By UTMB’s Victor Sierpina: Writer CS Lewis once said, “when pain is to be borne, a little courage helps more than much knowledge, a little human sympathy more than much courage, and the least tincture of the love of God more than all.”

In his same book, “The Problem of Pain,” Lewis further noted, “Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say “My tooth is aching” than to say “My heart is broken.”

Pain is much more than a physical event, the irritation of a nerve ending due to injury. A core phenomenological triad of experience of pain includes the intervention, the condition, and the patient and their motivation. Of course, one would think all of those suffering from pain would be highly motivated to be free of this burden; but it is not always so clear or easy as emotional, spiritual, and psychological factors often play hidden, powerful roles.

Over 25 percent of those on disability are there for musculoskeletal conditions, almost always with a pain component. The issues of guilt, such as not being able to take care of one’s family, and frustration are often present. This frustration may be with a medical system that hasn’t solved their pain problem despite multiple scans, procedures, surgeries, and accompanying expense. Past experiences of ineffective treatment may create a negative expectation on the possibility of anything helping the pain. Hopelessness, passivity, depression may set in.

Fears about the severity of pain can also be overwhelming. Pain usually signals immediate injury such as when we pull our hand quickly from a fire or lift our foot quickly on a sharp object. Chronic pain is a different beast as the persistent pain alters both central and peripheral pain processing systems. Added to these conditioned pain reflexes comes so often the inner suffering that goes well beyond the physical pain.

On the other hand, a supportive healing environment can include family, social connections, personal spiritual practice and community, an understanding and patient employer, as well as personal financial resources. Essential too in this equation is trust in the healing professional team to help with the problem. Active participation in treatment, a sense of control and self-efficacy, and one’s attitude toward the condition and its treatment all are predictors of successful treatment of chronic pain.

The standard pharmacological approach to pain uses a stepped program in which mild analgesics such as acetaminophen and ibuprofen are used initially and if ineffective, progresses to stronger drugs such as opiates like codeine and hydrocodone, and ultimately to morphine, fentanyl, methadone, and others. The problem with this model is the side effect risks of stronger medications including sedation, confusion, physical problems such as constipation, as well as tolerance, habituation, and addiction. Though highly useful in terminal pain conditions like cancer, this approach hits limits with other kinds of chronic pain.

At the recent UTMB Pain Conference, I spoke about the importance of considering an integrative approach to pain with examples of how this can be applied to recurrent migraines or chronic low back pain.

In an integrative model, the stepped approach would always include the following, well-evidenced methods:

1. Mind-body therapies — mindfulness, relaxation, hypnosis, biofeedback, and stress management methods can help to alter the perception of and reaction to pain. They definitely improve coping skills in the face of chronic pain. These low cost, usually self-directed techniques ought always be included in any approach to pain.

2. An anti-inflammatory diet and lifestyle — this includes food choices that reduce production of inflammatory reactions in our body that activate chemicals that bring on more pain. Some examples are using a more plant-based diet, using healthier fats like olive and fish oil, taking curcumin, or other herbal anti-inflammatories such as Zyflamend™. If the burger and fries you just had made your pain worse, blame it on the inflammatory and unhealthy fats you chose just now.

3. Movement therapies — regular motion, stretching, and activity is helpful in all chronic pain conditions, no matter the degree of disability. Some options here include home stretching exercises, physical therapy, water therapy or swimming, walking, and even bed exercises. Numerous studies have shown the benefits of yoga and tai chi for chronic pain and these gentle, low-impact, slow exercises can be done by all ages, even from a chair for those who have problems with balance and standing.

4. Body-based methods — these are therapies such as acupuncture, chiropractic, massage, osteopathic manipulation, myofascial release, and others that help realign and restore impaired body systems and injured parts. Energy methods like Reiki may also yield surprising results.

It is not an either/or decision but choosing a synergy that works for you. The problem of pain is never an easy solution as CS Lewis points out in the opening quotes. Always be sure to consider the full range of options.