You’re in pain and you’ve reached the end of conventional medicine
Do you often wonder if your long term struggle with pain will ever end? Do you feel like you’ve exhausted all the available pain management options? Very sadly, you are not alone. Chronic pain has been dubbed a healthcare epidemic, with the CDC estimating that approximately 50 million Americans are living with some form of chronic pain (1). Maybe pain is impacting your job performance or your relationships. You may be living with chronic pain every minute of every day, and it’s killing your mood and desire to engage in the activities you love.
The conventional medical system offers only drug therapy options (that may be addictive) and surgical procedures (that are costly and risky). This situation leaves you and your healthcare providers without safe options to treat chronic pain and frustrated to the point of depression.
Despite this bleak outlook, a new paradigm of pain science is emerging, one that offers a ray of hope to the world, and one that pain-focused clinicians like me are able to explain through one-on-one conversations and treatments suited to you specifically, drawing on herbal medicine, acupuncture and joint adjustments, physiotherapy tools, lifestyle optimization, and therapeutic movement.
Why is it often the case that for many people, chronic pain can linger indefinitely, sometimes for years after an accident? I want to empower you with the agency, knowledge, and resources to make meaningful improvement in how you feel for the long term.
Our misunderstanding of pain is hurting you
You’ve heard that physical pain is due to structural damage or deterioration. In the case of arthritis (both osteo and rheumatoid) and acute injuries, this is true, yet for everyone else living with chronic pain, this explanation falls short of reality.
When an injury occurs, depending on the tissue type (ie: bone, ligament, tendon, or skin), healing is often complete within 4 – 8 weeks followed by a very gradual remodeling phase. If a severely strained lower back muscle is fully healed after 4 – 8 weeks, why can the pain last for weeks, months, or even years longer?
A new understanding of pain has developed over the past few decades (2), and it finally recognizes the true root cause of pain. Chronic pain occurs because your nerves are on high alert, anticipating further injury, not because the nerves themselves are damaged.
Using pain patterns for your specific treatment
The first step I use in relieving your chronic pain is to identify your specific pain pattern. This allows me to tailor pain management treatment for your specific situation. First, I will determine if there is an injury, and what options will support healing and decrease inflammation, using both natural and conventional standpoints. If your pain is chronic with no associated injury, I will also add hands-on modalities like acupuncture and spinal adjustments to help retrain, readjust, and calm your nervous system so that pain signals return to normal. Maybe it is the case that your pain experience is more ambiguous, widespread, and has developed gradually over time. This would benefit from dietary and lifestyle changes such as stress reduction strategies and improved sleep quality. In all of these scenarios above, the broad Naturopathic toolkit offers diverse solutions, from which we will develop a holistic, whole-person approach to treating your pain. Let me explain each of these patterns in more detail.
Pain from injury or outside source
Nociceptive pain is the result of “noxious stimuli”: injury or irritation. The brain registers the subsequent inflammation as painful. From an evolutionary standpoint, this is a threat-detection mechanism (ie “that hurts, bad idea to keep doing what you’re doing”). Nociceptive pain tends to feel sharp with movement, dull and achy at rest, and is generally better at night.
Inflammation takes place after injury to repair tissue. Inflammation can also be chronic, and occur throughout your body due to diet (processed foods, refined sugar intake, alcohol) and lifestyle factors (lack of activity, emotional stress). Our white blood cells secrete a chemical called cytokines, that both address acute injury and agitate nerves at the biochemical and cellular levels.
Chronic pain at a specific area of the body
Peripheral sensitization is something that develops over time in a specific area of the body For example, you may strain your lower back landscaping your yard. A strain is a tear of a muscle’s tendon that attaches to bone. Depending on severity and need for surgery, such injuries will take between four and eight weeks to completely heal. During this time of healing, you may unconsciously tense your muscles to prevent further injury. This pattern can persist long after the injury has healed and becomes a part of chronic pain (3).
Pain that comes from your brain
Central sensitization is experienced as widespread, all over your whole body pain, without a specific cause. A frequent description of this pattern is “wandering pain”. Sadly, since this pain pattern often remains a medical mystery, patient’s often hear from clinicians the remark that “there’s nothing more we can do for you”. Needless to say, this understanding leaves people feeling defeated, hopeless, and without options.
