By Dr. Mercola
Pain is a widespread problem today, delivering serious blows to people's health, happiness, and productivity. The experience of pain is highly subjective—people feel pain differently. The pain process itself is a multifaceted phenomenon and understanding it has become a major focus of scientific inquiry.
The documentary The Secret World of Pain explores the biological, psychological, and genetic aspects of pain, including genetic mutations that interfere with pain signaling and even render certain individuals completely unable to experience pain—which can be quite dangerous.
Some of these rare individuals are featured in the film and are of great value to pain researchers. In addition to genetics, events in early childhood also help determine how you experience and respond to pain later in life.
The good news is that your pain response is not indelibly hardwired into you, in spite of your genetic predispositions and early childhood experiences. Studies show it's possible to distract or "manipulate" your brain into responding differently to pain—excellent news if you are a chronic pain sufferer.
With a few effective tools, you can manage pain effectively and reduce, if not eliminate, your reliance on painkiller drugs. This is important because these drugs introduce a whole new set of health risks, regardless of whether they are prescription or over-the-counter (OTC).
How Extensive Is the Pain Problem?
The latest statistics indicate that pain is a massive problem. According to the Institute of Medicine report, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research,"1 pain costs society between $560 billion and $635 billion annually—amounting to about $2,000 for every man, woman, and child living in the US.
Part of this cost is lost productivity. Overall, workers lose an average of 4.6 hours per week of productive time due to pain conditions, regardless of age. According to the American Academy of Pain Medicine, pain affects more Americans than diabetes, heart disease, and cancer combined.2
The global market for pain management is forecast to reach $60 billion by the year 2015,3 driven by our aging population, lifestyle trends, increasingly frequent surgical procedures, and escalating rates of chronic illness—such as arthritis and cancer.
Pain is an unfortunate sequela of many diseases, as well as their common medical treatments. Low back pain is the leading cause of pain in the US, according to NIH, followed headaches and migraines, neck pain, and facial pain.4 Back pain is also the leading cause of disability worldwide.5
Chronic Pain 'Defies Scientific Explanation'
Chronic pain is a particularly egregious problem, not only in the US but across the globe. As of 2011, at least 100 million adult Americans were estimated to suffer from chronic pain—a conservative estimate, as it didn't include acute pain conditions or children. According to the BBC documentary, chronic pain affects one in five people.
Globally, more than 1.5 billion people suffer from chronic pain, and about 3 to 4.5 percent of the world's population suffers from neuropathic pain, with incidence rates that increase with age.
In those with chronic pain, the pain response is flipped on—and stays on. For some reason, the feedback system is broken and repairing it is one of the greatest challenges facing medicine today.
Chronic pain, such as persistent pain after a stroke or the pain associated with fibromyalgia, is especially devastating because it serves no functional purpose and responds poorly to conventional treatments.
For chronic pain sufferers, pain signals fire incessantly, causing a cascade of changes to the nervous system that amplify these signals. This bombardment of your nervous system can significantly damage your brain, structurally and chemically. Brain scans show that chronic pain sufferers lose significant amounts of gray matter from their prefrontal cortex.
Determinants of Your Pain Experience
How can one person saw off his arm to escape entrapment and feel NO pain, while another may be in pain around the clock, absent of any pain stimuli? Geneticists believe DNA explains how people experience pain differently. Hundreds of genes and millions of neurons are responsible for transmitting messages between your body and brain.
On the other hand, many psychologists believe how you experience pain as an adult is determined by your early childhood experiences, and your beliefs and perceptions about pain. Chances are, both geneticists and psychologists are correct!
Mutations on one gene—the SCN9A gene, involved in the regulation of sodium channels—are responsible for congenital insensitivity to pain. But different mutations on that same gene can cause "paroxysmal extreme pain disorder," a condition where pain signals are mercilessly amplified.6
But genes can't explain everything—key life experiences are just as important. Pain pathways formed in early childhood are intricately connected with touch pathways. In fact, a pain pathway can be thought of as an overstimulated touch pathway.
