Deborah Coady, MD, is Clinical Assistant Professor of Obstetrics and Gynecology at NYU Langone Medical Center. She devoted a major portion of her medical practice to caring for pelvic pain, and currently writes, lectures, and mentors to promote integrative approaches to pain and chronic illness. As a four-year member of Body and Brain Yoga/Tai Chi, Deborah attributes her success in living with persistent cancer to this practice.
With over 100 million people in the U.S. living with chronic pain, each of us likely knows someone affected by it.
Over the years, I have seen 3 main patterns amongst my patients. The first is intermittent pain, in which the pain is only present from time-to-time and there is no pain between episodes. An example of this is frequent migraine headaches. The second, less common pattern, is constant stable pain with little variability over time. And the third and most common pattern, is when chronic pain exists at a certain level all the time, but with episodic flares that intensify it. These flares may be provoked by known triggers, which are within the patient’s awareness, and in some cases, ability to control. For example, many people with low back pain can experience and an episodic flare when lifting heavy loads, especially with an awkward posture or when fatigued.
Pain flares may also occur spontaneously, without obvious precipitating causes. This pain pattern is the most frustrating for patients and doctors alike, and understandably may lead to an ongoing and sometimes obsessive search by both for a trigger. If standard medical tests do not disclose a specific reason explaining the flares, patients may lose trust in their own bodies. They often become depressed and feel guilt and shame. Their doctors may also experience similar feelings, and subtly (or not so subtly) display pessimism to their patients about their prognosis, which can worsen the outcome.
These reactions in doctors add to a tendency to fall back on the habit of prescribing opioid pain relievers and other dangerously addictive medications, despite the now established scientific evidence that they are not effective for chronic pain. Fortunately, the integrative medicine approach offers better and safer options. Western medicine is slowly opening up to this approach, which provides many more tools to help patients heal, and to empower them to heal themselves. This self-healing is sorely needed, as 50% of U.S. physicians recently reported experiencing significant burn-out from their practice of medicine in the current system.
What is the integrative medicine approach to chronic pain? My personal definition has been based for years on one developed by Dr. Andrew Weil, a most influential pioneer, whose work in promoting this approach has improved medical care enormously.
Integrative Medicine is healing-oriented medicine that takes account of the whole person (body, mind, & spirit), including all aspects of lifestyle and environment. It emphasizes the therapeutic relationship, and makes use of all appropriate therapies, both conventional and complementary. Three basic goals underlie integrative care for chronic pain:
The patient becomes a partner in her/his care
The physical body is strengthened
The mind-body connection is developed
A healthy lifestyle is fostered through attention to the mind-body connection through exercise, nutrition, sleep, environment (e.g. removing toxins), self-care, receiving and giving support to others, and purposeful living.
The integrative medicine approach is crucial because unhealthy lifestyles and chronic stress have become an epidemic in modern living and both increase the risk of pain persisting beyond the time of normal healing. Pain is the voice of our bodies, a necessary alarm signal to our brain, and minds, alerting us to slow down, change direction, or alter our actions in some way, in order to prevent bodily injury. It quickly triggers our stress response (fight or flight), a well-designed system in our bodies consisting of a cascade of complex physical changes, all meant to prompt us to take action and get out of trouble.
People with chronic pain and stress experience repetitive surges of the stress hormones epinephrine (adrenaline) and norepinephrine in blood levels. This imbalance contributes to anxiety-producing physical symptoms of sympathetic over-activity, including rapid heartbeat, dry mouth, muscle tension, and draining of blood from the intestines causing a “butterflies” feeling. Increased muscle tension around a pain focus may irritate the local sensory nerves carrying pain signals to the brain, heightening the pain experience further.
The next phase of chronic stress, in which many pain patients live, is characterized by high levels of cortisol. If this adrenal hormone is out of balance, immune function and tissue healing are impaired.
A key benefit of integrative medicine for chronic pain is its promotion of mind-body therapies. A wealth of research shows that these therapies specifically tap into our body’s natural healing abilities, to limit physical responses to pain and stress. Body and Brain Yoga is an optimal mind-body therapy. Its practices of mindfulness, movement, stretching, tapping, breathing and postures activate the healing power of the parasympathetic system, and circulate healing blood, fluids, and energy into painful areas. Relaxation and meditation also allow for muscle tension to be released.
My personal reaction to developing chemotherapy-induced peripheral neuropathy was to want to protect my painful toes at all costs, which to me meant not moving them. Of course, without movement and circulation, my pain just increased. I needed encouragement to move and strengthen, and thanks to Body and Brain Yoga, I now have a very low level of pain, mostly just in cold weather. Several studies have shown that exercise programs reduce pain in diabetic neuropathy, a finding that unfortunately has not received sufficient attention in the medical community.
Through mindfulness, we can also modify the alarm reaction. We can redefine pain by switching our mind’s interpretation of pain signals away from them being a sign of danger and toward a perception that as our body’s voice, they are deeply connecting our mind and body through awareness. We can modulate the level of attention we give to pain, and place more awareness in other parts of our body, which often feel numb compared to our painful area.
Reducing our reactivity to the upsetting thoughts and feelings that pain provokes can lessen anxiety and depression. Enhancing our self-awareness and self-care habits improves our quality of life with or without pain.
In my next article, Living Well With Chronic Pain Part 2, I’ll be addressing additional integrative approaches, as well as what not to do, for chronic pain.
Stay tuned and be well!
Mind & Body Retreat for Physical Therapists (February 2016)
Calling all physical therapists! Dr. Deborah Coady is hosting a Mind & Body Retreat for Physical Therapists February 12-14, 2016 to provide tools for physical therapists to rejuvenate and recharge.
This 3-day experience will include strengthening the physical body, increasing awareness and enhancing meditation designed exclusively for physical therapists. Take better care of your patients by taking care of yourself!
Click here for more information and to reserve your spot today.
Alliance for Pelvic Pain Retreat (May 2016)
Are you living with chronic pelvic pain? Join Dr. Deborah Coady and 5 other Chronic Pelvic Pain Specialists for a 3-day wellness retreat for managing chronic pelvic, genital and sexual pain disorders. It will take place May 20-22 at Honor’s Haven Resort and Spa in the Catskill Mountains.
This all-inclusive weekend will include educational seminars, interactive workshops, one-on-one attention, healthy meals, and connecting with a supportive community in a beautiful natural surrounding.
Click here to reserve your spot today. The Early-bird special expires February 1st.