Poverty limits therapies for patients with chronic pain

Chronic pain plays no favorites — it crosses all cultural and socioeconomic circles — but the same is not true for getting that pain treated, educators gathered at Northwestern Health Sciences University in Bloomington said Saturday.

Access to help for chronic pain is improving for people with limited financial resources, but it continues to come mostly from traditional medical providers rather than through more cost-effective treatments, Alejandra Estrin Dashe, director of Northwestern's Office of Diversity and Inclusion, told a symposium audience.

Researchers and practitioners in such fields as acupuncture, nutrition, chiropractic care and massage therapy want to spread the message to needy Minnesotans that there are alternatives to expensive pain medications or surgery.

The Affordable Care Act, Dashe said, "has certainly done more good than evil" in terms of leveling the playing field for people seeking relief from pain — a $600 billion-a-year expense that almost equals the costs of treating cancer, diabetes and heart disease combined. Still, she said, providers don't often offer conservative treatments, especially to medically disadvantaged populations with income limitations or language and cultural considerations.

"Patients in chronic pain face all sorts of barriers to getting the best care," Dashe said. Lacking the money to seek treatment, some choose to live with their discomfort. "Or they work so much that they just don't take care of themselves," she said. "Others may not even be aware of their options. For instance, someone with pain from shingles doesn't know they might be given just one acupuncture treatment and, bam! — it's gone."

Cultural factors influence how a person expresses pain and how they seek help, Dashe said. "Roles and statuses the person has within their own culture intersect with age, race, sexuality and education," creating conflicts that get in the way of getting care.

Barbara Gosse, a licensed acupuncturist and family practitioner at the Bloomington Natural Care Center, has used acupuncture to treat patients with all kinds of acute and chronic pain. But the efficiencies of alternative care struck close to home when she recently needed treatment for bone injuries brought on by XLH, a metabolic bone disorder that leaves her vulnerable to breaks.

"I had two major bone surgeries. With one, I followed the track of traditional care and ended up wretchedly sick in bed for a week from the medications," she said. "With the second one, I had acupuncture prior to the surgery and while I was in the hospital, instead of any pain or anti-nausea medications," she said. "I was up and moving in 48 hours. It was a tremendous difference."

Other specialists said relief can be as close as the kitchen or neighborhood park, in the form of nutritional therapies and simple exercise to help combat inflammation, a root cause of much chronic pain.

"Foods can be both inflammation reducing and inducing," said Dr. Joseph Sweere, a Minneapolis-based chiropractic and health educator. "Just moving to a more balanced, less acidic diet with more fruits and vegetables can work wonders."

It also helps to get moving. "Exercise produces endorphins, which are natural pain relievers, " he said. "The key is to get people activated."