Three in five U.S. adults are in physical pain of some kind. More than 20% of U.S. adults suffer from chronic pain, and more than 7% experience high-impact chronic pain—or pain that severely limits daily activities and the ability to work. Mental health disorders, such as depression and anxiety, are also more prevalent among individuals with chronic pain.

In other words, pain is all too common—and pain hurts. Whether acute or chronic, it can be all-consuming. The impact of pain goes far and wide, affecting not just individuals, but also families, businesses, and communities.

In today’s world of medicine, the conversation around pain is usually about managing it. There’s a whole industry and medical speciality around helping people deal with their pain. But it is strange that we don’t talk more about preventing pain before it occurs and eliminating it (as opposed to just dealing with it) after it starts. Too often, we talk about pain as if it were an unavoidable part of life that must be endured. The reality is that many types of pain can be prevented and permanently eliminated via proactive pain care. But first things first…

What is pain?

Pain is a feeling, a sensation, a message from our brain that something is not right. Aching, burning, throbbing—these are all words used to describe how pain feels and how our body interprets the messages from our brain.

Pain can be acute or chronic:

• Acute pain comes on suddenly to warn the body of an imminent threat—for instance, the sharp pain of breaking a bone or spraining an ankle. Acute pain usually resolves when the underlying cause, or threat, is no longer present.
• Chronic pain is pain that lasts longer than three months. Often the result of illnesses such as arthritis or cancer, chronic pain can occur in any part of the body and last for months or years, severely impacting quality of life for those who suffer from it.

In some cases, acute pain can evolve into chronic pain, especially if the cause of the acute pain is overlooked or not treated in a timely and appropriate manner.

Some pain is work- or lifestyle-related. For instance, sitting at a desk for prolonged periods and not exercising can cause pain, as can jobs that involve heavy, physical labor. Imagine you have an employee who injures their back while lifting a heavy box on the job. Following the injury, their doctor recommends avoiding strenuous activity or lifting heavy objects. To help with recovery, the employee is reassigned to desk duty. But even with less physically demanding responsibilities, their pain does not improve, and they remain working at a desk for most of the year. They notice their back is not getting better—it is actually bothering them even more than before.

While it was necessary for this employee to avoid heavy lifting for a period of time post-injury, adopting a sedentary lifestyle for their new work assignment was likely detrimental to their healing. It is important to stay active with appropriate rehabilitative exercise while healing from an injury, as movement improves circulation and reduces inflammation. In this case, the employee’s pain has gone from acute to chronic, and both their quality of life and their productivity at work are sure to suffer.

What is pain management?

Pain management is the use of pain-relieving techniques and therapies to improve quality of life for chronic pain sufferers. Technically, all of the following fall under the umbrella of pain management:

• Medications
• Injections
• Acupuncture and massage
• Physical therapy
• Exercise and lifestyle changes
• Cognitive behavioral therapy (CBT)

Chronic pain is one of the most common reasons adults seek medical care. But due to the siloed nature of the U.S. healthcare system, it can be difficult for a sole provider to put together a multidisciplinary pain management plan that both alleviates pain in the short term and tackles the underlying cause of pain over the long term. The result is that, all too often, pain management relies heavily on the first two interventions listed above—medications and injections—to give patients quick relief from their pain. In other words, it simply “manages” their pain with quick fixes, as opposed to using longer-term strategies like physical therapy and CBT to attack its root cause.

This has led to the overprescription of highly addictive medications such as opioids. Opioids are drugs that block pain signals between the brain and the body. Often, they are prescribed by a physician after surgery. The most commonly prescribed opioids include:

• Hydrocodone
• Oxycodone
• Oxymorphone
• Morphine
• Codeine

Between 2019 and 2020, opioid-related death rates increased by 38%, and prescription opioid-involved death rates increased by 17%. Overprescribing and misuse of opioids has led to the opioid overdose epidemic. In 2017, opioid use disorder and deaths caused by opioid overdoses cost the U.S. over $1 trillion.

What is proactive pain care?

Proactive pain care refers to the aspects of pain management that can reduce existing pain, while simultaneously preventing further pain by attacking its root cause. Unlike medications and injections, which are reactive—i.e., prescribed as a reaction to pain symptoms—proactive pain care can and should be practiced even when no pain symptoms are present. And if used to mitigate a pain flareup, they should be continued after the pain episode resolves.

Take CBT, for instance. This psychological intervention helps chronic pain patients become aware of negative thinking that impacts their mental health and pain levels. People who are able to apply CBT techniques and take control of negative thoughts often see improvements in both their pain levels and the impact depression has on their daily lives. The efficacy of CBT for chronic pain conditions has been confirmed in medical literature, and its importance is acknowledged by the CDC.

But even when no pain symptoms are present, CBT is a powerful way to stave off future pain—because depression can cause pain, just as pain can cause depression. Proactively practicing CBT to get and stay mentally healthy reduces the likelihood of developing depression, and therefore pain, down the line. This is in stark contrast to pharmacologic pain management like opioids, which would never be advisable in the absence of pain symptoms—and certainly would not reduce the likelihood of developing chronic pain in the future.

Pain education as proactive pain care

One aspect of proactive pain care that is often overlooked is pain education. Education regarding pain and its impacts can empower people to self-manage their pain. It can also give people who don’t have pain symptoms the information they need to stay pain-free. Pain education is most effective at reducing and preventing pain when combined with other proactive strategies like physical therapy and CBT—but is undoubtedly an important part of the equation.

Let’s return to the example of the employee who was reassigned to desk duty after injuring their back on the job. Having been accustomed to a job that involved physical labor, it is likely that they know very little about the realities of a desk job and the toll it can take on the body. Therefore, it is important that they learn things like how to:

• Set up an ergonomic workstation
• Prevent tension and tightness from building up throughout the workday
• Properly stretch to prevent pain

Had they been armed with this information, they would have been far better equipped to handle their new work assignment. Perhaps they would have known how important it is to have a 90-degree angle in the hips, knees, and elbows while seated at a desk. Perhaps they would have known about breaking up the workday with consistent movements that disrupt the posture they spend most of their day in—for instance, extending the knees periodically throughout the day to balance out their bent position while seated.

Simple but crucial adjustments like these could have prevented the employee’s acute pain from developing into chronic pain over the course of the year. Likewise, this information could prevent an employee with no pain from ever developing pain in the first place.

Academy, Sword’s hub for premium educational content, provides members with the information and resources they need to prevent injury, understand pain, and build healthy habits. In order to reduce their risks and learn their way to a healthier, pain-free life, members can access our library of clinically validated video content on-demand in the Sword app. We keep our videos short and actionable, making pain education as easy and accessible as possible. And with 10 new episodes uploaded to the Academy every month, there is always something new to learn.