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    Everyone has experienced pain in some form or fashion. But, acute pain—such as stubbing your toe or breaking a bone—is uniquely different than chronic pain. People with persisting back pain, or residual pain from an injury, represent just one sect of chronic pain sufferers.


    Individuals with arthritis, certain autoimmune diseases, cancer, diseases like fibromyalgia, irritable bowel syndrome, and many more conditions are also victims of chronic pain’s impact. And, anyone of any age can be dealing with this issue.


    “All are equally valid. None of these types of pain are more ‘real’ than another, but it is important to acknowledge that not all pain comes from the same place. I say this because it helps us guide management,” states Dr. Molly Webber, Family Medicine Doctor at Palouse Medical.



    Patient-Focused, Team Approach to Chronic Pain Management


    Ideally, chronic pain management will enlist multiple resources and providers to assess the type or cause of pain and come up with a management plan. This team is typically led by a primary care physician, but it may also include a variety of specialists, such as physical therapy, occupational therapy, and behavioral health providers. Personal support members are also key for one’s success (e.g. a patient's family, friends, caretakers).


    While some patients’ chronic pain is easily identifiable, other cases need deeper investigation. The cause will determine the next steps in an individual’s pain management plan.


    “We set functional goals that matter to the patient. This is really important, because not all chronic pain can be cured or eliminated, meaning we can't always make chronic pain go down to zero. Instead, we frequently have to find ways to make pain manageable for the patient so they are able to do things that are important to them,” explains Dr. Webber. “This is such an important step, because you have to make goals that are realistic and measurable. If the patient's goal is to be able to work a certain number of hours per week, or walk their dog a certain number of times per month; we have a benchmark that we can measure against.”



    Building a Chronic Pain Management Plan


    With the opioid epidemic on every healthcare provider’s mind, there has been a concerted effort to explore alternative therapeutic options. Opioids can be appropriate in various situations, but they also pose a risk of significant harm. Per Dr. Webber, the first step in creating a treatment plan is rooted in the type/cause of pain.


    “I try to categorize what I'm trying to target before starting. One category would be thinking about the underlying problems. In arthritis, for example, it’s about focusing on things that have to do specifically with your arthritis, whether that's physical therapy, an injection in your knee, maybe seeing a surgeon. Those are things that are really specific for that problem,” she notes.


    Another category focuses on targeting any underlying conditions that might contribute to making a patient’s pain worse, such as depression, anxiety, stress, or sleep problems. These conditions may not be causing the pain, but they are likely contributing to one’s self care. “This whole other bucket of problems—which if we treat—can also help with the pain,” adds Dr. Webber.


    Massage, acupuncture, chiropractic, biofeedback exercises, and even hypnosis are also helpful as non-medication treatment options. Ultimately, the most successful pain management plan is one that works best for the patient—but which is guided by a team of pain management experts.


    “Some people can feel a little overwhelmed by not knowing where to start when they're in chronic pain; how to start the process. My recommendation is to begin thinking about building your team. So, bring it up to your primary care doctor or find a primary care doctor if you don't have one. Let them know very specifically what it is you want to work on and what your goals are,” advises Dr. Webber. “This is a big field, but the first step is really building your team.”



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