Whom should you visit first for a problem with chronic pain? Is Fibromyalgia a real disease or is a manifestation of chronic pain gone bad? Should chronic pain be a normal part of aging? Why is it so difficult to get effective care for why you ache without searching for a bottle of pills.
A while ago a patient told me this humorous story; A patient of his would always look at his grandfather when he got up in the morning. He would sit up in bed and say ucch. As my friend tells it, now that he was 65 years of age, he understands exactly what he meant. There is truth in this story, as my aging body try’s to deal with how an aging body functions, while trying to play the aging game better. The other truth is that aging is not a disease, and neither is pain, but chronic pain can be all encompassing and frustrating to the sufferer. What is more frustrating is that many of the methods offered to patients today for pain are addictive, risky, expensive and non curative. Often, those who offer pain management or other methods to improve or resolve pain are treating the symptom, while failing to understand why you hurt.
The opioid crisis
The opioid crisis has been borne out of an idea from the 1960’s that pain management by medical providers was of extreme importance, yet they had very little training in what chronic pain was and why their patients were in pain. Their only tool was medication, and since their education offered them only three credit hours in musculoskeletal diagnosis and treatment, they worked solely on the basis of a medical evaluation, blood tests, a history of the painful part and the dispensing of medication to treat the pain.
The crisis continues because the public who wants drug free safe care of their condition has been incentivized to take drugs as insurance companies have made it more expensive to get care that is more appropriate with high deductibles and tiered networks. Only one company, United Healthcare has looked at years of data and decided that this is inappropriate and is rolling out a program to make it cheaper to visit chiropractors, therapists and other non drug providers first. They realize that chiropractors and other non drug providers in the long run are cheaper and safer than patients visiting their regular doctor first to get a medication which masks the symptoms, rather than improves the problem.
When Rheumatologists emerged from a meeting in 1990, the term fibromyalgia was borne and it categorized a particular type of pain that was throughout the body and affecting sleep as a disease. Doctors are still looking for the right drug to treat it other than Lyrica, which was a sleep aide in Europe. The rheumatologists who were involved in developing this disease description had little training in how to diagnose the musculoskeletal system, yet they influenced generations of patients and doctors into thinking they now could diagnose or have this this disease. Reading the book, Cheating Mother Nature, what you need to know to beat chronic pain can help you understand Fibromyalgia since it has an excellent chapter explaining what the tender points described in the disease actually are.
Who is best qualified to diagnose and treat chronic pain?
Currently, two groups of providers are uniquely qualified to diagnose musculoskeletal conditions. These include chiropractors who take a holistic approach because they realize that often the painful part is not the mechanism behind chronic pain. The other group is physical therapists who use exercise, and work mostly by providing the care that doctors prescribed to the body part in pain and are well trained in rehabilitation protocols. The chiropractic profession uses exercise, nutraceuticals (nutritional supplements that help solve a health problem), manipulation, rehabilitation and because they are direct access, they will diagnose and then offer treatment based on the diagnosis. Foot orthotics are often used as well to balance out an asymmetrical gait. Both professions use methods that improve the way you move.
A recent study published in the Annals of Internal Medicine through the American College of Physicians offered some advice regarding back pain which included a number of methods used by chiropractors on a regular basis including exercise, manipulation, myofascial release, and movement based therapies. While they did not recommend one type of care specifically, they were quite firm on deemphasizing medications and surgeries, two of the mainstays of modern medical approaches because they were not supported by years of medical data.
Recently, Consumer Reports discussed chronic pain and they even suggested that a combination of approach is what works for chronic pain. This is what chiropractors do however, ironically, they never mentioned that for chronic pain, you should consider visiting a chiropractor first. More surprising is that Consumer Reports has shown that chiropractors have the highest levels of satisfaction when it comes to back pain treatment, yet there is no mention of the profession in their article.
The underlying mechanism of most chronic pain is movement and adaptation and the Annals of Internal Medicine supports that idea since everything they mentioned that works is movement based.
Who should you see first for chronic pain? The evidence supports seeing a chiropractor first. Whom you see first can determine your cost, success or failure and the safety of your experience in trying to mitigate chronic pain.