Managing Chronic Pain
Dr. Molly K. Webber, Family Medicine Physician at Palouse Medical, explains what chronic pain is and the best ways to manage it.
Featuring:
Molly K. Webber, MD
Dr. Molly K. Webber is a board eligible physician providing full-time primary Family Medicine care. Her professional interests include providing: geriatric care, lifestyle medicine, nutrition counseling, transgender/gender affirming care, treatment for chronic pain and in the field of psychiatry. Transcription:
Introduction: With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents The Health Podcast.
Caitlin Whyte: We've all experienced physical pain in some way before whether you stub your toe or break an arm, but when it comes to chronic pain, the kind that lasts, that's a whole different story. To talk about managing chronic pain. Today, we are joined by Dr. Molly Webber, a Family Medicine Doctor here at Pullman. Dr. Webber, what is chronic pain management?
Dr. Webber: I'm going to answer the question of what is chronic pain first, because that that's kind of essential for explaining management. It's going to sound obvious to most people, but it just means you heard all the time. It's important to acknowledge that there's many types and forms of chronic pain. So I think when people hear that they think of arthritis or maybe chronic back pain from an injury, but there's lots of other causes of chronic pain, certain autoimmune diseases, cancer, diseases like fibromyalgia, irritable bowel syndrome, and many, many, many more could take us a really long time to list all of them. But all of those are equally valid. None of those types of pain are more real than another, but it is important to acknowledge that not all pain comes from the same place. And I only say this because this helps us guide management. So you can get pain from like your organs, tissues, bones. So if you think like arthritis in your joints, you can get pain from nerves. So a lot of people have experience with things like diabetic neuropathy, and you can also have problems in how your body and brain process pain. And a good example of this is fibromyalgia. These are not mutually exclusive, so you can have pain from multiple of these sources, but it is kind of important for us to think about because that helps determine how we deal with this.
Host: So, when we talk about pain, who are some of the people who suffer from chronic pain?
Dr. Webber: So, it could be anyone, this is something that can affect all ages, all genders, race, ethnicity is. And you can't, you can't tell just by looking at someone, if there's someone who has, or doesn't have chronic pain or could, or could not develop this. Lots of people with chronic pain, find ways to live and deal with it. So it can be really hard to tell just from looking at someone and in going along with that, some people with chronic pain are able to do certain things and others, maybe disabled from their pain. So there's a huge spectrum there. And we can't make any assumptions.
Host: Now, what does chronic pain management mean and who is involved?
Dr. Webber: I'll address the second part of that first about who is involved. So the first is the patient, the person who is suffering from the pain that you're part of a team, but the patient is the center of the team because they know their body best. And they are the one with the lived experience of their pain. So I mentioned a team, ideally chronic pain management will take a couple of, of resources and providers to help come up with a management plan. Usually the team can be led by a primary care doctor. Obviously I'm a little bias as someone in primary care, but anyone who is a whole to see the big picture of the patient as a person, and then kind of guide that team, the team could also include a variety of specialists, including providers and pain medicine. It could include physical therapy, occupational therapy, behavioral health providers, and it could include, you know, personal supports like the patient's family, friends, caretakers, really anyone you could imagine. So I think that answers who's involved in the first part of the question is what does chronic pain management mean? So to me, chronic pain management is means a couple of things. It means assessing and figuring out the type or cause of your pain.
If that's not already known, some patients will have a really long history of a specific, you know, injury or type of pain. And it's kind of well understood. But sometimes patients come in to see me and, and they have pain that we just really don't know what's causing it yet. So the first is figuring out cause a pain if we can, which is not always straightforward, could take awhile. And that's fine that doesn't exclude us from moving on to these other steps. Next step is the most important one. Next step is setting functional goals that matter to the patient. And this is really important because not all chronic pain can be quote cured or eliminated, meaning we can't always make chronic pain go down to zero. And so instead we frequently have to find ways to make pain manageable for the patient so that the patient is able to do things that are important to them. This is such an important step because you have to make goals that are realistic and measurable. So if the patient's goal is to be able to work a certain number of hours per week, or walk their dog a certain number of times per month, whatever it is that you know is important to their quality of life. We have a benchmark that we can measure against when they come in for their appointment plan. The next two steps are developing a treatment plan and then building a team like I mentioned before.
Host: So, what Therapeutics options exist? And does this always include opioids?
