Building tolerance

I attended a pain management lecture given by a prominent physician a few weeks ago.  As expected given the presenter and the audience of doctors who treat pain, the conversation covered many topics.

The most interesting subject, though, was the philosophy of pain managment.  Patients and doctors all think about reducing pain.  There are, in fact, dozens of ways to decrease overall pain level.  Our focus often seems to be on eradicating pain with medications.

Perhaps instead we should consider not just reducing pain but also improving tolerance.  There are many ways to increase resistance to pain using both medications and other techniques. 

One of the biggest recent advances in pain is the concept of treating pain with seizure medications such as gabapentin and pregabalin.  While these drugs do decrease pain levels somewhat, their main mechanism of action is to increase the resistance of the pain nerves in the brain and spinal cord.  Norepinephrine medications such as milnacipran and duloxetine similarly improve the brain's ability to resist pain signals.

Exercise and physical therapy also improve pain levels, partially by increasing tolerance.  This effect is most clearly seen in patients with fibromyalgia.  Other similarly effective techniques include meditation, biofeedback and even simple positive thinking.

With the recent advances in the understanding of pain regulation in the brain and the spinal cord, I suspect improving pain tolerance will become a much more prominent component of pain managment over the next few years.  Keep an eye out for more options to improve your ability to resist pain!