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I practice pain management on a daily basis. Most people see a chiropractor
because they're in pain. My patients consult me because they have a grabbing
painful back that is keeping them up at night, or neck and arm pain that won't
go away and is taking over their life. I might see a young woman with debilitating
migraines, who wants an alternative to drugs; a weekend athlete suffering from
an injured shoulder; or an orchestra violinist whose livelihood is threatened
by the pain of a repetitive stress injury.
Broad Pain Categories
As a specialty, pain management deals with two broad categories of pain:
intractable pain, and chronic pain. Intractable pain is
a term first used by the British after WWII as a clinical definition to designate
those soldiers who required morphine for constant pain. It is a useful term
to designate patients who are in excruciating and constant pain of such severity
that it dominates virtually moment of their existence. Chronic pain is
ongoing pain, not usually constant and less severe than intractable pain that
persists beyond an expected time frame for healing and hasn't responded to the
usual means of pain control measures.
Chronic Pain May Affect Daily Activities
I don't treat intractable pain -- which is treated medically with opiate drugs
and surgery -- but I do treat chronic pain. The point at which pain has become
chronic cannot be precisely defined. It must be diagnosed on a case-by-case
basis. Often a patient has had persistent pain for some length of time, or has
had reoccurring pain, and has tried a number of different approaches without
significant relief. All pain has the potential to become chronic.
Consider a Chiropractor's View
How does a chiropractor, a drugless doctor who specializes in conservative
care, view pain -- especially chronic pain -- and its management? Like my medical
colleagues, when I have a patient in pain, I try my best to alleviate it as
quickly as possible, but there are differences. Let's follow a chronic pain
patient who comes into my office for a sense of how a chiropractor views pain
management.
The Chronic Pain Patient
Mary, has been to a number of different doctors before she comes to see me.
Referred by a friend, she has already seen her primary care physician, an orthopedist,
and a neurologist. She has had a course of physical therapy and been to an acupuncturist.
As a conservative practitioner who does not treat organic disease, I appreciate
the patient who has already been to medical specialists who have ruled out an
organic cause-such as cancer or infection -- for the patient's pain. Rather,
the pain disorder has been considered "functional", a disturbance which is not
a progressive disease, but a disturbance of function. Most of my chiropractic
practice is in what can be called "functional medicine".
Of course, I cannot definitively rule out disease, because it is possible that
an underlying disorder was missed or it has not yet manifested itself. On the
basis of the past medical findings and my own tests, however, I proceed with
the assumption that the presenting disorder is functional.
Copyright 2005, Arn Strasser DC
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