We've Gotta Have it
Treating Chronic Pain: A Holistic Approach
This “invisible disease”can lead to depression and anxiety. Dr. Christian Whitney disrupts the equation
What is Chronic Pain?
Caused by injury, an ongoing illness, or sometimes nothing obvious, chronic pain can be difficult to treat and wreak havoc on one’s physical and emotional state.
Dr. Christian Whitney, DO, a board-certified pain management physician and anesthesiologist, grew frustrated with the limited care he was able to provide with conventional medicine. There were too many limitations on insurance, and there was poor patient follow-up and a general unwillingness to coordinate care with nontraditional wellness experts.
Committed to helping people restore their lives and live pain-free (as a medical student, he suffered from debilitating back pain), Whitney opened Restorative Pain Solutions — a holistic pain and wellness treatment center in Greenwich, CT.
Dr. Whitney says the only way to help his patients is to get to know them on a deeper level. Instead of the traditional 10-minute appointment, he gives patients 90 minutes so he can explore their lifestyles and habits and get to the root cause of their pain.
TheCovey sat down with Dr. Whitney to get his perspective on how to handle chronic pain today, particularly in light of the opioid addiction crisis: a staggering 8-12 percent of Americans have developed an opioid use disorder.
TheCovey: What is the definition of chronic pain?
Christian Whitney: Chronic pain is defined as pain lasting more than three months and persists beyond the expected duration from an injury or illness. Your body keeps hurting weeks, months, even years after the injury.
TheCovey: Why is it so hard to get help? Is it because pain is invisible?
Christian Whitney: Chronic pain is an “invisible disability.” I often hear from my patients that their friends, family members and even doctors have said to them, “You don’t seem sick.”
Chronic pain is difficult to treat as not only do the physical symptoms need to be addressed, but also the emotional component. Over time, living with chronic pain can cause depression and anxiety.
One of the major reasons why chronic pain is so difficult to treat is that often times, the root cause of the problem has not been identified. Patients often get told the pain is “not real.” As health care providers, we need to be vigorous in our attempts to find the root cause of the pain as that will determine the appropriate treatment.
The Gender Pain Gap
TheCovey: How does chronic pain impact your social life, family, or work?
Christian Whitney: Chronic pain impacts practically every aspect of one’s life and since it is often misunderstood by others who are not living with pain, maintaining relationships and social connections is very challenging.
Pain actually changes the way the brain processes emotions including the pain itself. Over time those suffering lose the bandwidth to perform tasks such as cooking, cleaning, walking the dog, driving, etc.
TheCovey: Let’s talk about women and chronic pain. I have this feeling we’re told more than men that it’s all in our heads. Do you hear that? How do we fight that?
Christian Whitney: Pain does affect men and women differently.
While the sex hormones estrogen and testosterone play a role, psychology and culture play a role as well. Women feel pain more intensely due to the effects of estrogen. However, most researchers agree that women tend to recover more quickly from pain, seek help more quickly, and are less likely to allow pain to control their lives. They are also more likely to utilize coping skills and a support system.
There is a well-known “gender pain gap” where women are often under-treated for pain and dismissed compared to men. One of the reasons this occurs is that most diseases are based on the understandings of male physiology. For example, heart attack symptoms in women present differently than in men and the classic symptoms of crushing chest pain can be absent, and they may present only flu-like symptoms.
Women are more likely to receive prescriptions for sedatives, rather than pain medication for their condition. If something doesn’t seem right or [your] gut is telling [you] that something is wrong, speak up. If your doctor is not receptive, then find another doctor who will listen, take the time to hear you, and perform the appropriate workup and effective treatment plan.
Chronic Pain on the Rise
TheCovey: What kinds of chronic pain are on the increase today? Why? Is any kind of pain decreasing?
Christian Whitney: Our aging population includes an ever-increasing number of elderly people. Baby boomers who make up the largest demographic of society recently began to enter their 70s. That is the decade during which we begin to experience a much greater prevalence of arthritis, spinal pain, obesity, surgical operations and cancer.
In fact, more than half of all adults older than 65 experience arthritic pain of the spine and other joints.
Mortality rates for cancer continue to decline: greater than 40 percent of cancer survivors now live longer than 10 years. [But] cancer survivors can experience treatment-related chronic pain.
Also, the country’s obesity epidemic leads to diabetes, causing an increased load on the back and joints as well as peripheral neuropathy.
There is also the problem of chronic post-surgery pain, which is estimated between 20 and 50 percent. Relatively minor operations, such as inguinal hernia repair or a C-section, seem to lead to this problem in approximately 10-12 percent of all patients. As we perform more and more surgeries every year, this number will continue to escalate.
The Opioid Connection
TheCovey: It seems like physicians have freaked out about giving people painkillers today and in reaction to giving opioids, don’t give us the right medications. Is that a fact or fiction? Why can’t we go back to the old pain-killers like Darvon and Percocet if the opioids are so dangerous?
Christian Whitney: The Opioid Crisis is the rapid rise of the misuse of opioids (prescription and non-prescription) starting in the late 1990s and continuing through the present. Nearly half of all opioid overdose deaths in 2016 involved prescription opioids.
