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  • Dr Ashleigh Bhanjan

Chronic pain

Updated: Aug 25, 2023

Introduction


Chronic pain is a debilitating condition that affects millions of people worldwide. It is defined as pain that persists for more than three months and can be caused by a variety of factors, including injury, disease, or nerve damage. Neuropathic pain, a type of chronic pain, is caused by damage to the nervous system and can be particularly difficult to treat.


In this blog post, we will discuss the current concepts in chronic pain and neuropathic pain, including their symptoms, severity, and conventional treatment options.


We will also explore the role of neuroinflammation in the development of chronic pain syndromes and list common disorders. Finally, we will discuss the use of photobiomodulation therapy in treating chronic pain and provide research articles and human trials.


 

Chronic Pain and Neuropathic Pain


Chronic pain is a complex condition that can be difficult to treat. It is often characterized by persistent pain that lasts for more than three months and can be caused by a variety of factors, including injury, disease, or nerve damage. Neuropathic pain, a type of chronic pain, is caused by damage to the nervous system and can be particularly difficult to treat. Neuropathic pain is often disproportionately enhanced in intensity (hyperalgesia) or altered in modality (hyperpathia or allodynia) in relation to the stimuli




 

Conventional Treatment Options


Conventional treatment options for chronic pain and neuropathic pain include medication, physical therapy, and surgery. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and antidepressants can be used to manage pain. Physical therapy can help improve mobility and reduce pain, while surgery may be necessary in cases where other treatments have failed.



 

Neuroinflammation and Chronic Pain


Neuroinflammation is a process that occurs in the nervous system in response to injury or disease. It is characterized by the activation of immune cells and the release of inflammatory mediators.


Recent research has shown that neuroinflammation plays a significant role in the development of chronic pain syndromes.



Central sensitization, a phenomenon of synaptic plasticity and increased neuronal responsiveness in chronic pain, is maintained in part by neuroinflammation


 

Common Disorders


Common disorders associated with chronic pain and neuropathic pain include fibromyalgia, diabetic neuropathy, and postherpetic neuralgia. Fibromyalgia is a chronic condition that causes widespread pain and tenderness throughout the body. Diabetic neuropathy is a type of nerve damage that can cause pain and numbness in the feet and legs. Postherpetic neuralgia is a complication of shingles that can cause severe pain in the affected area.


Chronic pain is a symptom of many diseases and is considered a disease itself when it persists beyond recovery from an injury or illness. Chronic pain often goes away on its own or with treatment, but it can persist and develop into long-term chronic pain. Millions of Americans have pain every day. Chronic pain is one of the most common reasons adults in the U.S. seek medical care, affecting 50 million people1. Some common disorders associated with chronic pain include:

  • Fibromyalgia

  • Arthritis

  • Diabetes

  • Back pain

  • Irritable bowel syndrome

  • Endometriosis

  • Interstitial cystitis

  • Vulvodynia

  • Temporomandibular disorders

  • Cancer pain

  • Migraines

  • Cluster headaches

  • Tension headaches

  • Neuralgias and neuropathies that affect nerves throughout the body

  • Pain due to damage to the central nervous system (the brain and spinal cord)

  • Psychogenic pain



People living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders. Chronic pain can affect sleep, increase stress levels, and contribute to depression. An estimated 35% to 45% of people with chronic pain experience depression.


 

 

What are some non-pharmacological treatments for chronic pain ?

Chronic pain can be managed with non-pharmacological treatments that can be specifically tailored to the individual and used in tandem with pharmacological therapies if needed.





These treatments are often more cost-effective than traditional medical treatments and can improve stress management skills and an improved sense of well-being. Here are some non-pharmacological treatments for chronic pain:

  • Physical therapy: This can help improve mobility and reduce pain.

  • Acupuncture: This involves the insertion of thin needles into specific points on the body to relieve pain.

  • Massage therapy: This can help reduce muscle tension and improve circulation.

  • Relaxation techniques: These include deep breathing, meditation, and yoga, which can help reduce stress and improve pain management.

  • Cognitive-behavioral therapy: This can help change negative thought patterns and behaviors that contribute to pain.

  • Mind-body techniques: These include meditation, biofeedback, or relaxation techniques that can help reduce stress and improve pain management.

  • Dietary interventions: These include ketogenic and anti-inflammatory diets that can help reduce inflammation and improve pain management.

  • Exercise: Exercise and psychological treatment are effective for treating chronic pain because these treatments may help retrain the nervous system to reestablish more normal pain processing.

  • Mindfulness-based stress reduction: This was found to be as effective as cognitive-behavioral therapy for chronic low back pain.

It is important to consult with a doctor or other medical professional before trying any of these treatments, especially if dealing with severe chronic pain.

 

Can dietary interventions help manage chronic pain ?