Preemies show stronger brain activity than normal babies, suggesting heightened sensitivity to pain. This is believed to be associated with their exposure to a greater number of painful procedures when their nervous systems are so immature, which affects the development of their pain pathways.
This doesn't happen to all preemies, but it does give powerful insight into how pain responses develop. Interestingly, pain receptors and responses differ between the genders. Studies show that women experience pain more acutely than men.7
A 2005 study showed that women have 34 nerve fibers per square centimeter of facial skin, compared to only 17 for men. Women also report more pain throughout their lives, in more areas of their bodies and for longer durations.8
Emotions Play a Significant Role in Pain Intensity
Every pain experience activates different parts of your brain, creating its own neural signature, and this determines how much something hurts. Emotions play a key role, including anxiety, happiness, and sadness.
In the documentary, brain-imaging studies reveals how participants' brains light up differently when pain is paired with different emotions. In fact, multiple regions of your brain are involved with every pain experience—sensory, attention, motivation, and decision-making areas all contribute to how much pain you feel. Each pain experience is a unique, shaped by mood and context.
Emotional pain activates the same pathways in your brain as physical pain, which is one reason why being rejected "hurts" so much! The term "broken heart" turns out to be much more than a metaphor, as emotional stress is linked to chronic inflammation, lowered immune function, increased tumor growth, and other serious health concerns.
No one understands the power of emotional pain more than those trained in torture. According to the CIA's "torture manual," the threat of inflicting pain triggers fears that are more damaging to the person than the pain itself, because people typically underestimate their capacity to withstand pain.9 This is an excellent example of how powerful your beliefs and expectations influence your experience of pain.
An interesting study at Duke University10 tested how expectations influence pain relief. Participants were given painful electrical shocks, then placebo pills. A placebo pill costing $0.10 alleviated pain for about 64 percent of the participants, but an identical placebo costing $2.50 reduced pain for 85 percent of the participants.
Prescription Painkillers Are Bad News
It is shocking just how little education physicians receive in medical school about pain management, despite the fact that pain is one of the most common and debilitating conditions they will face with their patients. Most European medical schools have no required courses on pain, and even when compulsory pain courses are in place, they represent just 12 hours of a six-year program. With few other tools in their tool bag, it's easy to see why physicians typically resort to prescription painkillers—and as a result, we have an epidemic of prescription drug abuse and related deaths.
Prescription painkillers typically work by binding to receptors in your brain to decrease your perception of pain—but they also create a feeling of euphoria that can easily lead to physical dependence or addiction. Painkillers can also result in allergic reactions, slowed breathing, and death, if too many are taken, and the risks are compounded if you add alcohol into the equation.
Painkiller addiction is at epidemic levels; in the UK, significantly more people are addicted to over-the-counter and prescription painkillers than to illegal drugs. In the US, it's a similar story. According to CDC, prescription painkiller overdoses killed nearly 15,000 Americans in 2008, which is more than three times as many as in 1999.11 Middle-aged adults have the highest prescription overdose rates. In 2010, there were four times more deaths among women from prescription painkiller overdoses than for cocaine and heroin deaths combined.12
Even if you don't become addicted to painkillers, long-term use can significantly increase your risk for depression. The drugs may reset your brain's reward pathway to a higher level, making it more difficult to experience pleasure from natural rewards like food. Seventy-seven percent of chronic pain sufferers who take opioid painkillers report symptoms of depression, and 86 percent report inability to sleep well, as well as other impairments to their quality of life.13
Even non-narcotic painkillers are risky. Non-steroidal anti-inflammatory drugs, or NSAIDs, are among the most widely used painkillers in the world. In the US, more than 70 million prescriptions for NSAIDs are written each year. And each year, an estimated 107,000 patients are hospitalized for NSAID-related gastrointestinal complications—at least 16,500 NSAID-related deaths occur each year among arthritis patients alone.
