Chronic Pain: An Interview With Ridgefield’s Dr. David Johnston

Chronic Pain is a condition plaguing over 25.3 million Americans every day.[1] When we talk about chronic pain, we refer to recurring pain in the body. The difference between a stubbed toe that won’t seem to stop hurting and chronic pain lies in the nervous system. Acute pain is immediate—a sensation you trigger in your nervous system in response to a potential injury in the body. Pain is a natural response to outside stimuli your body is uncertain of. Once the danger has passed, or action is taken to address the wound or problem area, the pain subsides.

But Chronic pain is persistent. Nerve endings continue to fire off signals for weeks, months, or years with seemingly no reasonable cause. It’s possible your chronic pain derives from an initial point of trauma (ie: a bad ankle sprain), but some patients suffer from chronic pain without one. The most common symptoms include lower back pain, arthritis pain, headaches, neurogenic pain, or cancer pains.

More than likely, you’ve met someone constantly and silently coping with widespread, intense bodily pain. When you constantly feel aches and pains throughout the day it can really take a toll on your quality of life – not to mention your patience. While chronic pain sounds like an inescapable hell you must be lucky not to suffer from, patients can get help from an Osteopathic doctor.

The American Osteopathic Association defines a DO, or Doctor of Osteopathic Medicine, as a fully licensed physician who practices all areas of medicine[2]. DOs specialize in approaching treatment by addressing the issues of the whole body. With extensive understanding in musculoskeletal anatomy (the connection in your body of muscle, nerve, and bone), the DO can offer you a comprehensive understanding of what’s going on in your body.

Treatment primarily focuses on prevention and healthy lifestyle changes. The DO encourages the patient to re-attune their lifestyle and environment to improve and maintain their wellbeing. Drug prescription and manipulative treatment are also a possibility, depending on the case.

Here is an interview with Osteopathic specialist Dr. David Lester Johnston of Ridgefield, Connecticut to answer questions on Chronic Pain and Osteopathic Care.

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How would you define Chronic Pain?
Dr. Johnston: “Chronic pain is generally defined as any pain lasting for more than 12 weeks. It persists over time and is often resistant to typical medical treatments. Chronic pain may be related to a number of different medical conditions including, but not limited to, diabetes, arthritis, migraine, fibromyalgia, cancer, shingles, sciatica, and previous trauma or sustained injury.”

What is the most common treatment for Chronic Pain?
Dr. Johnston: “There are a variety of options for the treatment of chronic pain and most people find a tailored approach, utilizing a combination of treatments, is best. Some of these options are oral and topical medications like non-steroid, anti-inflammatory drugs, acetaminophen and opioids, as well as antidepressants and anticonvulsants (which can affect the way the brain processes pain).

Other treatments include trigger point injections of muscles with steroids and local anesthetic, or more invasive spinal region injections to block nerve pain and relieve inflammation. Non-invasive methods include osteopathic treatment, acupuncture, exercise, cognitive behavioral therapy, mindfulness based stress reduction, biofeedback, and physical therapy.

Nearly all people with chronic pain seek alternative treatments.”

What is Osteopathic treatment, and how does it work?
Dr. Johnston: “Osteopathic Manipulative Treatment (OMT), “is hands-on treatment–in a literal sense. Your DO uses their hands to diagnose, treat, and prevent illness and injury. Think of OMT as a kind of massage: your osteopathic physician uses their hands to knead, stretch, press, and move your muscles and joints.[3] The patient lays down or sits on a table, and the physician applies manual pressure on or at a distance from the area they are struggling with.

This technique addresses the problem area directly. In moving the joint or muscle the physician is able to relieve restriction or misalignment, restore muscle and tissue balance, improve bodily fluid movement, and treat structural or tissue abnormalities.”

Is Osteopathic Treatment as effective as other Chronic Pain treatment?
Dr. Johnston: “Osteopathic manipulation is useful as an adjunct to other medical therapies for acute and chronic pain, and plays an important role for back and other musculoskeletal conditions. The osteopathic physician has the unique ability to medically prescribe, plus provide traditional manipulative therapy.

For low back pain a study in the New England Journal of Medicine in 1999[4] showed that a group treated with osteopathic manipulative therapy needed significantly less non-steroid pain medicine and less physical therapy than the control group, which resulted in a significant cost savings.”

What are the risks of drug treatments for Chronic Pain?
Dr. Johnston: “Opioids, which are often used in chronic pain treatments, are highly addictive and can cause nausea, constipation, drowsiness or even death. There currently is an opioid addiction crisis in America that has reached epidemic proportions.

In addition, excessive use of acetaminophen and ibuprofen (non-steroidal drugs) can cause liver toxicity and GI bleeding, nausea and abnormal heartbeat. Osteopathy offers a safer, less invasive approach to managing chronic pain.”

Does Osteopathic treatment have side effects?
Dr. Johnston: “Sometimes there can be mild fatigue or soreness after the initial treatment for a day as the body goes through a healing crisis and integrates the gentle but powerful treatment.

