Ease Your Pain
What health care professionals know about getting to the source of pain and a few less common, drug-free alternatives for pain management

Sonoma Magazine Sonoma Health in December 2023

Includes quotes from an interview with Gloria Tucker, M.D. 

An active 60-year-old woman named Rose was on the court, playing a pickleball match with friends, when she stooped down for the ball she missed. Suddenly, she was overcome with pain in her lower back. It was swift, sharp and excruciating. “I could barely walk,” she says, explaining that an injury on a rope swing in her 20’s is the root of the problem and has caused regular anguish and flare-ups over the past 40 years.

She’s seen numerous physician and tried various pain medications and muscle relaxers, but the search for relief is a constant struggle. “Navigating the road of pain management is chaos,” says Rose, who prefers not to disclose her last name. In the last five years, she’s turned to alternative treatments that she’s found to be more effective.

Everyone experiences pain at some point in their life and, for those who experience chronic pain, it’s a callous companion that attacks the body physically, mentally and emotionally. It may be mild or excruciating, but chronic pain is persistent, inconvenient, sometimes incapacitating, and it can lead to depression and anxiety.

According to the National Pain Advocacy Center, one of every six Americans experiences daily pain. Some of the most common forms include back or neck pain, arthritis or joint pain, headaches and migraines, fibromyalgia and pain from cancer and its treatment. Chronic pain – defined as pain that lasts for more than three months – affects more Americans than any other disease, including heart disease, cancer and diabetes, and it’s the number 1 cause of disability. “Pain is a big reason people miss work,” says Andrea Rubinstein, MD, chief of pain medicine for Kaiser Permanente in Santa Rosa.

THE SOURCE OF PAIN

When it comes to chronic pain, the first step in treatment is to understand the source of pain, which is akin to viewing a hologram that contains physical, environmental, emotional and behavioral aspects simultaneously. “Pain comes in many different types and each person experiences pain differently,” says Daciana Iancu, MD, who is board certified in integrative and internal medicine and practices in Sebastopol. “There is always a strong emotional component to pain. Stressful experiences and trauma cause us to tense our bodies, and sometimes that tension stays trapped for a long time.”

Iancu’s integrative approach begins with listening to her patients’ stories, which, she says, “reveals a lot about their pain: the cause, contributing factors and what type of treatments would benefit them.”

The cause of back pain, for example, could be muscular, or problems with the nerve, joints and bone, or a combination of all these things. “But what is the underlying cause of that?” Iancu asks. “Is it lifting something heavy, sitting too much or bad posture? Or, is it from being stressed, sleep deprived or overwhelmed?

“If we’re stressed out, sit too much, maybe don’t eat well or get sufficient sleep, and then lift something heavy and ‘slip a disc,’ (the true cause of injury) could be heavy lifting or it could be wear and tear. Or, maybe we were too tight and contracted and disconnected from the body due to stress and lack of sleep.”

If a doctor only treats the slipped disc with pain meds and steroids, and fails to address the underlying issue, healing will only be partial, says Iancu, which could lead to chronic pain. “When patients work with me, they’re often surprised how we reach the true root cause of their pain just from sharing their stories,” she says. “Then, we can explore together their options for improvement.”

ALTERNATIVE TREATMENTS

Some of the most common alternative, drug-free treatments used as a front-line approach to pain include: acupuncture, a key component of traditional Chinese medicine to balance the flow of energy and treat pain; Reiki, which means “universal life energy,” a hands-on or hands-over-the-body energy healing technique that promotes relaxation, reduces stress and anxiety to improve the flow and balance of energy, and relieve pain; Chi Nei Tsang, an abdominal massage therapy, the name itself meaning “working the energy of the innermost organs”; and chiropractic care, a therapeutic treatment that involves manipulating joints to realign the spine and reduce discomfort.

How do these types of energy medicine work? Pain and illness may reflect that we’re too out of balance physically, mentally or emotionally, says Iancu, and alternative treatments can help restore that balance: “The treatments are subtle, but they help people return to a more balanced way of being.”

These non-Western treatment modalities often bring comfort to those suffering from chronic pain. But for those who aren’t finding relief from these methods, here are a few lesser-known treatments available in the North Bay.

