Technology assists self-care for chronic pain
Article written by Heidi Bilas RN MSc(A), July 2007
Implications of chronic pain
Chronic pain is recognised as "major medical and social problem and a massive drain on national resources". Estimates of the prevalence of chronic pain in the general population range from 7% to 55%. UK estimates of the number of people suffering with musculoskeletal pain vary from 7-16m.
The McEwen Report notes that chronic pain affects between 1 in 5 and 1 in 6 Scottish adults. Of these adults, two-thirds suffer moderate pain, one-third suffers severe pain, and approximately 6% (250,000) suffer severe pain. In addition, one-third of those patients suffer chronic pain all the time. One in 5 pain sufferers have the pain for more than 20 years.
Between 1 in 6 and 1 in 5 patients seen in primary care have chronic pain and service utilisation is up to 5 times more frequently than the rest of the population, yet a national chronic pain strategy is absent.
Chronic pain also becomes a family problem as pain behaviours may cause harm to personal relationships as well as to self-esteem. Family members often feel a loss of control over their daily lives and normal routines, and frustration and anger at the situation facing them as well as from the economic impact.
According to the Dr Foster report 6, chronic pain warrants recognition "as an entity in its own right". Functional disability commonly exceeds what is expected on the basis of physical findings and limitations. Social and workplace demands become difficult challenges, and unemployment is an issue. It is the second most common cause of days off work, accounting for 206m lost workdays in 1999-2000.
Clinical picture and its evolution
Chronic pain is a complex pathophysiologic state. Rather than the generally accepted pain duration of 3 to 6 months as the time that is usually accepted for definition of chronic pain, Cochran (2004) suggests that chronic pain begins when pain becomes a mind dominant or cerebral experience rather than a somatic one. It is pain that continues beyond what is normally expected for either an illness or injury, and occurs on and off over a period of months or years. Chronic pain is not necessarily associated with objective clinical findings corresponding to fluctuations or progression of specific disease.
Our understanding of the underlying mechanisms of persistent pain is still evolving, as is our ability to prevent the onset, evolution, and associated morbidities that are associated with chronic pain. Psychological and social factors play a major role in influencing pain perception and in the development of chronic disability. The behavioural effects are "a product of a mind in disarray, and they are the cardinal symptoms and identifiers of chronic pain".
What treatment is appropriate?
Chronic pain cannot be cured, but is managed best by an integrated multi-disciplinary approach so that patients' needs are assessed and then passed to the most appropriate treatment pathway according to the need. Most services are lacking in some aspect of that multi-disciplinary care.
The treatment of chronic pain condition however is often a frustrating aspect of primary care, as it tends to be resistant to conventional therapies, and drug dependency is a concern. Furthermore, there is ongoing debate, controversy and at times friction among health care providers regarding the optimal treatment of these patients.
For example, pain and ageing, and best practices for elder care is not well researched. Over 4,000 studies related to pain are published annually while only one percent of those look at pain and ageing.
Hence there is a clear need for more investigators to further the efforts of current researchers .
The current provision of chronic pain services is perceived to be inadequate to meet the need. Services frequently fall short of recommended levels of service for access and availability, and there is significant variation in the services available.
The Dr Foster report also examined the availability of specialist chronic pain clinics in the UK. For a first appointment with a pain team consultant the national average waiting time for patients referred by their GP was 20 weeks, and ranged from 4 to 110 weeks. The need for earlier intervention to try and prevent chronic pain is clear. Better solutions and accountability are needed.
Goals of treatment
Appropriate treatment can improve quality of life and functioning, returning patients to more normal, productive, and enjoyable lives. Restoration of a feeling of control is critical.
An important aspect is enlisting the patient as a central figure in the healing process. Self-administration of pain relieving therapies would is undoubtedly a paradigm worth pursuing.
Patients can take responsibility for their own pain management by managing physical, complimentary, and relaxation therapies.
Self care
Numerous factors that play a role in initiating, maintaining, and exacerbating chronic pain. According to Nash (2004), chronic pain management requires both knowledge and the development of self-care skills, to reduce suffering. "Pain is inevitable; suffering is optional."