However, most patients do not experience this.
There are virtually no side effects of osteopathic treatment.”

Are a lot of Americans affected by Chronic Pain?
Dr. Johnston: “More than 100 million Americans suffer from chronic pain annually[5], resulting in a cost of approximately $600 billion in medical treatments and lost productivity, according to a report from the Institute of Medicine, June 30, 2011.”

Do a lot of Americans undergo Osteopathic treatment?
Dr. Johnston: “Osteopathic physicians all over the US treat many Americans. As of 2016 there are more than 102,137 Doctors of Osteopathy (DOs). Osteopathic medicine is one of the fastest growing health professions in the US. Since 1986, the number of DO physicians has increased by 276%. 56% of active DOs practice in primary care specialties including osteopathic manipulative medicine, family medicine, internal medicine and pediatrics.”

What is the most common group of people to suffer from Chronic Pain?
Dr. Johnston: “The most obvious group commonly suffering from chronic pain are those who have suffered a traumatic injury in the past. This is especially common to victims of sprains, or ongoing illness.

Poor and less-educated older Americans are at a higher risk of suffering chronic pain than those with greater wealth and more education. The disparity between the two groups is significantly higher than we previously suspected, according to new research[6].

According to the National Center for Health’s statistics, women are also more likely to suffer from chronic pain.[7]

Are there limits to Osteopathic treatment?
Dr. Johnston: “As with all types of treatment, there are limits to what osteopathy can do. With chronic pain, it is not always a quick fix, especially if there are other complications or health problems. The biggest limiting factor is time. On occasion, it can take 3-6 months of regular weekly treatment for some clients to get more significant relief.”

What are the most common types of Chronic Pain?
Dr. Johnston: “27% of patients suffer from lower back pain.
15% of patients suffer from headaches and chronic migraines.
Another 15% of patients suffer from neck pain
And 4% of patients suffer from fascial pain. [8]

Aside from the obvious, what are some symptoms of prolonged Chronic Pain?
Dr. Johnston: “Obviously, the pain can take a toll on not only on one’s body, but also on their mental health. Chronic Pain is known to cause fatigue, depression, anxiety, insomnia, and difficulty concentrating in patients.”

How long would Osteopathic treatment take?
Dr. Johnston: “It depends on the type of pain and how long it has been present. About 70% of patients will experience relief in as few as 1 or 2 treatments, while some patients will take 4-6 visits to have more permanent relief.”

Can Osteopathy treat other conditions beside Chronic Pain?
Dr. Johnston: “Of course! Osteopathy can address trauma from sports injuries, concussions, whiplash, car accident injuries, jaw pain, and dental imbalances. It can also help newborns with colic or issues with feeding.

How has Chronic Pain treatment changed over the last few years?

To be frank, opioids are still playing a major role in Chronic Pain treatment today.

However, there’s been a radical shift from opioid prescription to osteopathic treatment over time. Actually, the opioid crisis in America has changed the way we deal with pain. With a drastic rise in citizens suffering from Chronic Pain, increases in opioid drug sales, and the consequential epidemic of opioid dependence and potential for abuse,[9] doctors have been increasingly more hesitant to prescribe opioids. In fact, new laws have been developed to urge doctors against opioid prescription. Limitations on pain medication have been put in place to remedy the growing epidemic of abuse.

Health care professionals everywhere are working to better understand the nature of Chronic Pain, and alleviate it without prescribing opioids. For example, the Boston Children’s Hospital conducted a study to determine the relationship between sleep and chronic pain, and found that sleep loss increases sensitivity to pain.[10] A report by the IASP also suggests chronic pain may be genetic.[11]

With time and an increasingly disturbing Opioid abuse epidemic, science has focused its efforts towards alleviating the dangers of medicating Chronic Pain.

In stark contrast, Osteopathic care has flourished in recent years, developing new means of addressing chronic pain in patients day by day. Osteopathic Manipulative Medicine has been shown to improve results for chronic back pain in as little as 3 months, with results lasting as long as a year.[12]

How many patients have you treated?
Dr. Johnston: “I have performed over 20,000 osteopathic treatments on patients in my practice over the course of my career, not including family and friends.”

How long have you worked in the Osteopathic field?
Dr. Johnston: “Over 20 years, including my residency at St. Barnabas Hospital in the Bronx.”

Why did you get involved in Osteopathic Treatment?
Dr. Johnston: “I was interested in health and helping others since childhood and the more natural approaches to healing with less medication and less invasive treatments made more sense to me. Osteopathy seemed a natural fit, in that I would be medically trained while still being privileged to develop the art and science of actual hands-on healing.

Watching my father endure cardiac bypass in his forties was an awakening for me. I realized that there must be a way to prevent chronic disease with proper diet and lifestyle adjustments. It was my goal to help people like my father.”

Author
Dr. David Johnston Dr. David Johnston is a licensed, board certified osteopathic physician with more than twenty years experience working with infants, children, and adults. He pursued his childhood dream of becoming a physician and currently has a successful private practice in Ridgefield, CT.

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