Chronic pain affects millions of people around the globe every year. According to a 2019 National Health Institute Survey, over 20% of adults suffered from chronic pain, and nearly half of those people said pain limited their daily activities. As one of the most prevalent health concerns chiropractors and other medical professionals see, chronic pain treatment requires a commitment from all parties involved.
Treating acute pain often has a rapid resolution, while treating chronic pain can take years. Chronic pain patients can experience a level of adaptability or resilience since their bodies have not been able to heal for so long. Often, patients will have to work through some of their pain during treatment to battle the development of scar tissue and to restore strength back to their bodies. Such a tough course of treatment can cause anxiety, fear, and despair.
Managing chronic pain can quickly turn into a slippery slope. Physical issues can morph into psychological issues because patients may think they will never be able to resolve or find solace in their pain. Often, their bodies have become deconditioned, and they’re physically unable to perform normal tasks, which leads them to become isolated from others. Patients may feel alone and trapped in their current situation, which triggers the fear-avoidance cycle.
The fear-avoidance cycle begins with the fear of pain. The patient begins to complete a simple task, such as washing dishes or taking a walk. They feel pain from this minimal effort, and because they perceive pain negatively, they avoid those activities altogether. More deconditioning of the body takes place, and the patient’s body becomes much weaker than before. Now, it takes an even smaller amount of activity to create pain. The patient does not want to give up, so they push themselves to complete tasks they are used to being able to complete and start to feel pain once again. This takes them back to the beginning of a vicious cycle, which can become tighter as the body becomes more deconditioned.
Chiropractors play a vital role in the treatment of chronic pain, finding success with their patients because of the long-term, deeply rooted relationships they form with their patients. As medical professionals, chiropractors realize how deconditioned a patient’s body has become due to chronic pain. They also assess and recognize secondary problems caused by dysfunctional compensatory pathology, issues caused by chronic pain. For example, if a patient suffers from back pain, they may begin to walk with a limp, which may eventually cause a knee or hip problem.
These situations can also trigger the fear-avoidance cycle, so chronic pain rehabilitation has to be very slow, consistent, and persistent. It takes a long time to restore a patient’s strength after their body has become deconditioned. There will be obstacles to overcome, and it is the doctor’s responsibility to set clear expectations with their patients. The patient may have an unrealistic view of what they can accomplish, so it is important to work together to set expectations so the patient doesn’t become discouraged. Sometimes, chiropractors may have to bring their patients to the reality that they may never get back to what they could do before their injury. There will be glitches and setbacks, but those are necessary. However, there is always a way to resolve these issues to meet treatment goals. It is also essential for chiropractors to communicate the importance of avoiding pain medication and addiction, which, besides significantly hindering a patient’s recovery, is one of the biggest epidemics facing the United States. According to the National Institute on Drug Abuse, nearly 50,000 people died from opioid-related overdoses in 2019. Our duty as health professionals is to ensure our patients do not become part of that harrowing statistic.
When creating a patient’s rehabilitation and recovery plan, I always start by asking the patient what recovery means to them. Of course, the goal is always complete recovery and restoration, but that may not always be realistic. This plan also takes into account any secondary or tertiary factors from an injury, such as health-related concerns including diabetes, cartilage issues, opioid addiction, or obesity. It is also important to keep predictors of delayed recovery top of mind. These predictors can include depression, anxiety, fear, avoidance, maladaptive behaviors, job dissatisfaction, and adverse childhood experiences.
As a chiropractor treating chronic pain, you are not just a doctor but a cheerleader and source of encouragement and hope. Facing chronic pain may be one of the most difficult things a patient has gone through, and knowing they have a built-in support system in their healthcare provider can make a world of a difference.
Alan Banaszynski, DC, MSW completed his Master of Social Work at Washington University in St. Louis, Missouri before pursuing his Doctor of Chiropractic from Logan University. After his graduation in 2000, Dr. Banaszynski worked in private practice for a decade before becoming a clinician and professor at Logan's Montgomery Health Center. Contact info: [email protected]. (314) 805-5713.