All NSAIDs, including aspirin and ibuprofen, are associated with potentially serious side effects such as atrial fibrillation, hypertension, and GI bleeding. The best way to avoid the downsides to painkillers is to avoid taking them in the first place. A better approach to pain is treating it with natural, drug-free strategies, before resorting to OTC or prescription drugs.
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Study Shows Distracting Yourself May Cut Pain in Half
The good news is that you're not stuck with your genetics and old pain wiring—at least, not completely. As multiple studies have demonstrated, your pain pathways are plastic—they can be molded and transformed using a variety of approaches, because so many areas of your brain and nervous system are at play.
Researchers on the burn unit at Seattle's Harborview Medical Center are capitalizing on the fact that the brain's attention centers can be "distracted away" from a painful experience. Burn victims frequently undergo painful wound care procedures and debridement. Since we all respond strongly to visual stimuli, even the mere sight of wound care instruments can amplify pain for burn victims. So researchers developed an action video game, called "Snow World," that burn patients could engage in during wound care. The results have been astonishing—burn patients experience more than 50 percent less pain during their burn treatments when playing Snow World.
Your brain has limits to its processing power, so if you're highly engaged in an activity, your brain will not be able to process all of the pain signals. The net result is that you experience less pain. Similar studies show that when your mind is encouraged to "wander" away from painful stimuli, an opiate-rich region of your brain is stimulated, resulting in pain suppression.14
Another new technique that shows great promise for pain treatment is transcranial magnetic stimulation, or rTMS. Altering your brain activity with magnetic fields may indeed relieve chronic pain, but it's also been found useful for treating depression, obsessive-compulsive disorder, and Parkinson's disease. Unfortunately, the treatment is not yet widely available and is fairly pricey. According to Scientific American:15
"The magnetic field affects the electrical signaling used by neurons to communicate, but how exactly it improves symptoms is unclear—scientists suspect rTMS may redirect the activity of select cells or even entire brain circuits."
Medical Cannabis Is Typically Highly Effective for Pain Control
In California, medical marijuana has been legal for 18 years. Dr. Allan Frankel, a board-certified internist in California, has treated patients with medical cannabis for the past seven years. By and large, cannabis is highly favored by people across the US. According to Dr. Frankel, 85-95 percent of Americans are in favor of medical cannabis, and 58-59 percent are in favor of legalizing marijuana. The pharmaceutical industry strongly opposes medical cannabis, as it's their stiffest competition—particularly when it comes to treating pain, anxiety disorders, and seizures. Cannabis can take the place of a wide variety of synthetic drugs, and the last thing they want is a therapy that's going to take away from their bottom line.
Dr. Frankel has used cannabis to treat a variety of pain disorders, including degenerative neurological disorders like dystonia and multiple sclerosis. Although he has experienced many successes, he is reluctant to call it a panacea. Nevertheless, occasionally his patients will experience very dramatic results. Cannabis can be eaten, smoked, vaporized, or applied topically as a cream. Even eating raw cannabis—meaning, eating the leaves in a salad or juiced—can have healing effects, including pain relief, reduced anxiety, and improved sleep.
The effects are largely dose-dependent, but the dosing can be a bit tricky. Dr. Frankel shared that some patients may be taking 10 or even 100 times higher dosage than is really needed to treat their ailment. Access to medical cannabis remains a problem for many. At present, only 20 US states have legalized cannabis for medical purposes, but access is gradually expanding as more states vote in legalization. In states where medical cannabis is legal, you can join a collective, whose members have the legal right to grow and share cannabis medicines with each other.
Effective, Natural Pain Control Measures You Can Implement TODAY
Everyone's experience of pain is different, so you may have to do some experimenting to see what strategies work best for you. The following table lists many tried and true non-drug pain therapies that have stood the tests of time and scientific scrutiny.
