Chronic pain conditions are one of the most significant barriers to quality of life, affecting almost half (43%) of the UK population. Of those, around 8 million people in the UK live with chronic pain that is moderate to severely disabling. Chronic pain affects over 100 million people in the US each year, more than cancer, diabetes, and heart disease combined and is the most common cause of disability.

People can suffer from a chronic pain condition from various causes, but the older we get, the more likely we will suffer from chronic pain. Older adults especially are looking for better treatment options for arthritis pain to avoid potent painkillers and side effects. Many young people with conditions such as fibromyalgia, connective tissue disorders, and low back pain are also looking for answers to live better and avoid becoming disabled by their pain conditions.

Chronic pain can also lead to mental health problems such as anxiety, depression, and sleep problems. Often these issues go hand in hand, and we must treat the whole person with an integrative approach.

Chronic pain that is not well treated can disrupt hobbies, family and relationships, work, energy levels, and passion for living. Sadly, chronic pain is often poorly understood and poorly treated by conventional drugs and surgery alone – the leading toolkit of traditional medicine.

Pain is in The Brain Too.

When the pain goes from acute to chronic, the pain isn’t just in a specific body part anymore. The pain messages and signals also become wired in our brains and our nervous systems. Chronic pain creates a constant stress burden and increases our allosteric load (total body stress burden). It uses up mental and physical resources and energy and can lead to a hyper-aroused ‘tired but wired’ nervous system that has trouble relaxing and calming down due to the constant internal threat of pain.

Treating chronic pain effectively, even when you cannot cure it permanently, is one of the most important and powerful things you can do to improve your quality of life drastically.

Types of Pain

  • Neuropathic or nerve pain
    • Here, the pain is in the nerve itself. This can occur after a direct injury to a nerve or from a process like diabetes (diabetic neuropathy)
  • Somatic or body pain
    • This is pain from a muscle or skeletal system/soft tissue or joint–like in arthritis or muscular pain
  • Brain& Body Stress Cycle related Pain
    • Here, there is a brain stress network component and a physical component, such as tension headaches. Stress, anxiety and fear brain pathways can worsen the muscle tension and spasm in a vicious cycle. It can include feelings of mental anguish and suffering on top of the physical tension pain. This type of ‘mental pain’ is just as real as physical pain from an injury, and despite well-meaning advice, you can’t just ignore it or talk yourself out of it. It must be appropriately treated, just as you would with any other type of body pain.
  • Central sensitivity Pain
    • Here, the brain’s pain networks become so sensitive that even non-painful things start to register as pain in the brain, such as in complex regional pain syndrome and other chronic pain disorders where the pain signal is amplified out of proportion to the original injury – ramped up brain pain signals. This type of pain is challenging to treat, and often patients are not listened to or told they are exaggerating, which is both false and detrimental to treating the pain effectively. However, this pain type can be treated effectively with a multi-modal RM approach.


The Resilience Medicine Approach to Chronic Pain

Diet
Supplements
Medication
mind-body
BioData + Habit Tracking

Dietary Approaches

  • The Resilience Medicine diet principles-Low GI, low sugar, whole foods based anti-inflammatory diet high in micronutrients, olive oil with good sources of protein and healthy fats
  • If pain has an autoimmune component, consider cutting out gluten and nightshade vegetables for a trial period and monitor inflammation/symptoms.
  • Include food high in magnesium
  • Cut out MSG and aspartame, carrageenan

Supplements

Many people find nutraceuticals and botanical supplements can help, including:

  • CBD, cannabinoids, and terpenes from the cannabis plant, including beta-caryophyllene for inflammation and myrcene (calming).
  • PEA (Palmitoylethanolamide)
  • High absorb curcumin
  • High Absorption Magnesium
  • Vitamin D3
  • Herbal sleep support if sleep is disrupted
  • See the Fibromyalgia page for specific recommendations if this is a source of pain.
  • See the CFS page for help with fatigue symptoms.
  • Stress support botanicals (see burnout and stress page)

Cannabinoids

Medical cannabis – start with high CBD low THC strains generally although more THC may be needed for severe or opioid dependent pain. Full spectrum CBD may be helpful for mild pain and inflammation type pain at over the counter doses but for other people higher doses of CBD or adding THC may be needed tog et best effects with prescription based medical cannabis. A base of oral oil and then vaporized flower for breakthrough pain if needed depending on the pattern of pain and severity is a general starting point for medical cannabis for pain. Daytime vs nighttime products are chosen to be either neutral or energizing (daytime) or calming (nighttime) to help support sleep was possible. Other cannabinoids like CBD may be helpful for night pain and sleep read our deep dive into cannabis for chronic pain here.

Medications can also help, particularly:

  • Other pain medications, if needed, generally minimize or avoid opioids due to the high risk of side effects and low efficacy for chronic pain, especially low back pain.
  • Consider medications to treat other symptoms, e.g. treat restless legs syndrome if present, depression, anxiety, insomnia, etc.

mind-body Tools

Many forms of relaxation practices can help decrease brain and body hyperarousal which may help dampen pain signals in the brain and help improve pain coping over time. These may include:

  • PMR-progressive muscular relaxation
  • MBSR-this has been explicitly shown to help with many forms of chronic pain
  • Breath-focused mini-meditation minutes throughout the day, focusing on a longer exhale than inhale and experimenting with a few seconds of holding the breath at the top of the inhale. This can help check in with energy levels, decrease stress response to pain signals, and avoid overexertion.

Apps, BioData and Habit Tracking:

  • You can track your pain and related symptoms like mood and fatigue and sleep in the app and see any interventions and resilience tips you have started and if they are helping over time.

The Resilience Medicine App is a free tool developed over a decade of practice treating patients using a quality of life approach. It can help you track how you feel in the four main Resilience Medicine areas of mood, stress/anxiety, energy and mental clarity.

Dr Dani’s Summary:

Chronic pain is the most common reasons people come to see me for medical cannabis and integrative medicine in terms of the sheer humber of patients I have treated. It often causes or worsens mental health too resulting in anxiety, low mood and sleeping problems which makes the pain even worse. Chronic pain is often not well treated with conventional drugs and quality of life is poor when they first come to see me. Using cannabinoids plus an Resilience Medicine approach has been life transforming and many of my patients says that medical cannabis to treat their pain saved their marriage, gave them a life again and allowed them to have hope again for living a full satisfying life. This approach has given them more energy, improved depression secondary to pain, healed sleep dysfunction and allowed them to manage their pain so that it no longer rule d their life.