David Simon, MD, on Diagnosing and Treating Chronic Pain

By: David Simon, M.D., Co-Founder, CEO, and Medical Director, Deepak Chopra Center

August 20th, 2009 • Mind-Body MedicinePrint Print

There are many different causes for chronic pain. Before anyone treats pain just for the sake of relieving the pain, you want to know what it is that’s causing that pain. Assuming you have a disorder for which there’s no easy medical fix, which usually means you’re talking about some kind of arthritis, begin a process of trying to relieve yourself of that pain — starting with the most non-invasive and gradually working your way to the more invasive approaches.

Let’s take a common problem: chronic low back pain. Over time, most people get low back pain, because we’re not that well-designed, mechanically, to stand up on two legs, against gravity, our whole lives. As people reach middle age and beyond, it’s quite common for them to get degeneration of their discs and bones, resulting in chronic discomfort.

So usually you will start off by getting an evaluation from your doctor — family doctor or orthopedist. More often than not, the response will come back that you have chronic degenerative arthritis that will not benefit from a surgical approach. From a medical perspective, that usually means you’ll need to try anti-inflammatory medications or other types of anti-pain medications.

From a more holistic perspective, however, we know that a person’s perception of pain has as much to do with the overall sense of their life as does any particular irritation in a joint or nerve root. So the first thing that we suggest for people with chronic pain is to learn how to quiet their minds and relax their bodies through a combination of meditation and relaxation techniques – stretching, yoga postures, and gentle, calming breathing exercises. These classic techniques from the yogic tradition can raise a person’s pain threshold and also improve circulation, reduce muscle spasm, and improve flexibility in the area that is causing the pain.

There is increasing scientific understanding that our interpretation of the sensation of pain is as important to its pattern as whatever is causing the problem. Take a chronic pain situation like fibromyalgia, where people complain of pain throughout their muscles and joints: Although we used to think that the problem was in the muscles and joints, we now believe that the primary problem is actually in the brain. The pathways that modulate pain are, in a sense, letting too much traffic through those pathways, so the pain is as much a brain problem as it is a muscle or joint problem. 

There are a fairly limited number of studies looking specifically at the role of meditation, yoga, or massage on pain. The reason these studies are limited is that it is difficult to control for these techniques. It is difficult to round up 100 people with the same type of pain, have half the people doing nothing and have the other half doing yoga alone. The people who are willing to participate in these studies are generally not just going to sit around for six months doing nothing.

But the studies that have been done suggest that people who take a more active role in their own pain management – for example, exercising to improve their flexibility, strength, and cardiovascular ability – naturally produce pain-relieving substances that lower their perception of pain. These substances also improve the people’s mood, and we know that mood and pain go hand in hand:

When someone is in a lot of pain, they are more likely to feel depressed or anxious. Conversely, when someone is depressed or anxious for other reasons in their life — loss of a relationship or challenges with work or financial situations — their anxiety and depression lower their pain threshold, so the same level of pain is perceived as being more serious.

David Simon, M.D., is a board-certified neurologist and ayurvedic practioner; co-founder, CEO, and Medical Director of The Chopra Center for Wellbeing; and assistant clinical professor in the Department of Neurosciences at The University of California. Dr. Simon has authored popular wellness books including The Ten Commitments: Translating Good Intentions into Great Choices and Grow Younger, Live Longer: 10 Steps to Reverse Aging (co-authored with Deepak Chopra, M.D.). Dr. Simon is a keynote speaker for the March of Dimes, American Cancer Society, California Medical Association, Harvard Medical School, and other prestigious institutions.

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