Dietary interventions can help manage chronic pain by reducing inflammation and improving overall health. Here are some ways that dietary interventions can help manage chronic pain:

  1. Ketogenic diet : A high-fat, low-carbohydrate, ketogenic diet can alleviate symptoms including generalized pain and headache in a wide variety of neurological conditions

  2. Anti-inflammatory diet : An anti-inflammatory diet can help reduce inflammation and pain. This diet involves removing inflammatory foods and replacing them with better options

  3. Plant-based diet : The intake of the plant-based diet can reduce inflammation and improve chronic pain

  4. Nutritional interventions : Nutritional interventions are often necessary for reversing chronic pain. A simple diet change that removes inflammatory foods and replaces it with better options can help reduce inflammation and pain

  5. Anti-oxidant therapy : An anti-oxidant therapy, can help reduce oxidative stress, and inflammation, including neural inflammation.


 

Photobiomodulation Therapy


Photobiomodulation therapy, also known as low-level laser therapy, is a non-invasive treatment that uses light to reduce pain and inflammation. It has been shown to be effective in treating chronic pain and neuropathic pain.

Research has shown that photobiomodulation therapy can reduce pain and improve function in individuals with chronic lateral elbow pain.



 

How does photobiomodulation therapy reduce inflammation in the body ?



Here are some of the proposed mechanisms of how PBMT reduces inflammation:



  1. PBMT activates light-sensitive ion channels, allowing calcium to enter cells, which can reduce inflammation

  2. PBMT can modulate the immune response, reducing inflammation

  3. PBMT can reduce oxidative stress and up-regulate anti-oxidant defenses

  4. PBMT can activate NF-kB in normal quiescent cells, leading to the production of anti-inflammatory cytokines

  5. PBMT can reduce acute pain and inflammation by inhibiting the production of pro-inflammatory cytokines

  6. PBMT can reduce inflammation by modulating the microbiome

PBMT is a non-invasive therapy that utilizes non-ionizing light sources, including lasers, light emitting diodes, and/or broadband light, in the visible and near-infrared electromagnetic spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical and photochemical events at various biological scales.


The fundamental principles that underpin PBMT therapy, as currently understood in the scientific literature, are relatively straightforward.


There is consensus that the application of a therapeutic dose of light to impaired or dysfunctional tissue leads to a cellular response mediated by mitochondrial mechanisms.

Studies have shown that these changes can impact pain and inflammation, as well as tissue repair.

 

Research Articles and Human Trials


Research has shown that neuroinflammation plays a significant role in the development of chronic pain syndromes.

A study published in the Journal of Neuroinflammation found that TNF-α, a pro-inflammatory cytokine, is involved in the development of neuropathic pain

Another study published in the Journal of Pain Research found that photobiomodulation therapy can reduce pain and improve function in individuals with chronic low back pain.


A human trial published in the Journal of Clinical and Diagnostic Research found that photobiomodulation therapy can reduce pain and improve function in individuals with chronic plantar fasciitis.


Another human trial published in the Journal of Physical Therapy Science found that photobiomodulation therapy can reduce pain and improve function in individuals with chronic neck pain.



 

What are the specific conditions that photobiomodulation therapy is FDA-approved to treat ?

Photobiomodulation therapy (PBMT) is an FDA-recognized clearance in the USA for treating certain conditions. Here are the specific conditions that PBMT is FDA-approved to treat:

  • Acute and chronic pain management

  • Stimulating hair growth

  • Decreasing fat deposits

  • Treatment of oral mucositis following chemo or radiation therapy

  • Treatment of neurobiological diseases

PBMT is a form of light therapy that utilizes non-ionizing light sources, including lasers, light emitting diodes, and/or broadband light, in the visible and near-infrared electromagnetic spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical and photochemical events at various biological scales.





PBMT has several advantages, including:

Non-invasive: PBMT is a non-invasive therapy that does not require surgery or medication.
Safe: PBMT is a safe therapy with few side effects.
Effective: PBMT has been shown to be effective in treating certain conditions.
Cost-effective: PBMT is a cost-effective therapy compared to other treatments.

 

Conclusion


Chronic pain and neuropathic pain are complex conditions that can be difficult to treat. Conventional treatment options include medication, physical therapy, and surgery.



Neuroinflammation plays a significant role in the development of chronic pain syndromes, and common disorders associated with chronic pain and neuropathic pain include fibromyalgia, diabetic neuropathy, and postherpetic neuralgia.


Photobiomodulation therapy is a non-invasive treatment that uses light to reduce pain and inflammation and has been shown to be effective in treating chronic pain and neuropathic pain.

Research articles and human trials have demonstrated the effectiveness of photobiomodulation therapy in reducing pain and improving function in individuals with chronic pain.
It is important to consult with a doctor or other medical professional before trying PBMT, especially if dealing with severe chronic pain.


 

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