The Opioid Crisis started with the over-prescription of opioid pain relievers. At that same time, a third of the US population was affected by chronic pain.
As a result, drug companies and the federal government pushed for the expanded use of opioids, which led to the over-prescription of opioid pain relievers. I was in medical school in 2000 and can still remember being lectured that there is no ceiling effect on the dose of pain medication prescribed and that patients cannot become addicted if they are in pain. Another contributing factor to the opioid crisis is the fact that only one in 10 patients addicted actually gets into treatment for addiction.
The lack of resources available for those struggling with addiction is certainly a contributing factor to the current opioid epidemic.
There are several types of medications available to treat pain. The choice of pain reliever depends upon the severity of the pain and the type of pain that is being treated.
Over the counter (OTC) pain relievers include:
- Acetaminophen (Tylenol)
- NSAIDs (Advil, Aleve, Motrin, etc.)
- Topical pain relievers (Ben Gay, Icy Hot, etc.)
Prescription pain relievers include:
- Opioids (Morphine, Dilaudid, oxycodone, etc.)
- Antidepressants (Amitriptyline, Duloxetine)
- Anticonvulsants (Gabapentin, Lyrica)
- Muscle relaxants
- Topical patches
Due to this ongoing crisis, guidelines have been implemented by the CDC regarding the proper prescribing of opioids. Physicians are more reluctant to prescribe opioids now. However, there certainly are patients who require long term treatment with opioids.
In these cases, the prescribing physician should closely monitor the patient with drug screens, opioid agreements, and prescription monitoring programs to ensure compliance and to detect opioid misuse, abuse, and diversion.
It is also important to mention that patients should feel comfortable discussing their concerns regarding addiction with their health care provider and [be] aware of the resources available to treat addiction if a problem should occur.
TheCovey: What kinds of chronic pain do you see and treat most often? What are the misconceptions?
Christian Whitney: The most common types of chronic pain that I treat include neck and low back pain, arthritis, headaches, TMJ, shingles, and nerve damage. When patients see me, they are often pleasantly surprised that there are treatment options that were not offered to them in the past.
TheCovey: You are approaching treatment from a holistic point of view. What does that mean? What kinds of unusual tools do you use for treatment today?
Christian Whitney: Pain is best treated with a multi-modal approach. What that means is that I incorporate a wide array of traditional and alternative treatment options to provide the best outcome for the patient.
The approach is individualized and custom-tailored. It is not a one size fits all approach. Rather, I look at what was tried in the past, what worked and didn’t, and what I can offer, or do now that will have an effective impact and provide a better outcome.
While over the counter (OTC) and prescription medications are often used to manage pain, a combination of treatments and approaches is most helpful.
Some of the other treatment options other than medications include:
Physical modalities such as physical therapy, exercise, massage therapy, yoga, Tai Chi, chiropractor, osteopathic manipulation
Alternative treatments: acupuncture and acupressure, biofeedback, cognitive behavioral therapy, meditation, relaxation techniques, aromatherapy, breathing exercises, imagery, healing touch
Interventional options: injections (nerve and joint blocks), pain pumps, spinal cord stimulator, PRP and stem cell injections, etc.
Devices: TENS units, topical creams and medications, heat/ice, herbal supplements, nutrition — such as an “anti-inflammatory diet.”
Surgery is usually a last resort if the condition is not life threatening or urgent.
TheCovey: What role do insurance companies play in preventing people with chronic pain from getting the help they need?
Christian Whitney: Insurance companies do not recognize the value in holistic care or the “multi-modal” approach.
Alternative therapies like massage and acupuncture have not been widely available due to lack of insurance coverage. Thus, many people in chronic pain have not had access to any therapy except opioids. This can partially explain why there was an increase in the number of opioids prescribed from 2001 to 2014.
Insurance companies also do not reimburse for the value of care, or the amount of time that is truly required to evaluate someone living with chronic pain.
TheCovey: How can society treat individuals with chronic pain in better ways? What can friends say/do to be helpful?
Christian Whitney: The first thing is to learn about chronic pain. Understand that it is an invisible disability with an emotional, behavioral, and physical component. Listen to the person and create an environment free of judgement where they feel safe. Continue to treat them as the person you know and provide support.
TheCovey: What mistakes do people suffering from chronic pain make?
Christian Whitney: They don’t ask for help as they believe that they are a burden. This leads to isolation, loss of motivation, and eventually they lose their sense of purpose. When this happens, depression and anxiety set in and it can create a vicious cycle of pain and emotional distress.
For those suffering with chronic pain, ask for help. Look for support groups and find a physician that is empathetic and provides effective treatment options and coping strategies.
TheCovey: Where do individuals with chronic pain go to get help? What should they avoid?
Christian Whitney: The first thing is to find a doctor that has empathy and listens. When pain becomes chronic or difficult to treat, consultation with a pain management specialist can be of benefit. A board-certified, fellowship-trained pain management specialist like myself can evaluate the painful condition, order additional diagnostic tests, and offer a variety of treatment options, including interventional treatments for the painful condition.
To schedule a consultation with Dr. Whitney, call (203) 992-1845 or visit rpsgreenwich.com.