The Complexity of Pain

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By Mary Carpenter

“THERE ARE hundreds of types of pain, and scientists don’t understand how best to treat their unique features,” reads the NIH Heal Initiative’s announcement of a $50 million, 12-center study to evaluate treatments for pain “…because pain is a lived experience affected by biology (such as an injury or a disease), psychology (such as anxiety or depression about not getting better) and cultural expectations (such as the urge by some to just ‘tough it out’).”

Desperate pain sufferers take drastic measures—from possibly dangerous treatments like DMSO, to unproven ones like sound vibration healing. Other people rely on medication like Advil despite notorious side effects, such as stomach ulcers. For chronic pain that “lasts longer than three months, is taking over your life and hasn’t improved with surgery and medication,” medical centers, such as Cleveland Clinic offer residential programs lasting weeks or months—to work on all “medical, physical and psychological” contributors to chronic pain.

For a DC-area student (who asked that no identifying factors, including her initials be used), infection with the bacteria Bartonella— in the US best known as cat scratch disease—led to months of unbearable nerve pain in her feet that often confined her to home or even bed. Three weeks at Cleveland Clinic’s Chronic Pain NeuroRehabilitation Program did not lessen her pain, she said, but helped her to “handle activities, walking and even playing soccer, and to engage in social events that required standing for periods of time”—with the belief that she was better able to manage the pain, and she feels ready for college next fall.

“You can’t see it, you can’t feel it, and you can’t touch it,” University of California, San Diego pain specialist Mark Wallace told the Heal Initiative. “Pain is the main reason people go to a doctor but…a diverse set of medical conditions is a difficult target to hit,” according to the Heal site. And then there’s the fact that any type of pain—a migraine, bone pain from a tumor, sickle cell disease, pain after surgery, or many others—can feel very different depending on personal circumstances…Because pain is invisible and difficult to define, it’s hard to assign it a simple numerical value, which complicates the search for treatments.”

A different way of thinking about pain—commonly referred to as “Explain Pain”—is based on the idea that pain is an output of the brain—rather than a signal from the body to the brain, from Australian practitioners David Butler and Lorimer Moseley in books that include The Explain Pain Handbook Protectometer. Writes Butler, their “biopsychosocial” approach teaches “people that pain can be over-protective” and “that the brain can turn down the danger message at the spinal cord…it is always the brain that decides whether or not to produce pain.”

Dietary solutions based on the idea that inflammation is a major contributor to joint pain include a 30-day diet that “emphasizes large amounts of antioxidant-rich produce, like berries and dark leafy greens, plus a relatively high intake of healthy fats and seafood, such as salmon and nuts—all of which may be helpful in removing inflammatory triggers,” according to EatingWell.” For those who blame sugar, the “100 diet” limits daily sugar calorie consumption to 100—including natural sugars, for example, apples that contain about 80.

But for some people, the best or only relief comes from prescription drugs, notably Celebrex— “developed with the aim of reducing the common side effects of traditional NSAIDs,” according to the Mayo Clinic. COX-2 inhibitors, “commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps…are as effective as NSAIDs and may be the right choice with less risk of stomach damage.”

For local pain, topical NSAIDs can be helpful on smaller joints and those that are closer to the surface, such as hands, knees, elbows and ankles, according to the Arthritis Foundation.  Voltaren, which is topical Advil, can work quickly – but because an uncertain amount reaches the bloodstream, it might not be a good alternative for people concerned about stomach pain with NSAIDs.

Among topicals is the unproven DMSO, dimethyl sulfoxide—which surfaces from time to time on questionable health sites, but is “possibly effective [for] limb pain that usually occurs after an injury (complex regional pain syndrome),” according to WebMD. Even among pain treatments, DMSO is notoriously difficult to test because of the “death breath” give-away for individuals taking the active drug.

With all the drawbacks of drugs and challenges of long-term programs—especially those involving diet and psychotherapy—some people pursue alternative medicine options, such as sound vibration healing. According to Ohmazing Art of Healing, vibroacoustic therapy (VAT) uses low-frequency vibrations, delivered through specialized devices such as mats or chairs, which can penetrate deep into tissues to promote relaxation and potentially reduce pain sensations. Alternatively, whole-body vibration (WBV) therapy—standing or sitting on a vibrating platform—can help with various health conditions, including peripheral neuropathy.

With any new, severe pain, I begin the days-long drug regimen of Aleve, maximum medical dose morning and night, plus Tylenol as needed in between. For chronic arthritis pain, I apply Voltaren—trying to abide by the no-slathering precaution.  And I investigate new treatment candidates—until I get to the drawbacks: for example, tart cherry juice for pain requires two 12-ounce bottles a day for seven days—starting a week before a strenuous event. For the future, I am planning a session or two of vibration therapy—with the hope of an interesting experience, if not relief of pain.

NOTE: To all my good readers and commenters, this is my last post for MyLittleBird. The site will no longer publish new pieces but will remain open for reading archived posts. I will post future Well-Being articles at https://carmedpub.substack.com. Please email me with story ideas, questions and comments—and to receive Substack notifications—at carmedpub@gmail.com. Thank you for being loyal readers of MyLittleBird.