As a trained acupuncturist and TCM practitioner I approach the treatment of pain in a very specific way. Let’s be clear, in the main I am treating people who are suffering with Chronic pain, i.e. prolonged physical pain that lasts longer than the natural healing process should allow. Pain signals in the brain keep firing within the central nervous system for weeks, months or even years, long after when the pain should have dissipated and reduced. This means that sometimes the person receiving treatment is unable to clearly identify the root cause of the pain, it seems to them to be ‘all over the place’ So what are the first steps that I take to approach the treatment of pain? Basically it is a series of questions;
- Area of pain: is it local or moving about? Where exactly is the pain?
The location of the pain; that sounds pretty obvious, but it’s important to find out exactly where. The person may say ‘stomach’ and when I ask them to point the area it could be they are pointing their lower abdominal area. That gives me a different kind of information to work with as I can then ask specific more focused questions.
- Nature of pain: is it an ache, dull, sharp, intense, stabbing, vice like, sore, has a sense of heaviness, burning, colicky like, spastic, feeling distressed, sense of stuffiness, pushing or pulling, cutting, throbbing, boring, lurking, etc?
I ask the person to describe it spontaneously, in their language and terms. A clear difference here is that most people use language that is western or medical and I ‘translate’ that for my work into TCM terms; for example the person may say “bloating” in their tummy, I will translate that to meaning “distension” or “feeling like being pulled down” in the abdominal area, translating it to mean “bearing down”. This process helps me understand what is going on in their body so in a case of unexplained abdominal pain I can ask “is the pain accompanied by a feeling of heaviness?”. In many cases the person concerned will confirm that is exactly what they are feeling.
- Time of pain: day time, night time combined with either intermittent or continuous pain?
This not only is related to time of day but also time of the year or before or after an event or behaviour. Depending on the answer this will give me more information to help determine treatment methodology. So for example if a person complains of joint pain I will ask something like “does the pain feel worse when the weather is cold or rainy?” Or “what time of day does the pain feel worse or gets worse?” What I’m trying to work out is if the pain is affected by external changes, seasonal changes or weather conditions as arthritic joint pain can get worse when the weather is cold and damp and it usually gets described it as ‘an aching, tiring pain’ instead of a ‘sharp stabbing’ pain.
- Response to pressure and temperature: we ask how the pain responds to pressure so we say something like “does the pain feel better if you rub it or press it?” or “do you dislike it being touched?”
If the pain is made worse with pressure then that tells me it’s a full condition (TCM interpretation), there is too much of something, whereas if pressure helps get rid of the pain or reduce it, it tells me it’s a deficient condition, there isn’t enough of something. Conditions which respond to pressure include stomach aches, menstrual pain, joint pain and abdominal pain. If the pain is helped by warmth then that tells it is due to cold or Yang deficiency; this can be heat from a hot water bottle or hot/warm weather. Backache, joint pain, stomach ache, abdominal pain and menstrual pain all tend to respond better to warmth and heat instead of cold. In TCM no pain is generally helped by cold except in the case of acute joint sprains where there’s inflammation and swelling of the tissues. In these cases we don’t treat with ice but may use tepid heat such as a flannel rinsed in tepid/room temperature water to draw out the heat caused by the inflammation gently.
- Food and drink: is the pain made worse by eating? Is the pain made better by eating? Is it worse by drinking cold liquids? Is it made worse by drinking hot liquids? Is it made better by drinking hot liquids? Is it made better by drinking cold liquids?
If food and/or drink is involved then in TCM terms the stomach is involved so it needs to be considered in treatment strategies.
- Movement and rest: How does the pain respond to movement? What does resting or lying still do for the pain?
How the pain responds to movement and rest will gives information about how the Qi and blood is affected by pain. If movement helps reduce pain then that tell us Qi is not moving well enough so causes the pain or it’s cold. If movement makes the pain worse then that tells me there is a deficiency of Qi or blood. If rest makes the pain worse then it’s also cold and/or Qi stagnation and if rest helps then that tells me there isn’t enough Qi or blood. Once the answers to these questions have been established we can move onto to explaining how pain is affecting their body, describe what could be happening internally and create a plan for pain management.