Dr. Webber: So, it definitely does not always have to include opioids. In fact, opioids can be appropriate in various select situations, but they also can pose a risk of significant harm. So the risks and benefits of opioid therapy have to be weighed very carefully. That being said, the decision to initiate them is very personal between you and your physician. In my practice, this would generally be considered a last resort with only a few exceptions. If you're already on opioids, there's still lots of safe and effective ways to either taper down on them, taper off of them or add in some of the other therapeutic options help with your pain. So that being said, no, it doesn't have to include opioids. So other therapeutic options, there's a ton of them. So I kind of tried to group them together. And before I start listing some of the common interventions, I will mention that I usually try to categorize what I'm trying to target before starting. So to clarify what I mean by that one category would be thinking about the underlying problems. So if we take the example of arthritis, focusing on some things that have to do specifically with your knee arthritis, whether that's physical therapy, an injection in your knee, maybe seeing a surgeon, those are things that are really specific for that problem.
But then I will also make a category with my patients about targeting any underlying conditions that might contribute to making their pain worse. This could be things like depression, anxiety, stress, sleep problems. And that's not to say that any of those conditions are causing the pain, but as we all know, when we're stressed, it's really hard to take care of ourselves appropriately. And so we can make this whole other bucket of problems that if we help treat it can help our pain. So that being said, there's lots of options for treating pain. I'll start with maybe the most obvious one people think of when they think about going to the doctor for chronic pain, which is medications. Obviously, there's a lot more than opioids that exist, and I'm not going to sit here and list a bunch of medications to you. Cause I think that'd be pretty boring for both of us, but suffice it to say that education options for pain can be very individualized based on the type of pain that you have. Which is why that step that we talked about earlier about assessing where your pain is coming from is really important, focusing on a type of pain. So that can make an individualized medication plan.
Medications can be necessary for a lot of people, but they're definitely most effective when we combine them with other modalities. So what I mean by that is I also like to think about another category of sort of rehab or, or movement focused treatments. So this could include physical therapy, occupational therapy, aquatic therapy, cardiac, or pulmonary rehab. We are definitely lucky to have some awesome therapy providers in this community. You know, that is something that can make a huge difference in patient's lives. I also think of pain medicine as its own kind of category here. And these are things, some of them can be done by your primary care provider. Some of them can be done by pain medicine specialists, which we definitely have available to us in the community. And these are things like injections, whether that be in a joint or in your back or in a muscle trigger point, this can be things like radio frequency ablation, and nerve blocks, so that the nerve supplying a certain area don't register the pain that's being caused. These are powerful tools for patients to feel better. And usually it gives them kind of the time and the break to go work on some therapy, feel stronger, maybe get off some medications.
There's also a lot of options that historically have been perhaps considered nontraditional medicine. And this includes things like massage, acupuncture, seeing a chiropractor, these things might not be right for everyone, but they can be really helpful. And the nice thing about providers and use fields is that this care can be really individualized to the patient's type of pain. And more and more often, this kind of care can be covered by insurance. Sometimes insurance company will have a requirement like you need to have a referral from your primary care doctor before they'll cover massage. But there are more options then I think people realize as far as not having to pay out of pocket for that stuff. And then the last category of therapeutic options is kind of support focused. And so this can include therapy with a counselor. I know sometimes patients tell me, but Dr. Webber, I'm not depressed.
Why is therapy going to help me? And my answer to that is that even if you're not depressed, dealing with chronic pain can be really difficult since it can be kind of a silent condition. In many cases, people can feel alone, overwhelmed, like they have enough support. And so a counselor is someone who can help you manage that. The burden of having chronic pain, there are also specific interventions that certain therapists can do that can also be directly helpful to pain. This can include biofeedback, which is a really cool opportunity to kind of learn about what your body is doing in certain situations and eventually kind of train yourself to, to respond to that. It can include things like hypnosis and once again, maybe not right for everyone, but I think we can all do with a little more support when we're hurting.
Host: Absolutely well, as we reached the end of our time here, Dr. Webber, is there anything else you want to add to this conversation?
Dr. Webber: I think the only other thing I'll add is that some people can feel a little overwhelmed a bit by not knowing where to start when they're in chronic pain or how-to kind of start this process. And so my recommendation is to start thinking about building your team. So bringing it up to your primary care doctor or finding a primary care doctor, if you don't have one and letting them know very specifically what it is you want to work on and what your goals are just from the, all the stuff we talked about right now, you can tell that this is a big field, but the first step is building your team.