It’s not fully understood by current science, but one theory is that central sensitization is a consequence of long term chronic pain changing the brain’s ability to perceive pain (4). Unfortunately, it can also develop in the absence of chronic pain, gradually developing out of nowhere, without an identifiable cause. There could be a variety of factors: genetics, hormones, and life stressors.
Fibromyalgia is now understood to be a form of central sensitization. There also appears to be a connection between central sensitization and depression, life stressors, and lifestyle . Treatments, like medication, that are effective in relieving pain from injury are not effective in relieving pain due to central sensitization.
Start with an holistic examination of your pain from east to west
There is nothing quite as satisfying to me than removing the experience of pain from your daily life. In our initial consultation, we will take the time to explore the root of the issue, the type of pain pattern you’re living with, and determine unique aspects of your constitution that modern conventional medicine often ignores. You will receive a hands on treatment featuring a combination of acupuncture, spinal adjustments, cupping, gua sha, and physiotherapy devices, as well as a detailed at home, self-care treatment strategy. It may take several visits before we make significant progress, but my goal is for you to experience pain relief on your first clinic visit, and for up to a week beyond that. I’m looking forward to meeting you, and beginning our work together on this meaningful mission.
Dr. Grady Nesbitt is a naturopathic physician at Heart Spring Health in Portland, Oregon whose mission is to provide same day pain relief so that you can fully enjoy all that life has to offer. Using a diversity of modalities such as acupuncture, spinal adjustments, and physiotherapy devices, combined with naturopathic staples such as herbal medicine, homeopathy, and nutritional counseling, Dr. Nesbitt provides solutions for sports injuries, all types of chronic and acute pain, and degenerative conditions such as osteoarthritis and osteoporosis. His skills were acquired over nine years of medical training and orthopedic focused preceptorships at both the prestigious National University of Natural Medicine (NUNM) and Bastyr University, as well as decades of athletic pursuit. Click here to learn more about Dr. Nesbitt.
- CDC – Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. Weekly – Periodical 2018. James Dahlhamer, PhD; Jacqueline Lucas MPH; Carla Zelaya PhD; Richard Nahin PhD; Sean Mackey MD, PhD; Lynn DeBar PhD; Robert Kerns, PhD; Michael Von Korff ScD; Linda Porter PhD; Charles Helmick MD www.cdc.gov
- Back in the 1600s, the French intellectual Rene Descartes postulated that pain is the result of tissue injury sending signals to the brain, a phenomenon that the modern medical community would label “sensory input” from nerves. While certainly ahead of his time with such a theory, it is rooted in the assumption that there is a “Noxious Stimuli” (i.e. injury, trauma, or just generally something physically bad) present that’s responsible for an individual’s experience of pain. Fast forwarding roughly 350 years, Dr. Ronald Melzack was in the process of developing the “Neuromatrix” hypothesis of pain: In summary, that the sensation of physical pain is an emergent property resulting from a multitude of influencing factors such as memories of painful experiences (“the time I hurt my back doing x y and z…”), sensory systems (witnessing the painful experience of another), the limbic system (often called the “emotional” or “mammalian” region of the brain), sensory input, habitual action and movement patterns, and stress regulation systems. This current understanding recognizes pain experiences as divisible into three subcategories, called Nociceptive, Peripheral Sensitization, and Central Sensitization. I’ll explain these in more detail, but know that there’s inherent significance to recognizing a particular type of pain, since that recognition will inform an effective and tailored treatment plan, as well as offer the therapeutic benefit of patients understanding why they are in pain and what they can do about it as far as self-care.
- Nerve cells (neurons) activate and send signals by way of an electrochemical gradient (ie, electrolytes like sodium, calcium, chloride, magnesium, and potassium, etc), whereby the movement of these mineral ions carry with them the movement of electrical charge. The specific microscopic change that occurs to nerve cells affecting their functionality is that they produce more channels for these ions to move through. If there are more ion channels (referred to as “abnormal impulse generating sites”), nerves in a particular area of the body are more excitable, which works out to someone experiencing more pain, near constantly, and in the absence of any associated injury. This is the evolutionary threat detection system gone awry: That nerves are on hyper-alert, producing a threat signal where there is no threat or structural damage.
- Brain changes specifically occurring in the Thalamus, a structure in the brain that is basically the information processing hub of the nervous system