Part I
As COVID-19 pandemic continues to change the relationship between doctor and patient, doctors are trying to adapt to this changing climate and see patients the best we can. But when it comes to chronic pain, telemedicine is truly stretching the capacities of its providers, be that acupuncture, physical therapy or medical doctors.
Approximately 35% or American’s have chronic pain and about 50 million are disabled either partially or totally due to it. Chronic pain has a significant impact on person’s ability to function and quality of life. For one, chronic pain doesn’t just go away and if undertreated can cause complications such as:
- Transition from acute to chronic.
- Increased risk of complications and morbidity.
- Increased physical, psychological and emotional stress.
- Over-stressed immune system.
Transition from Acute to Chronic
Though pain isn’t uncommon, we have to differentiate between chronic and acute. The difference is important to understand because when the acute pain becomes chronic, it has to be recognized and stopped or it will only get worse.
When we are active, pain and injuries are essentially inevitable and we all had them. But after you ice, rest and heat for a few days to a few weeks, pain should go away. If it does not go away, in 3 months it’s considered chronic. In a mild case, we just write it off to getting old, we slow down or even stop doing the activities we enjoy. We gradually loose the mental, emotional and physical boost we used to get from them. We put on the weight, loose muscle mass and our health overall declines and it only serves as a confirmation that we are indeed getting old.
Some push through that pain, when it’s relatively mild and/or use different techniques such as stretching, massage, acupuncture or chiropractic to get their bodies to not hurt. But it wasn’t enough before the pandemic shutdown, it is especially true now.
Take a look at the following example. A 43-year-old female patient, Jane, came in for the pain in the lower back, right glute and knee that she had for years, but recently have gotten worse. Jane has mostly a sitting job and now that she’s working at home. Her kids are home as well and need to be supervised so there is even less walking, her exercise of choice, but she can’t walk more than 10 minutes without pain.
My assessment revealed that her prolonged sitting has been putting pressure on her sciatic nerve and the muscles of the hip that it’s going through. In addition, her right foot was overpronating, causing her femur to rotate externally, thus shortening the iliotibial band (IT). IT connects the lateral knee to the hip and in my patient’s case, transfers forces to the hip and result is pain, especially in the sacroiliac joint. Upon checking her hip, two muscles, gluteus medius and tensor fasciae latae, both were tight and very painful to even a light touch. To treat Jane’s pain, it is necessary to treat her hip muscles, her overpronation as well as shortening of her sciatic nerve. Treatment consisted of electroacupuncture which decreases sensitivity and pain and increases stem cells (1, 2). Stem cells promote healing by increasing the type of collagen that tendon repair and anti-inflammatory cells, known to be a predictor of faster healing time. Next is Clinical Flexibility and Tension-Resistance Exercises. CFTRE is based on kinesiology and bio-mechanics, combined with myofascial and acupressure techniques. It balances the body from the movement perspective and helps to undo the pathological tension. Jane was also prescribed mobility exercises that she could do at home. After 3 treatments her pain was gone and as long as Jane did these, she would be pain free.
Increased Risk of Complications and Morbidity
As if pain wasn’t enough, people with chronic pain experience a wide range of other symptoms. Depression, anxiety, sleep disturbances, lack of energy, neurocognitive changes, reduced libido, drug and alcohol dependence, disability, often disproportional with impairment, marital problems and opioid abuse.
These comorbidities reduce the quality of life of the patient and by themselves cause the loss of working days and obstruct the living of a healthy social life.
Acupuncture is nearly a perfect therapy for these as well as chronic pain. You see, when needles are inserted, that facilitates blood circulation and healing. Next, stimulating the nerves, body is releasing its natural painkillers called endorphins and enkephalins. Further, the immune system is stimulated via the vagus nerve to produce anti-inflammatory chemicals thus decreasing inflammation. Needles also signal the brain to decrease pain responses and to promote healing in the injured area, in addition, it promotes the production of key neurotransmitters in the brain. Serotonin, dopamine, GABA and acetylcholine and various opioid pathways such as cannabinoid. All these together help to explain the modulatory effect of acupuncture in the treatment of numerous diseases and conditions, including drug and alcohol dependence and opioid abuse. (You can read my article on this here).
In Part II will discuss the epidemic of physical, psychological and emotional stress that this virus is creating, how it affects our pain levels, as well as how this puts an enormous pressure on our already overly stressed immune system.
As always, if you have any questions, comments or suggestions, let me know via email, blog, appointment page or call(818)999-0300.
We are open to business and except new patients.
Stay well and safe,
Arthur Gazaryants, DOM, LAC, PNM