Host: Well, we so appreciate your time and work in this field Dr. Webber. Find out more about Pullman Regional, as well as more episodes like this at pullmanregional.org. This has been The Health Podcast from Pullman Regional. I'm your host, Caitlin Whyte. Thank you for listening, and stay well.
Introduction: With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents The Health Podcast.
Caitlin Whyte: We've all experienced physical pain in some way before whether you stub your toe or break an arm, but when it comes to chronic pain, the kind that lasts, that's a whole different story. To talk about managing chronic pain. Today, we are joined by Dr. Molly Webber, a Family Medicine Doctor here at Pullman. Dr. Webber, what is chronic pain management?
Dr. Webber: I'm going to answer the question of what is chronic pain first, because that that's kind of essential for explaining management. It's going to sound obvious to most people, but it just means you heard all the time. It's important to acknowledge that there's many types and forms of chronic pain. So I think when people hear that they think of arthritis or maybe chronic back pain from an injury, but there's lots of other causes of chronic pain, certain autoimmune diseases, cancer, diseases like fibromyalgia, irritable bowel syndrome, and many, many, many more could take us a really long time to list all of them. But all of those are equally valid. None of those types of pain are more real than another, but it is important to acknowledge that not all pain comes from the same place. And I only say this because this helps us guide management. So you can get pain from like your organs, tissues, bones. So if you think like arthritis in your joints, you can get pain from nerves. So a lot of people have experience with things like diabetic neuropathy, and you can also have problems in how your body and brain process pain. And a good example of this is fibromyalgia. These are not mutually exclusive, so you can have pain from multiple of these sources, but it is kind of important for us to think about because that helps determine how we deal with this.
Host: So, when we talk about pain, who are some of the people who suffer from chronic pain?
Dr. Webber: So, it could be anyone, this is something that can affect all ages, all genders, race, ethnicity is. And you can't, you can't tell just by looking at someone, if there's someone who has, or doesn't have chronic pain or could, or could not develop this. Lots of people with chronic pain, find ways to live and deal with it. So it can be really hard to tell just from looking at someone and in going along with that, some people with chronic pain are able to do certain things and others, maybe disabled from their pain. So there's a huge spectrum there. And we can't make any assumptions.
Host: Now, what does chronic pain management mean and who is involved?
Dr. Webber: I'll address the second part of that first about who is involved. So the first is the patient, the person who is suffering from the pain that you're part of a team, but the patient is the center of the team because they know their body best. And they are the one with the lived experience of their pain. So I mentioned a team, ideally chronic pain management will take a couple of, of resources and providers to help come up with a management plan. Usually the team can be led by a primary care doctor. Obviously I'm a little bias as someone in primary care, but anyone who is a whole to see the big picture of the patient as a person, and then kind of guide that team, the team could also include a variety of specialists, including providers and pain medicine. It could include physical therapy, occupational therapy, behavioral health providers, and it could include, you know, personal supports like the patient's family, friends, caretakers, really anyone you could imagine. So I think that answers who's involved in the first part of the question is what does chronic pain management mean? So to me, chronic pain management is means a couple of things. It means assessing and figuring out the type or cause of your pain.
If that's not already known, some patients will have a really long history of a specific, you know, injury or type of pain. And it's kind of well understood. But sometimes patients come in to see me and, and they have pain that we just really don't know what's causing it yet. So the first is figuring out cause a pain if we can, which is not always straightforward, could take awhile. And that's fine that doesn't exclude us from moving on to these other steps. Next step is the most important one. Next step is setting functional goals that matter to the patient. And this is really important because not all chronic pain can be quote cured or eliminated, meaning we can't always make chronic pain go down to zero. And so instead we frequently have to find ways to make pain manageable for the patient so that the patient is able to do things that are important to them. This is such an important step because you have to make goals that are realistic and measurable. So if the patient's goal is to be able to work a certain number of hours per week, or walk their dog a certain number of times per month, whatever it is that you know is important to their quality of life. We have a benchmark that we can measure against when they come in for their appointment plan. The next two steps are developing a treatment plan and then building a team like I mentioned before.
Host: So, what Therapeutics options exist? And does this always include opioids?
