, backaches in their lifetime.
In fact, autopsies have shown that – regardless of the cause of death – 50 percent of people examined had a herniated disc and budging disc despite no significant history of complaints of any back problems.
So how is pain graded? The best scoring parameter is a simple 1-10 scale, with 1 being very mild and 10 being severe pain. This scale is important because it helps indicate what level of medical attention is needed.
Pain lasting longer than six months at a constant pain rating, with no improvement, is usually considered to be past the period of normal healing. If there is no obvious mechanism of injury, no simple explanation for the pain, then one needs to seek medical attention. The higher the score on the pain scale, the faster one needs to move.
Your body has a natural stress response. “Flight or fright” hormones and chemicals in the body that normally provide relief can be exhausted by chronic pain. This is when chronic pain takes charge. The result is possibly weight gain, followed by decreased activity, depression, sleep disorders and an attitude of simply giving up.
Using pain pills is not always the answer. Pain pills do not treat the problem. They just dull one’s senses and fog up the brain. Many pain medications are addictive and can potentially end a driver’s career.
“Well, I have a legal prescription for this narcotic!”
Schedule 1 drugs – which include a lot of narcotics – do not preclude you from having a CDL. However, their use and possession by CDL holders is regulated by FMCSA.
The use of a narcotic can make a driver a safety hazard. Common sense should dictate this to professional drivers.
So how do we treat these conditions without making “pill poppers” out of everyone who has an ache or pain? Here are some suggestions, which are not found in most medical books or used by many doctors.
- Know what is causing your pain. Think of a mechanism of injury and don’t forget that obesity is the leading cause of pain in hips, knees, ankles and feet.
- Try non-pharmacological treatment whenever possible. Walking, stretching, and making sure that your sleep patterns are good are the best.
- Vitamin D deficiency and low testosterone levels are becoming front page news as causes for chronic pain. Not every doctor agrees.
- Make time for exercising and stretching. Start slowly and be religious about your routine.
- Remember, smokers have more pain-related problems than nonsmokers.
- Lean to relax; find something that you enjoy doing.
- If you use heat to relieve pain, follow with a ice rub or cool showers.
- Know that depression is a major cause of pain, and everybody is depressed at sometime in their life.
- Remember, when pills that are used for chronic pain are stopped, one may experience severe headaches called “medication overuse headaches.” These rebound headaches can be from the overuse of a simple over-the-counter remedy such as ibuprofen or a prescription medication.
- Stimulators and ice/heat therapy can be used and work well for certain neck and low back problems.
Be careful what you let a doctor prescribe to you and remember to explain that you are subject to regulations governing CDL holders. LL
Editor’s note: John McElligott is an M.D. and Fellow of the American College of Physicians. Jeff Heinrich, who serves as the column’s medical editor, has a Doctor of Education degree and PA-C, which means Physician Assistant-Certified.