When you read the word “pain,” what do you imagine? Maybe it’s the residual sensation after surgery, the way your legs feel after an intense leg-day workout, or maybe it’s a chronic condition that you experience each and every day as you go about daily tasks. Regardless of what you think about when you read the word pain, I think we can all agree that pain is unpleasant and most people go to extreme lengths for pain management.
A common definition of pain that has been used is “…an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.” More recently researchers have attached an emotional component to pain, as pain can create a myriad of emotions which can then contribute to the continuation of pain. Also, pain can be present without actual tissue damage.
Pain is something that impacts on average nearly 50 million – 100 million Americans and therefore is something that scientists are constantly seeking interventions for. Unlike other conditions such as diabetes which can be measured via blood sampling, pain is entirely subjective. No one knows the intensity of the pain as much as the individual who is experiencing it. The enigma of pain and pain management has been a challenge for decades, but research has recently started diving into pain management interventions that are safe and effective, and weighted blankets are making a breakthrough in the pain management industry.
An Interdisciplinary Treatment Approach to Pain Involving Weighted Blankets
One intervention or treatment approach alone is typically not enough for true pain management care. Weighted blankets alone will not take away all of your pain, but rather when they are used as part of an interdisciplinary treatment approach, there is anecdotal evidence of benefits.
Owen et al., (2018), in my opinion, presented information on pain management the best and they appeared to be mostly driven by science. Therefore, my outline below will be based on this article. The strongest selling point that drew my attention to this article as a main source of information was the call for an interdisciplinary model while working with patients who are experiencing pain. I have said this in previous articles, but there is a noticeable divide between the disciplines of health, and to help patients this divide needs to be deconstructed.
Owent et al. To treat pain, clinicians and physicians must work together to look at the whole person including their “educational background, cultural belief systems, social conditions, and psychological and psychiatric comorbidities in addition to the patient’s physical state.” Somatic symptoms are common in mental health conditions, so if a patient presents to the physician for pain and the physician does not address potential psychological conditions, they are doing the patient a huge disservice and neglecting an essential piece of treatment. The goal with all pain management treatment is to use medication-assisted treatment as a last resort. Before looking at potential medications, the first 2 treatments described below, are suggested:
1) Physical Therapy
When people are in pain they often don’t want to move around as they anticipate this will cause more pain, however, this fear of pain can hinder treatment. For example, regular strength training has been shown to alleviate some fibromyalgia symptoms, and consistent yoga practice has been shown to alleviate chronic back pain. The biggest challenge with physical therapy is overcoming the mental barrier that the activity will increase pain rather than decrease it, which brings us to treatment suggestion two.
2) Psychological Treatment
Anxiety and depression are common comorbid disorders that can maintain the perception of pain or lower the threshold in pain sensitivity. A psychological component to pain management treatment is necessary and can include multiple facets such as psychotherapy to aid in the development of coping skills.
The psychological component of pain is where weighted blankets can fit into pain management. Weighted blankets can work within a pain management treatment plan in the following ways:
- There is evidence to suggest that weighted blankets can de escalate the sympathetic nervous system response and heighten parasympathetic response. When a person is experiencing anxiety, often their muscles are tightened as a result of sympathetic nervous system activation, which can cause pain. Also, pain itself can activate the sympathetic nervous system. Thus a person with chronic pain can utilize a weighted blanket to reduce sympathetic nervous system activity, which will likely mitigate pain and allow them to engage in the physical therapy activities suggested in #1 above.
- People like weighted blankets and it’s typically not a chore to use them. In nearly all studies that look at deep pressure stimulation interventions –including weighted blankets–it was found that there was either subjective and/or objective data that demonstrated an alleviation of anxiety symptoms. Anxiety can contribute to the persistence of pain, as people who experience chronic pain may be nervous that engaging in certain activities will cause pain and thus they become stuck in a loop of anxiety and avoidance which can make the pain worse.
- Unpleasant emotions activate the amygdala, anterior cingulate cortex, and anterior insula which are areas of the brain which process emotions and draw attention towards a pain sensation (paying attention to pain can intensify the sensation). The amygdala is also linked with the sympathetic nervous system, which as bullet point one explains, can be reduced with the application of a weighted blanket. Essentially, pain is perpetuated by emotions, and emotional distress can be managed with a weighted blanket which will reduce the conscious awareness of the pain sensation.
- Weighted blankets can improve sleep, and research has demonstrated that poor sleep is associated with a decrease in pain tolerance. Chronic pain can even develop as a result of poor sleep habits. Research has shown that when a weighted blanket is used, people fall asleep faster, remain asleep, and restlessness is reduced.
Thus, weighted blankets may not cure pain, but they have the ability to reduce the perception of pain and thus improve functioning. Of course, weighted blankets should be used in conjunction with the other treatment options highlighted above (i.e. physical therapy), as a multidisciplinary approach has the best prognosis.
3) Medication-Assisted Therapy
What pops into your mind when you think about medication for pain? Did you think of opioids? You’re not alone. A common opioid used in pain management is Oxycotin, which was introduced to the market in 1996. The drug company that developed Oxycotin quickly capitalized on the drug and spent $200 million dollars in 2001 to advertise and promote the drug for pain management. This massive advertising convinced physicians and consumers that opioids were the gold standard for pain management. Unfortunately, this led to the opioid abuse epidemic that most are familiar with today.
Opioids have their place in pain treatment, but their place isn’t prominent and most research has found that opioids a) don’t do a good job at eliminating pain over a long period of time, b) can alter the brain to create a LOWER pain threshold, c) can cause lasting depression, d) can delay recovery in acute pain e) and have the potential for accidental overdose if a dose is too high or if the drug is mixed with another substance. Opioids are NOT an effective solution for long-term pain management treatment; the brain adapts to the analgesic effects very quickly and thus the dose would continuously need to be increased which would exacerbate the issues highlighted above. So when should opioids be used? In highly selective cases and for a brief duration –the exact qualifications for opioid prescriptions are still being researched. Overall, physicians are trying to avoid prescribing opioids like the plague!
Similarly, Benzodiazepines are a medication that is used to treat anxiety, and there has been a huge surge of these medications being prescribed. However, benzos have similar side effects as opioids, and thus are not recommended as a treatment option for people who are struggling with anxiety and chronic pain.
Medication management is not the enemy with pain management, I can’t stress that enough. Some types of chronic pain will likely require medication-assisted treatment in addition to the two complementary treatments identified above. For example, people who experience musculoskeletal pain should be started on NSAIDS (i.e. Aspirin). Patients who are suffering from neuropathic pain will not experience much mitigation from NSAIDs and instead should be started on membrane-stabilizing medications. Although some medications are appropriate for treatment pain, I will reiterate that opioids are typically not an effective route.