Dr. Webber: So, it definitely does not always have to include opioids. In fact, opioids can be appropriate in various select situations, but they also can pose a risk of significant harm. So the risks and benefits of opioid therapy have to be weighed very carefully. That being said, the decision to initiate them is very personal between you and your physician. In my practice, this would generally be considered a last resort with only a few exceptions. If you're already on opioids, there's still lots of safe and effective ways to either taper down on them, taper off of them or add in some of the other therapeutic options help with your pain. So that being said, no, it doesn't have to include opioids. So other therapeutic options, there's a ton of them. So I kind of tried to group them together. And before I start listing some of the common interventions, I will mention that I usually try to categorize what I'm trying to target before starting. So to clarify what I mean by that one category would be thinking about the underlying problems. So if we take the example of arthritis, focusing on some things that have to do specifically with your knee arthritis, whether that's physical therapy, an injection in your knee, maybe seeing a surgeon, those are things that are really specific for that problem.
But then I will also make a category with my patients about targeting any underlying conditions that might contribute to making their pain worse. This could be things like depression, anxiety, stress, sleep problems. And that's not to say that any of those conditions are causing the pain, but as we all know, when we're stressed, it's really hard to take care of ourselves appropriately. And so we can make this whole other bucket of problems that if we help treat it can help our pain. So that being said, there's lots of options for treating pain. I'll start with maybe the most obvious one people think of when they think about going to the doctor for chronic pain, which is medications. Obviously, there's a lot more than opioids that exist, and I'm not going to sit here and list a bunch of medications to you. Cause I think that'd be pretty boring for both of us, but suffice it to say that education options for pain can be very individualized based on the type of pain that you have. Which is why that step that we talked about earlier about assessing where your pain is coming from is really important, focusing on a type of pain. So that can make an individualized medication plan.
Medications can be necessary for a lot of people, but they're definitely most effective when we combine them with other modalities. So what I mean by that is I also like to think about another category of sort of rehab or, or movement focused treatments. So this could include physical therapy, occupational therapy, aquatic therapy, cardiac, or pulmonary rehab. We are definitely lucky to have some awesome therapy providers in this community. You know, that is something that can make a huge difference in patient's lives. I also think of pain medicine as its own kind of category here. And these are things, some of them can be done by your primary care provider. Some of them can be done by pain medicine specialists, which we definitely have available to us in the community. And these are things like injections, whether that be in a joint or in your back or in a muscle trigger point, this can be things like radio frequency ablation, and nerve blocks, so that the nerve supplying a certain area don't register the pain that's being caused. These are powerful tools for patients to feel better. And usually it gives them kind of the time and the break to go work on some therapy, feel stronger, maybe get off some medications.
There's also a lot of options that historically have been perhaps considered nontraditional medicine. And this includes things like massage, acupuncture, seeing a chiropractor, these things might not be right for everyone, but they can be really helpful. And the nice thing about providers and use fields is that this care can be really individualized to the patient's type of pain. And more and more often, this kind of care can be covered by insurance. Sometimes insurance company will have a requirement like you need to have a referral from your primary care doctor before they'll cover massage. But there are more options then I think people realize as far as not having to pay out of pocket for that stuff. And then the last category of therapeutic options is kind of support focused. And so this can include therapy with a counselor. I know sometimes patients tell me, but Dr. Webber, I'm not depressed.
Why is therapy going to help me? And my answer to that is that even if you're not depressed, dealing with chronic pain can be really difficult since it can be kind of a silent condition. In many cases, people can feel alone, overwhelmed, like they have enough support. And so a counselor is someone who can help you manage that. The burden of having chronic pain, there are also specific interventions that certain therapists can do that can also be directly helpful to pain. This can include biofeedback, which is a really cool opportunity to kind of learn about what your body is doing in certain situations and eventually kind of train yourself to, to respond to that. It can include things like hypnosis and once again, maybe not right for everyone, but I think we can all do with a little more support when we're hurting.
Host: Absolutely well, as we reached the end of our time here, Dr. Webber, is there anything else you want to add to this conversation?
Dr. Webber: I think the only other thing I'll add is that some people can feel a little overwhelmed a bit by not knowing where to start when they're in chronic pain or how-to kind of start this process. And so my recommendation is to start thinking about building your team. So bringing it up to your primary care doctor or finding a primary care doctor, if you don't have one and letting them know very specifically what it is you want to work on and what your goals are just from the, all the stuff we talked about right now, you can tell that this is a big field, but the first step is building your team.
Host: Well, we so appreciate your time and work in this field Dr. Webber. Find out more about Pullman Regional, as well as more episodes like this at pullmanregional.org. This has been The Health Podcast from Pullman Regional. I'm your host, Caitlin Whyte. Thank you for listening, and stay well.