NATURAL PAIN CONTROL Treatments Medical cannabis has a long history as a natural analgesic.16 Its medicinal qualities are due to high amounts (about 10-20 percent) of cannabidiol (CBD), medicinal terpenes, and flavonoids. As discussed in this previous article, varieties of cannabis exist that are very low in tetrahydrocannabinol (THC)—the psychoactive component of marijuana that makes you feel "stoned"—and high in medicinal CBD. The Journal of Pain,17 a publication by the American Pain Society, has a long list of studies on the pain-relieving effects of cannabis. Emotional Freedom Technique (EFT): Few people want to be told that their pain is psychological or emotional in origin, but there's quite a bit of evidence that backs this up. Underlying emotional issues and unresolved trauma can have an enormous influence on your health, particularly as it relates to physical pain. Dr. John Sarno, a psychiatrist who uses mind-body techniques to treat patients with severe low back pain, has experienced more than 80 percent success using EFT. Acupuncture: A novel experiment showed that acupuncture relieves pain by deactivating certain parts of the brain, particularly in the limbic system, which is involved with pain perception. Acupuncture stimulates the conduction of electromagnetic signals, which may cause your body to release natural pain-killing chemicals/endorphins. Other studies have found acupuncture more effective for chronic pain than drug treatment.18 Massage: Massage releases endorphins, which help induce relaxation, relieve pain, and reduce stress chemicals such as cortisol and noradrenaline. Latest studies suggest many people may not be getting massages frequently enough for pain relief—two or three 60-minute massages per week may be necessary. Chiropractic: According to a study published in the Annals of Internal Medicine19 and funded by the National Institutes of Health, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain-free in 12 weeks, compared to those who took medication. Relearn proper posture: Foundation Training—an innovative method developed by Dr. Eric Goodman to treat his own chronic low back pain. The exercises are designed to help you strengthen your entire core and move the way nature intended. K-Laser: Laser therapy helps reduce pain and inflammation and enhances tissue healing—both in hard and soft tissues (muscles, ligaments, and bones). Laser therapy can be helpful for acute and chronic issues, alike. Mind-body approaches such as yoga, Tai Chi, biofeedback, breath work, and music therapy may be effective. Meditation can help you reduce stress-induced inflammation. Even holding hands with a loved one can relieve pain! Applying ice or heat, or alternating between the two, can provide relief and facilitate healing.20 Foods, Herbs, Creams, and Other Supplements Astaxanthin: One of the most effective fat-soluble antioxidants known, astaxanthin also has potent anti-inflammatory properties and in many cases works more effectively than anti-inflammatory drugs. Higher doses are typically required—you may need 8 mg or more per day to achieve this benefit. Ginger: This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice. Curcumin: In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. A prior study also found that turmeric extract (rich in curcuminoids) blocked inflammatory pathways, effectively preventing the overproduction of a protein that triggers swelling and pain. Boswellia: Also known as boswellin or "Indian frankincense," this herb contains specific active anti-inflammatory agents. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients. Krill Oil: Many clinical studies have found the omega-3 fats EPA and DHA, contained in krill oil, to have anti-inflammatory properties beneficial for pain. Bromelain: This enzyme, found in pineapples, is a natural anti-inflammatory. Bromelain can be taken in supplement form, but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful. Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and anti-inflammatory. I have used a topical CMO preparation myself to relieve ganglion cysts and a mildly annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. Evening Primrose, Black Currant, and Borage Oils: These contain the essential fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain. Capsaicin Cream: Capsaicin comes from dried hot peppers and has pain-relief and anti-inflammatory properties. Capsaicin depletes your body's supply of substance P, a chemical component of the pain signals your nerve cells transmit to your brain. It is available in pain-relieving creams and patches, and has shown promise for relieving shingles pain, osteoarthritis, psoriasis, and more.