"Aging is not for the faint of heart. Moving from my bed to the toilet to pee in the middle of the night for the fourth time can feel like an Olympic endurance event. As I made my way to the bathroom last night, I think the snapping and popping of my achy joints actually woke up my wife. I am always tired and just can't move like I used to. It hurts too much when I try."
– Stephen, 61
Stephen is a new patient at my clinic. Suffering from chronic low-back pain and osteoarthritic knees, he was interested in trying acupuncture to help alleviate his pain.
Anyone living with chronic pain knows that it amounts to much more than physical discomfort. Anxiety and depression, fatigue, sleeplessness, lack of drive, a weakened immune system and disability often accompany long-term pain, suggesting that the condition is more of a whole-brain disorder than simply erratic pain signalling.
Moving through life in a body that reminds you of its significant limitations with every movement can have a devastating impact on your mental health and quality of life. Like it is for many Canadians, this is Stephen's reality.
It is estimated that one in five Canadians suffer from chronic pain. With an aging population this number is likely to climb. Statistics Canada reported that roughly 27 per cent of seniors living at home and 38 per cent of those living in health-care institutions suffer from chronic pain – and 60 per cent report that it interferes with most daily activities.
By definition, chronic pain is any pain lasting more than 12 weeks. It is different from acute pain, a normal sensation that acts like a warning of possible injury. Chronic pain, which can persist for months or more, may begin after an initial trauma or injury, such as a back sprain, as it did many years ago for Stephen. There may also be an unresolved cause, such as illness. In some cases, however, the cause remains unknown.
Pain itself often modifies the way the central nervous system functions. A patient can actually become more sensitive and experience greater pain with less provocation. This is called "central sensitization." Patients are not only more sensitive to things that should hurt, but ordinary touch and pressure can also become painful. Their pain can have an "echo," which fades more slowly than in other people.
The physical toll of chronic pain is obvious. The emotional toll is not, but can be equally devastating. The emotional stress of chronic pain can amplify the experience, creating a vicious cycle. Anxiety, depression, hopelessness, anger and fatigue interact in complex ways with chronic pain and may decrease the body's production of natural painkillers. Even the body's most basic defences may be compromised. There is considerable evidence that long-term, unrelenting pain can suppress the immune system.
Treating patients with chronic pain presents many challenges. There are no standards, and traditional medical approaches commonly tend to look at chronic pain as a secondary problem. This opinion, however, is changing. Clinicians who specialize in treating chronic pain now recognize that it is not merely a sensation, like touch or smell, but rather is significantly influenced by how the brain processes pain signals. More and more experts and institutions are beginning to define chronic pain as a disease.
This shift is leading many clinicians to recommend acupuncture – often thought of as a last resort – as a therapy of choice. Acupuncture is increasingly being recognized by Western medicine as an effective alternative or adjunct to conventional treatments for a long list of conditions, including headache, menstrual cramps, joint pain, low-back pain and asthma, as well as for the side effects of chemotherapy and nausea related to pregnancy.
Although acupuncture has long been used to treat chronic pain, its effectiveness has been a controversial topic among physicians and scientists. This is largely because no biological mechanism has been identified to explain how the insertion and stimulation of specialized needles at specific points on the body generates lasting effects.
In an extensive analysis, published in 2012 in JAMA Internal Medicine, data from nearly 18,000 individuals involved in 29 high-quality clinical trials demonstrated that acupuncture is an effective treatment for chronic back and neck pain, osteoarthritis, shoulder pain and headaches. Acupuncture has been shown to be more than just a placebo.
I commonly use acupuncture in my practice as a pain management tool for patients suffering from chronic pain. After more than 15 years of experience, nearly every day I witness a patient's positive response to acupuncture that cannot be explained using Western medicine. It is understood that acupuncture triggers the release of endorphins, the body's natural painkilling chemicals, and affects the part of the brain that governs serotonin, a brain transmitter involved with mood, resulting in pain relief. But there is more to it than that. Acupuncture triggers a healing response that is still not clearly understood.
Stephen is not looking for a miracle or the ability to wind back time. A pain-free walk to the toilet in the middle of the night, however, would make him a happy man. With an open mind and a good sense of humour, this is where his journey will start.
Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.
Dr. Dwight Chapin, B.Sc(H)., D.C., is the clinic director of High Point Wellness Centre in Mississauga (highpointclinic.com), team chiropractor for the CFL's Toronto Argonauts and on-site clinician for employees of The Globe and Mail. Follow him on Twitter @HighPtWellness.