A senior moment taming pain choose your weapons and your team of helpers carefully gas kush


In “Dream Land: The True Tale of America’s Opiate Epidemic,” Sam Quinones, has valuable insights about who is to blame for our current drug nightmare. He points a finger at those who have profited — big pharmaceutical companies, drug advertising czars, overprescribing physicians — but he also points out that as patients, we are often too willing to expect a quick and easy fix provided by a pain pill.

Quinones quotes John Bonica, an anesthesiologist who wrote a classic textbook, “The Management of Pain” and who opened the first pain clinic in America in 1960: “The population wants to be fixed overnight … They have to learn it’s their body, their pain, their health. The work is done by them.”

Bonica may be overstating his case, but people in pain need to make the effort to explore other avenues for pain relief besides drugs. This column will briefly touch on some physical treatments that can help control pain. None of these is a permanent, total pain fix, but several can aid healing and most can give at least temporary relief.

Exercise. Yes, it’s the last thing you want to do when you hurt, but staying physically active is one of the best ways to prevent or at least improve low back pain, arthritis, and even migraine headaches. Strengthening weak core muscles helps prevent back pain. Muscles and tendons that are stretched and supple are less likely to be injured.

Swimming is especially good because it takes the weight off joints. Walking is accessible and allows you to be out among people and in nature. You should choose physical activities that you enjoy. Dr. Phillip Filbrandt of Rehabilitation Medication Associates has found in his own experience that consistent, regular exercise is even more important than the duration or specific type of activity.

Cold and heat, when applied correctly, are cheap and easy options for moderate pain control you can do at home. An ice pack or package of frozen vegetables should be an early response to acute pain caused by an injured muscle, tendon, or ligament.

Cold can also help with chronic pain. It reduces the excitability of muscles, constricts blood vessels to reduce swelling, blocks the release of histamines, and may decrease the conduction of nerve impulses that signal pain. Tissue temperature should not go below 60 degrees. Also avoid using ice packs for several days in a row because too much cold can restrict blood flow and interfere with healing.

Heat can also help with pain, especially for sore joints. It relaxes muscles and improves circulation, but it can make acute arthritis flare-ups worse if joints are inflamed. While heat from hot packs and heat lamps can heat tissues to about one inch below the surface, deep heat treatments provided by physical therapists and others use other forms of energy like ultrasound and microwave electromagnetic energy to affect areas two inches below the surface or deeper.

Several of the physical treatments available for pain control seem to work on the Gate-Control mechanism whereby the larger nerve fibers that carry sensory signals such as touch or pressure garble the pain message carried by smaller nociceptors, so less pain signal reaches the brain.

While some forms of massage can be painful, a lighter touch may be more relaxing and beneficial for painful conditions such as fibromyalgia or chronic fatigue syndrome. Massage should never be used on inflamed areas of skin or with certain heart conditions, infectious disease, or phlebitis. Physicians and physical therapists may be able to recommend good licensed massage practitioners .

Acupuncture, an ancient art in Asia, has grown as an accepted practice in Western medicine since it was introduced in the 1970s. In Eastern medical thought, the insertion of slender needles into specific areas affect the flow of energy or qi (pronounced chee) that run in meridian channels lengthwise through the body. From a Western medical perspective it seems that the insertion of needles probably release the body’s natural painkilling endorphins and also provides larger nerve stimulation that block nociceptor pain signals.

In 1997, the National Institutes of Health found evidence that acupuncture provided pain relief after dental surgery, and for menstrual cramps, tennis elbow and fibromyalgia. Dr. Filbrandt reports that acupuncture seems to affect the fascia (tissue between the muscles, joints, and tendons) and can help with pain of the neck, shoulder, and some back pain. Acupuncture needles are regulated by the Food and Drug Administration and acupuncture is sometimes covered by insurance.

Low back and hip pain can be helped by Transcutaneous Electrical Nerve Stimulation (TENS). A low voltage electrical current is transmitted through electrodes attached to the skin near the painful area. In keeping with the gate-control theory of pain relief, the electrical impulses close the gate and keep the pain signals of smaller nociceptors from reaching the brain.

TENS units can be purchased for home use and can be worn during daily activities. The effect lasts past the time the unit is turned off. There also seems to be some benefit derived from the fact that the pain sufferer is able to control the current level and therefore the level of pain. Studies have shown that it works better for some than for others, but in my personal experience it is quite effective.

Dr. Filbrandt reports that for those who find the TENS approach to pain control helpful, implanted programmable TENS units are available that are remotely controlled by the patient. They have been found to mute pain substantially. First there is a trial of several days with lead wires inserted and the unit used externally. If that is successful in delivering relief, the device can be surgically implanted. Batteries last up to 10 years. Insurance can cover this procedure.

The application of quick, strong pressure on a joint between two vertebrae, known as chiropractic spinal manipulation, has become part of conventional physical therapy for low back pain. Chico Chiropractor Dr. Matt McCowan explains that spinal adjustment, like acupuncture and massage, works as a Gate-Control mechanism to alleviate pain, at least temporarily. “The patient may only feel better for hours, days or weeks at a time, but it’s pain relief without the daily use of medications that often have side effects that can cause other health issues.”

Furthermore, Dr. McCowan feels that “When pain is caused by rubbing or irritation at the facet joint caused by misalignment (subluxation) or fixation, an adjustment can fix the cause of the pain and the pain does not recur.” Dr. McCowan also offers a spinal decompression protocol of cold lasers and oxygen therapy to treat serious conditions like degenerative disc and joint disease and disc herniations and finds that it provides significant pain relief for around 80% of his patients.

When exploring which forms of physical treatment will provide the most effective pain relief, a pain sufferer should carefully assess credentials and recommendations for the various practitioners available in the area. It is your pain. It is up to you to be a good patient, to make recommended life style changes, to choose your pain team carefully, to follow treatment plans and to assess whether a treatment is helpful for you.

Readers: Have you or a loved one had any personal experience with a Personal Emergency Response System (an “I’ve fallen and I can’t get up” system)? I plan to write a column on these devices and would like your input. Please email leslie.t.howard@gmail.com. with details about your experience.