TENS

Transcutaneous electrical nerve stimulation (TENS) involves using a mild electrical current to change the perception of pain. A TENS machine is a small, battery-operated device with two electrodes and sticky pads. The pads are attached directly to the skin. “TENS has always been popular with some patients, though it is not as widely used as it could be,” says Kaiser’s Rubinstein. “It works by delivering a small electrical impulse to nerves, which changes the way pain is perceived. TENS works best for at least 30 minutes per sessions and can be used as often as needed.”

Units can be purchased online and range in price from $30 to $100, though Rubinstein recommends beginning with an appointment with a professional first (often a physical therapist) to determine whether the pain responds to treatment and to find the optimal placement of the pads.

TENS is used to help reduce pain caused by conditions such as arthritis, knee pain and sports injuries. Treatment with TENS provides short term relief. According to Rubenstein, it’s not recommended to relieve pain from cancer, heart disease or bleeding disorders and shouldn’t be used on or near open wounds.

“TENS can be quite effective for some patients and feedback is generally good, but it doesn’t work for everyone,” says Rubinstein, adding that it’s best when used as part of a multi-disciplinary approach that includes physical therapy.

RADIOFREQUENCY ABLATION

Radiofrequency ablation (RFA) – also known as rhizotomy – is primarily intended to treat arthritis or joint pain of the spine.

There are small sensory nerves along our spinal joints, and their job is to tell the brain how the joint feels. These nerves are the primary source of pain signals coming from the joints of the back.

“It’s a fairly interventional technique,” says Rubinstein. “Though there’s no incision, it’s usually performed in an operating room. The procedure is done using fluoroscopy (a form of X-ray) and needle placement to find the nerve you’re trying to ablate – or knock out – using radiofrequency.”

RFA uses heat produced from radio waves to target diseased tissue. For pain management, radio waves are sent through a precisely placed needle to heat an area in the nerve, which damages the nerve tissue and prevents pain signals from being sent back to the brain. RFA is considered for long-term pain conditions, especially of the neck, lower back or arthritic joints that haven’t been successfully treated by other methods. The goal of RFA is to stop or reduce pain, improve function, reduce the number of pain medications taken and avoid or delay surgery.

The procedure is reserved for patients with facet-mediated pain that responds to medial-branch blocks (See sidebar). Even then, it’s not always appropriate. “In some instances, [treatment] doesn’t work because medial branches have been overgrown by severe bony arthritis, or this is another reason for the pain,” says Tabitha Washington, MD, an interventional pain specialist at Kaiser Permanente’s Santa Rosa Medical Center.

“However, for those patients who qualify, the medial branches on the outside of the facet joint capsules are heated,” says Washington. The procedure disrupts the connection between those pain fibers from the pain pathways that travel up the spinal cord to the brain,” she adds, “so pain from the joints cannot be perceived by the brain.”

RFA treatment takes at least four to six weeks to take effect, says Washington, and often patients will experience a slight increase in pain for at least two weeks. Though results vary among patients, the effectiveness of RFA may last 10 to 12 months.

Generally, the cost of RFA procedures ranges from $2,000 to $5,000. Kaiser Permanente offers RFA at some of its clinics, and the treatment is part of its medical plan. However, most insurance companies do not cover treatments.

PROLOTHERAPY AND PRP

“People are seeking relief for their pain outside of traditional medicine because there are really effective treatments,” says Gloria Tucker, MD, a board-certified sports medicine specialist, instructor of proliferative therapy and a founding member of the International Association of Regenerative Therapists. Tucker, who practices in Novato, specializes in treating the ligaments and tendons that support the body’s joints. She uses prolotherapy and platelet-rich plasma (PRP) treatments.

These are treatments she first learned about when she was seeking help for her own chronic, low-back pain, a result of her passion for long-distance running and mountain biking. She eventually switched from those high-impact sports to swimming, but her back still hurt. She tried chiropractic treatments, which would help for a few hours, but then the pain returned. Finally, a doctor recommended she try prolotherapy. “It saved my life,” says Tucker. “I felt so hopeful again.”

Prolotherapy is an injection treatment used to relieve pain by jumpstarting the body’s natural healing abilities. Tucker uses two types of injection treatments: PRP and dextrose prolotherapy.

PRP prolotherapy involves using a patient’s own blood. The benefits of using PRP – sometimes called “liquid gold” – are the growth factors contained in the blood that can help heal tissue more effectively than dextrose therapy. Dextrose (sugar) is the most commonly injected material. PRP and dextrose inflame the ligaments. “The reason we want to inflame the tendons and ligaments,” says Tucker, “is so the patient’s own body will heal itself naturally. The healing process takes four to six weeks following treatment.”

