Abstract
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain. In addition to its negative aspects (deprivation of various size), is pain in its acute form a significant positive element in the form of a warning signal to the body.
Test group and research methods: At our clinic, we observed the respondents, both men and women, with chronic spinal pain of non-tumor origin. The objective pursued was to compare the effect of pharmacological and non-pharmacological therapies in a set of 100 patients with chronic musculoskeletal pain.
Results: We analyzed not only the impact of therapy on pain sensation, but also indicators of the patient's lifestyle, their nutrition and physical activity. Based on the subjective sensations of pain, we suggested changes in current treatment in a selected group of patients, and with their informed consent we started with non-pharmacological treatments aimed at bringing relief to the body using ecological therapies such as acupuncture, physical therapy and lifestyle changes.
Introduction: Pain is a sensation induced by specific painful stimuli. It signalizes a malfunction in the body and emergence of a pathological process, thus protecting the body from further damage. The experience of pain involves also specific psychological effects. The issue of nonmalignant chronic pain is highly relevant in the present and it is included in the WHO policies for worldwide health protection and health care support.
The significance of health determinants such as nutrition, physical activity, mental health, alcohol, nicotine, drugs, injuries, communicable disease etc., emphasize the need for intervention at national and international level. The economic situation and protection from over-use of pharmaceuticals and prescription drugs are brought to the fore as a part of the health care policy, as well as the effort to support the individual engagement in activities improving the public health.
The main objective of research at our clinic was to use data analysis to compare the pharmacological and non-pharmacological treatment in patients with chronic musculoskeletal pain. We wanted to find out more about their lifestyle, eating habits, physical activity, evaluate the efficiency of current treatment and suggest relieving ecological therapies, such as acupuncture, physical therapy, lifestyle change, etc. The results would greatly improve the health care at our clinic.
Test group and research methods: The test group was comprised of 100 patients aged 59,3 ± 11, 2 years. There were 39 men and 61 women recommended to our clinic due to being diagnosed with long-term (over 5 years) vertebrogenic algic syndrome, patients with chronic pain of tumor origin were excluded. The patients were divided into two groups; the first group of 49 patients was treated pharmacologically (pills, suppository, drops, infusion, local injections), the second group of 51 patients was treated non-pharmacologically (acupuncture, massage, physical activity). The acupuncture treatment kept to several selected standard points. The data were collected from a questionnaire filled in by patients with their informed consent. The questionnaire was based on the diagnoses associated with vertebrogenic algic syndrome (for example low back pain, osteoporosis, spondylosis). Pain was evaluated also by the interference of pain intensity with other psychosocial and physical factors. Patients answered 49 questions; their pain level was examined and marked on a numeric scale (1 – 10).
Results: Based on the average pain levels in the compared test groups, we identified significantly lower pain intensity in patients treated with non-pharmacological methods (6,0 ±2,14 vs. 7,29±1,4, p<0,05). The results show that women have better pain tolerance than men. The average pain intensity in women on scale 1 – 10 was 6,29±1,96, while in men it was 7,24±1, 67 point (p<0,01). As to the type of pain, men indicated pressure pain and blunt pain more frequently and women indicated sharp and throbbing pain.
The patients with non-pharmacological treatment who subjectively described their lifestyle (diet and physical activity) as good or satisfactory indicated significantly lower pain intensity than the patients with pharmacological treatment. In case of bad lifestyle, the difference between pharmacological and non-pharmacological treatment was not confirmed. Also, the patients with non-pharmacological treatment indicated lower pain level if their intake of calcium from milk and dairy products was higher, compared to patients with pharmacological treatment. In the patients without calcium intake, the difference in pain level between pharmacological and non-pharmacological treatment was not confirmed.
Most patients described their physical activity as low or medium and the pain intensity was higher in the group with pharmacological treatment in each case. The pain intensity in patients with non-pharmacological treatment was lower in respective weight categories; the difference in pain intensity between the groups with pharmacological and non-pharmacological treatment was proved significant only in the normal weight category.