Living with pain and disability requires an active strategy to better understand, accept and manage the chronic pain condition. Therefore, more emphasis is required on supported active self-management of pain and use of multidisciplinary/multimodal approach to treatment, rather than simply receiving treatment. Defining characteristics of modern pain management programmes include a focus on function rather than disease, on management rather than cure, integration of specific therapeutics, multidisciplinary management, and an emphasis on active rather than passive methods.
What treatment isn't desirable?
With chronic pain, dependency on "pain-killers" is an ongoing risk. While these are chiefly prescription drugs, prolonged use of some OTC products such as ibuprofen and acetaminophen produce side effects. The effects of continuous use of herbal medications are still insufficiently explored.
Drugs are not without concerns and side effects, and caution is needed. Patients may be sensitive to the sedating or cognitive side effects, and toxicity a limiting factor. Risk management remains the primary concern of regulatory agencies and those who are prescribing these therapies, to limit misuse, abuse or inappropriate prescribing.
Role of technology
Demand for complementary and alternative treatment (e.g. chiropracty, massage, or acupuncture) is increasing, as is their acceptance in pain management. Whether the medicine of the future will be an integrated hybrid of complementary, alternative medicine, and western medicine is unknown. Effective modalities that are safer and healthier alternatives than therapies that risk dependency benefit both consumers and providers.
Cell Function
Almost all illness is the result of impaired cellular function. A healthy cell operates at a voltage between 70-110mV in order to produce ATP molecules (Adenosine Triphosphate), which are vital for a healthy body.
A sick cell, with voltage range between 40-50mV loses energy as there is not enough ATP available. Cancer cells for instance only have a voltage of 20mV and are incapable of regeneration, requiring almost 20 times more energy than healthy cells.
Therefore, the human body relies on a healthy cell network to avoid poor circulation, declining performance, premature ageing, and degenerative diseases. Normal cell functioning and energy levels can be achieved with the use of pulsating electromagnetic fields that stimulate cell metabolism, increase oxygen absorption and accelerate the removal of toxic chemicals and waste. This empowers the body to recover its self-healing capabilities.
Pulsed electromagnetic wave field therapy (PEMF) is a long-established medical science and is a universally used and accepted method of therapy. Hundreds of experiments in this therapy has proven that it can reduce pain sensations.
PainSolv® have developed a combination of modalities and applied patented technologies to these proven medical procedures which promises to revolutionise pain management, by making safe, effective therapy affordable and accessible to all chronic pain sufferers around the world, which can be either self-administered or provided by home-carers.
Therapy with pulsating magnetic fields (PEMF) is a relatively new and very effective form of physical therapy. It is not a miracle, but simply a physical (or better, biophysical) modality used for accelerated therapeutic purposes. Pulsed electromagnetic field therapy has been proven to be very effective for pain reduction and the management of chronic pain.
The internationally patented PainSolv® utilises Bioelectromagnetism to deliver gentle pre-programmed PMFT oscillating wave currents in extremely low frequency fields through magnetic energy resonance induction therapy. These extremely low-frequency pulsed electro-magnetic fields (ELF-PEMF) have been proven to be beneficial in bone fracture healing, circulation improvement and alleviation of pain.
Pain should not become the focus of attention in patient's lives because it has such a negative effect on everything they do. While support and understanding are important in treatment so, too and increasingly is self-care. Assistive therapeutic technology, such as the PainSolv, empowers patients to take charge of their own care through self-administration of a safe and healthy modality.
REFERENCE LIST
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Bowsher D, Rigge M, Sopp L. Prevalence of chronic pain in the British population: a telephone survey of 1037 households. Pain Clin 1991; 4: 223-230.
Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain 1993; 9: 174-182.<Actinic:Variable Name = 'ISI'/><Actinic:Variable Name = 'Medline'/>
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*This study is published in the journal Pain Medicine.
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Williams, ME. Improving Geriatric Quality of Life by Integrating Eastern and Western Medicine. Medscape Nurses. 2006. Coverage of: American Geriatrics Society 2006 Annual Scientific Meeting http://www.medscape.com/viewarticle/532941?src=mp