Why Expanding Access to Alternative Drug-free Pain Management May be the Key to Improving Chronic Pain Patient Outcomes

Chronic pain is a debilitating condition that has long puzzled healthcare professionals because it isn’t always linked to visible damage in the body. According to the Centers for Disease Control and Prevention (CDC), approximately one in five adults or 50 million people in the United States (U.S.) experiences chronic pain, defined as pain lasting more than three months. This represents a major health issue, as pain affects almost every aspect of a person’s life, including physical and mental functioning, productivity and quality of life, and is associated with substantial financial and social costs.

Over the past couple of decades, medications such as prescription opioids have been the mainstay to treat pain, despite very limited evidence to support their use long-term; on the contrary, they have led to increased risks of addiction, overdose and death. Unfortunately, therapeutic alternatives have been inaccessible to many patients because of a myriad of factors such as lack of insurance coverage and limited reimbursement policies. 

Given the increased use — and misuse — of opioid medications, it is imperative that we continue to expand access to drug-free pain treatment options that can effectively address the underlying cause of many chronic pain conditions, the brain’s perception of pain. As a cognitive neuroscientist specializing in chronic pain, I have seen a great deal of evidence that shows how chronic pain is linked to a hyperactive threat response in the brain. I believe chiropractors are uniquely positioned to help address and improve the lives of people living with chronic pain by retraining the brain’s pain response for their patients. 

The American College of Physicians (ACP) recommends non-pharmacological treatments for low back pain instead of medication. However, two-thirds (67%) of U.S. adults who have ever experienced back or neck pain have turned to over-the-counter (OTC) (56%) and/or prescription (30%) pain relievers to ease their back and neck pain, according to a recent survey. Despite the mounting rates of chronic pain and increasing evidence of the clinical efficacy of chiropractic care, only about 30 percent of people have received care from a chriopractor. 

The source of chronic pain  

In recent years, scientists have come to believe that many spinal abnormalities previously believed to cause chronic back pain may simply be a natural consequence of the aging process; for most, these abnormalities (e.g., disc herniations, vertebrae deformaities, etc.) cause no pain at all. When pain is present, studies have suggested that it is less a signal of serious damage or harm to the body, and often occurs due to the body’s pain signaling mechanisms changing with age. It’s now understood that rather than an ongoing response to harm or damage in the body, chronic pain might stem from the brain’s misfiring signals, which interpret everyday sensations as painful. This is consistent with recent studies that indicate at least 80 percent of chronic back and neck pain cases are not correlated to any clear structural problems. 

In light of the realization that structural problems may not be causing the majority of chronic pain cases, researchers began exploring brain-based mechanisms and identified a culprit – the amygdala. An area critical in orchestrating our fight-or-flight response, the amygdala acts as our body’s watchguard, responding to threats with quick, protective reactions and can trigger a pain response to halt us in potentially harmful situations. Imaging studies have shown that the amygdala is extremely active in chronic pain cases, even when no structural damage is present.

Think of the amygdala as a smoke alarm. Just as a smoke alarm is meant to help us respond quickly to a fire, the amygdala is designed to warn you of perceived danger. When danger is present, both a smoke alarm and our amygdala are incredibly effective at keeping us safe. But we have all experienced an alternative scenario where an alarm becomes overly sensitive, ringing at the slightest cue. That, in essence, is chronic pain — an alarm sounding off even when the threat is minimal or non-existent.

As more evidence mounts to support the amygdala’s hyperactive threat response as a root cause of chronic pain, healthcare providers are now researching drug-free treatments options that recalibrate the brain’s response to these “false alarms”. This includes chiropractric care; rather than trying to “correct” a spine that has no clear damage, chiropractors can use their skillset to reshape neural pathways to prevent persistent activation of the pain response.

If an oversensitive amygdala is to blame for chronic pain, then it becomes clear why pain scientists and practitioners are investigating chiropractic treatments that target the amygdala to redirect and recalibrate the brain to differentiate between real and perceived threats. Alternative drug-free pain management by trained chiropractors can safely and effectively expose patients to physical sensations that are setting off the brain’s false alarms; this type of treatment is known as touch therapy. Rather than using pills to dull the pain, touch therapy may be the solution to treating chronic pain at the source, by regulating the amygdala and preventing the persistent activation of the pain response.

Chiropractic’s role in rewiring the brain

Touch has a profound role in the way our brains interpret and respond to the world around us. The gentle pressure from a chiropractor’s hands during palpation isn’t just about the preparation for the adjustment of your spine; it’s sending a cascade of signals to the brain that can help retrain that overactive amygdala.

When a chiropractor applies a specific and deliberate touch to an area, applying gentle pressure without triggering pain, it acts as a reassurance to the brain that there is no damage present. Each therapeutic touch acts as a counterargument to the brain’s false narrative of pain, providing a sense of safety that deactivates the amygdala’s alarm. With each session, this tactile communication disrupts the fear-pain feedback loop, convincing the brain that the body is safe and unharmed, thus eliminating the amygdala’s threat response (and the pain it triggers).

Research shows that hands-on care, including chiropractic adjustments, can lead to changes in brain function. Studies utilizing functional MRI scans have observed alterations in brain activity following spinal manipulations and deep tissue massages. By directly interacting with the body’s physical state, chiropractors and other providers can effectively influence these intricate neural networks. And the subtle yet significant changes in the brain that occur after a touch therapy session, triggered by the reassuring and secure sensations that are being signaled to the brain from the body, achieve the recalibration needed to more permanently quiet the false chronic pain alarm.

When it comes to managing pain, payers can help guide patients to non-drug pain relief methods. Several studies have shown that chiropractic care can improve pain in patients while incurring lower healthcare costs compared to traditional medical management. Although access to occupational therapy or physical therapy is generally similar among Americans with various incomes and insurance providers, use of chiropractic care is low among low-income adults and those with public health insurance. 

While non-pharmalogical treatments are increasingly endorsed as therapy for chronic pain, disparities by race and ethnicity remain despite the stronger clinical recommendations for certain conditions including low-back pain. With the backing of clinical evidence for this kind of intervention, health insurance and policy changes are needed to increase access to non-pharmacological care for chronic pain, particularly in underserved communities.

By applying the principles of the most recent neuroscience on chronic pain, chiropractors can play a pivotal role in drug-free treatments that address the true nature of these conditions — a miscalibrated alarm system in need of a reset. It is this reset that brings forth the combination of neurological, physiological, and psychological factors that contribute to improved whole being care that impacts quality of life for individuals living with chronic pain.

Photo from flickr user Michael Dorausch

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