How to Treat Chronic Pain with Melissa Cady, DO

Pain. We all experience it. It is as much a part of life as breathing itself. But what is pain? Is it physical? Is it mental? Is it emotional? Is it mechanical? Also, how does pain become chronic? One of the few things experts on pain can agree on is that our ability to treat pain - especially chronic - is not very good.

What is Pain?

My guest today is Dr. Melissa Cady, an anesthesiologist who is pain fellowship trained. She wrote the book, Paindemic, which describes her journey to explain what pain is and why she felt she could never open a pain practice. Pain, according to Cady, is a combination of physical, mental, and emotional impulses that congregate in our brain to give us a sensation of pain. It is not objective which makes it impossible to measure precisely. Most importantly, unless you address all of the aspects of chronic pain, Cady says you will never be able to effectively treat it.

Much of what drives chronic pain is fear. Fear from moving. Fear that the patient will never get better. Fear that whatever may have caused the pain will occur again. Therefore, procedural and pharmacologic interventions may not be effective since they do not address the core of the pain.

What is Diagnocentricty?

The term that Dr. Cady coins in her book, is diagnocentricity. Basically, this means that the patient becomes referring to him or herself as a diagnosis instead of a whole unique person. They define themselves as "back pain" or Parkinson's disease instead of the many people they really are (mother, professional, hobbyist, loving, funny, etc.) This self-pigeon holing makes it very hard for them to climb out of the pit of chronic pain since their identity is now wrapped up in a diagnosis instead of a fuller picture of themselves.

The epigenetics of Pain

This definition of ourselves as just a diagnosis is similar to the belief that we are products of our genes with no ability to affect our outcomes. But much as I discussed with Dr. Jason Fung, our notions of how genes work and are expressed is terribly outdated. We have an immense ability to change our gene expressions with diet, activity, and other environmental factors. A simple way of thinking of this is that although there may be a gene regulating your height, it is impacted by your nutrition status as a child. If your diet lacks calories, you will not be as tall as someone who receives a nutrient rich diet in their years of growth.

What is an antiPain Lifestyle?

Boiled down to its most basic, and antiPAIN lifestyle is simply a wellness program. It means you should move as much as possible to prevent worsening of pain and help with fitness. The most important emotion to overcome is fear of further injury or exacerbation of pain. That is often the biggest limitation to an improvement physically and mentally. It is why it is so critical to have a doctor evaluate the pain to rule out something serious and then work with a trainer or physical therapist to increase strength and stamina.