The results confirmed the difference between the pharmacological and non-pharmacological treatment in patients who were non-smoking or former smokers, the pain intensity was higher in pharmacologically treated patients. This difference was not confirmed in regular smokers. Higher pain intensity was indicated by smokers compared to non-smokers within the group with non-pharmacological treatmet; however, it was not significant (p=0,109).
Similar differences were found in the alcohol consumption indicator between the patients with pharmacological and non-pharmacological treatment and between the teetotallers and regular alcohol consumers treated non-pharmacologically.
Our test group did not confirm any difference in pain intensity indicated by patients related to their educational level. The group with elementary education indicated average pain intensity 7,2±1, 5 points, with high school education 6,8±1, 9 b. and with university education 6,3±1, 9 points. The average pain intensity level was slightly higher in patients living in families (6,8±1,9) than in patients living alone (6,1±1,9; p=0,154).
Discussion: Our test group of 100 patients was not a representative sample, so the results of our survey have limited validity and do not allow drawing general conclusions; however, they proved significant for our work in ambulatory care. Our main objective was to map the chronic pain issues in diagnoses frequently occurring in our practice in the past 10 years. We supposed that the effect of non-pharmacological treatment would not be comparable to patients treated pharmacologically. However, this hypothesis was not validated. All patients who changed their lifestyle, reduced smoking and alcohol, increased daily physical activity, increased their calcium intake in food and had normal weight, achieved better results in non-pharmacological treatment and experienced higher pain alleviation compared to the patients treated by pharmaceuticals. The type of therapy did not influence the pain intensity in patients who made no effort to change their life or changed it only minimally. There were statistically relevant differences in physical activity, where in case of prescription drug over-use and increased activity the pain intensity was higher. We will need to examine this problem in more detail to identify its cause.
The effect of acupuncture treatment is supported by the attitude of patients. This means that the non-pharmacological treatment will be more successful in case the patients change their lifestyle, improve their physical activity and reduce the nicotine and alcohol intake. Our hypothesis, that the patients who in case of chronic pain conditions (such as osteoporosis, vertebrogenic algic syndrome, dorsalgia) change their lifestyle, reduce or suspend medication and add food supplements experience lower pain intensity, was validated.
In both groups of patients (with pharmacological and non-pharmacological treatment), the pain occurred mainly at night, lower number of patients indicated pain in the morning. This can be explained by the fact, that most patients use medication at night, which alleviates the morning pain. In these cases, the pain returned during the day, since with irregular use of medication the pain is not sufficiently regulated and can occur unexpectedly.
Another hypothesis was that the musculoskeletal chronic pain is more frequent in women than in men. We found out that the subjective perception of pain is worse in men than in women. They are afraid of pain, not mentally prepared for it and less cooperative in making the lifestyle changes. We also established statistically relevant differences in cases of alcohol abuse. The results in the group of teetotallers and occasional alcohol consumers were significantly in favor of the patients with non-pharmacological treatment. The pain level in regular alcohol consumers was aggravated in both groups, which contradicts previous research by McCaffery (1980).
Conclusion
Musculoskeletal disorders associated with chronic pain are among many recently occuring disorders that undoubtedly require a comprehensive approach. The results of presented paper show that the non-pharmacological treatment combined with changes in lifestyle bring a significant positive effect in patients with chronic pain and vertebrogenic algic syndrome. Alleviated levels of pain in these patients were verified. The effects of acupuncture in patients compared to other patients with non-pharmacological patients have proved to be statistically relevant.
References:
Over my almost 30 years in clinical practice, I have used Chai Hu Long Gu Mu Li Tang extensively for a wide array of clinical presentations ranging from chronic headaches to anxiety, insomnia, and prescription drug withdrawal symptoms if these situations fit the appropriate patterns – all with extremely positive clinical outcomes.
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