Treating Chronic Pain - Have you heard of Dry Needling? Pt. 1

[SafetyNurse1968, ADN, BSN, MSN, PhD]

We Are In So Much Pain

According to the CDC, the prevalence of chronic pain in the U.S. ranges from 11%-40%.¹ In 2016, an estimated 20.4% (50 million) adults had chronic pain and 8% (19.6 million) had high-impact chronic pain. Chronic pain is defined as pain on most days or every day in the past 6 months. High-impact chronic pain is persistent pain with substantial restriction of life activities lasting 6 months or more.² These are sobering statistics, but even more disturbing is that both types of pain are more prevalent among adults living in poverty, adults with less than a high school education, adults with public health insurance, women and rural residents.¹ We are taught in nursing school to set aside prejudice and bias and meet the patient where they are. When it comes to pain management, however, it appears we aren’t following this directive.

Chronic pain is one of the most common reasons adults seek medical care. It is linked to restrictions in mobility and daily activities, dependence on opioids, anxiety, depression, poor perceived health, and reduced quality of life.

One of the many goals of Healthy People 2020 is to decrease the prevalence of adults having high-impact chronic pain. Chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity and disability programs.¹ Pain is a problem that just won’t go away.

A History of Pain

Pain has been our teacher from the beginning, directing us to avoid harm; fire, poison, sharp objects. It is a signal for body injury and disease. It is a constant for humanity. The question for healthcare workers is, how much is too much? Pain is the oldest medical problem, but it isn’t well understood. Pain was treated by opium in the 1600s, Chloroform and ether were used in the 1800s for anesthesia. Up until the 1900s, when morphine and heroin were used as pain medication, pain was an acute care issue – related to injury, surgery or death from cancer. When patients complained of pain they were told “it’s all in your head” and were referred to psychiatrists and neurosurgeons.³ In the 1980s, there was an increased push to use opioids for long-term, non-cancer pain. Drug companies began a 20-year campaign to convince physicians to prescribe opioids more freely. According to Marcia Meldrum, a researcher at the University of California, “We are in this culture now where too many people see drugs as the answer not only to pain, but to improving their lives.”³

In 2001 the Joint Commission published new pain management standards, billing pain as the fifth vital sign. They added pain to HCAHPS patient satisfaction surveys, tying pain management to reimbursement. I came up as a nurse during this time, and it’s hard for me to wrap my brain around it now, the idea that some amount of pain is okay. We were taught to ask every patient about their pain. It was drilled into me as a student that any amount of pain was considered abnormal; outside of normal limits. We pursued the pain target on our patient’s walls, the center being the elusive “0”. It never occurred to me that I was giving my patients the idea that their pain score should be zero, all the time.

The goal of better pain management is a great idea; however, the end result for the JC's pain initiative was not. Some experts believe that focusing patient attention on pain has led to an increased perception that pain is undertreated.⁴ Physicians for Responsible Opioid Prescribing (PROP) have lobbied the JC to stop calling pain a vital sign and to remove it from patient satisfaction surveys. They believe that pain is not a vital sign, since it can’t be measured objectively. PROP states, “aggressive management of pain should not be equated with quality healthcare as it can result in unhelpful and unsafe treatment.” The JC has responded that the requirements to assess patients for pain do not require the use of drugs to manage the patient’s pain.⁴

Dry Needling – A Drug Alternative

I had chronic pain for over 10 years. It was in my right hip. On a daily basis, I had a deep, cramping pain where my sciatic nerve passed through my hip on its way from my spine to my leg. I leaned on desk corners and tennis balls, I stretched, I exercised, I took handfuls of ibuprofen, but it only let up briefly. At times it interfered with my sleep. It was always in the back of my mind, ceaselessly throbbing. It never occurred to me to seek help for this pain. It was just part of my story, part of who I was. I assumed the pain was my fault – I ran too far, played too hard, did too much. My refusal to stop was causing my pain.

Now, that pain is a distant memory thanks to physical therapy. I married a PT who ended up becoming certified in dry needling. It took me a while to trust him enough to let him stick a 5-inch needle into my gluteus maximus, but I’m very glad I did. I hope you’ll join me for part 2 to learn more about dry needling and how it can be used to treat chronic pain (…and you don’t have to marry a PT).

REFERENCES

1. Centers for Disease Control and Prevention - Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults-United States, 2016
2. American Pain Society - United States National Pain Strategy for Population Research: Concepts, Definitions, and Pilot Data
3. National Center for Biotechnology Information, U.S. National Library of Medicine - A Short History of Pain Management
4. MedPage Today - Opioid Crisis: Scrap Pain as the 5thVital Sign?

[K+MgSO4, BSN]

I love it, had it about 6 months ago for an acute flare of a chronic issue (what I refer to as tall, fat nurses back) and the relief was amazing. Coupled with clinical pilates I have never been this comfortable.

[SafetyNurse1968, ADN, BSN, MSN, PhD]

2 hours ago, K+MgSO4 said:

I love it, had it about 6 months ago for an acute flare of a chronic issue (what I refer to as tall, fat nurses back) and the relief was amazing. Coupled with clinical pilates I have never been this comfortable.

SO glad! Thank you for sharing your story - I just posted part 2, which goes into way more detail about how dry needling works. I hope you'll read it when it comes up - I'd love to know how your experience compares to mine.