How do PRP and dextrose prolotherapy work? Though blood is mainly liquid (plasma), it also has small solid components (red cells, white cells and platelets). In addition to helping clot the blood, platelets also contain hundreds of proteins. According to Tucker, these proteins called growth factors, are extremely helpful for healing injuries.

When a patient needs PRP therapy, blood is drawn (usually about 600 cc, which is about two ounces or six vials) and placed into a centrifuge, which spins to separate out the platelets. Then, the platelets are mixed together with the plasma, producing about 6 to 8 cc of fluid. “This greatly increases the concentration of growth factors found in this small amount of fluid,” explains Tucker. Using ultrasound and very precise palpitation skills, the PRP is injected into the area with the most damage. Generally, dextrose prolotherapy is used around the joint to help stabilize it, provide further healing and prevent additional damage to the area.

To understand what conditions PRP and dextrose prolotherapy help, says Tucker, you must understand the process of what’s happening when someone has joint pain. “A joint in the space between two bones. The structures holding those two bones together are the ligaments and tendons, which are like short pieces of thick twine. When someone has a long-term, overuse syndrome – tennis elbow for instance – the tendons become worn out, like a frayed rope. This occurs because the muscles aren’t strong enough to handle the excessive action of the joint, so the tendons do the work.” When that happens, she says, the avid tennis player is going to feel pain. “We can inject PRP or dextrose to strengthen those tendons, and return the player back to her activity.

PRP therapy can be used for most conditions that cause pain as a result of movement that involves overuse of the tendons and ligaments (known as degeneration). “It’s also fantastic for hypermobility syndromes,” she says. Joint hypermobility syndrome is when a person has very flexible joints and it cause them pain (it’s often referred to as being double jointed). This syndrome is often mistaken for fibromyalgia.

Other common syndromes that prolotherapy may help include golfer’s elbow, wrist strain or over-use of the thumb; instability of the neck, back or sacroiliac joint; plantar fasciitis or shoulder pain; early bunions and hip pain, among myriad other, says Tucker. Studies are ongoing as to its efficacy in treating osteoarthritis.

Interestingly, these conditions usually look normal on an X-ray and MRI, she adds, so it can be frustrating for both the patient and doctor. “When a patient tells me that they feel much better after seeing their chiropractor or osteopath, but (the treatments) don’t hold, I know I can help them,” says Tucker.

The risks of prolotherapy are minimal. Generally, there will be bruising of the treatment area. Occasionally, patients report feeling faint or dizzy right after treatment (this typically clears quickly). Those who are living with conditions such as diabetes, heart disease or pulmonary edema should check with their primary care doctor before undergoing treatment. There are other risks, says Tucker, but they are rare.

“The feedback we receive is heartwarming. We change people’s lives every day,” she says. “I feel grateful to have something to offer people in pain that really works. As we strengthen the structures around the joint, our patients can function better and better. It may take a single round or multiple rounds of treatment to obtain permanent results.”

Generally, PRP therapy ranges from $700 to $2,000 per treatment, which involves multiple injections during one session. Most insurance companies do not provide coverage.

MANAGING PAIN FOR A LIFETIME

Everyone navigates pain at some point during their life. Injuries happen and as people grow older, chances are there will be some physical aches and pains to navigate as well. “As people live longer and spend more and more years in the over-age-60 category, well, their bank accounts may be good, but their bodies might keep them from traveling and playing with their grandchildren,” says Rubenstein. “If we take better care of our bodies and treat them as well as our bank accounts, there’d be a lot less pain.”

What are her go-to strategies for preventing or navigating pain? “Stay strong, flexible and have good balance – the body is a use-it or lose-it machine.” She offers some practical advice she’s learned from a career in pain management: Take care of your body. Be active. Eat well. Get enough sleep. Learn how to manage stress. Avoid excessive alcohol and don’t smoke. “Take good care of your body, and that means don’t abuse it,” she says. “It has to last you to the finish line.”

Karen Hart is an author and writer, who’s been writing about health for 30 years. She has a passion for health and wellness, and believes in the healing power of nutritious food and exercise. Hart’s goal is to break a sweat every day. She lives in Santa Rosa and can be reached at writerlady.sonomacounty@gmail.com.