Pain is considered chronic when it lasts for weeks, months or even years. Causes include trauma and conditions such as arthritis, cancer, infection, degenerative disc disease and neuropathies. Common complaints are headaches, low back pain, arthritis and neurogenic pain — pain that results from damaged nerves.

According to the American Academy of Pain Medicine, more than 1.5 billion people worldwide suffer from chronic pain, and approximately 3 to 4.5 percent of the global population suffers from neuropathic pain. Incidents increase with age. In 2011, the Institute of Medicine of the National Academies stated that 116 million Americans suffer from chronic pain. The next most-widespread condition is diabetes with 25.8 million Americans diagnosed and estimated to be undiagnosed. 

By the time chronic pain patients seek out a naturopathic physician, they are usually on a combination of medications, which normally aren’t working very well or the side effects are too debilitating. My patients have usually been dealing with chronic pain for many, many years. This necessitates being very aggressive with natural agents to get ahead of the pain, and then backing down.

Diet 
Losing those extra pounds is a must. I have never not seen a food sensitivity or intolerance play a role in chronic pain. Therefore, it is prudent to put patients on a gluten-free, casein-free, allergy elimination diet. This involves removing many usual suspects of food intolerances for two to three weeks. Then they are systematically challenged every 72 hours to see if there is a reaction. A reaction can take on almost any form, from irritability to sleep issues to increased pain. 

Exercise, therapy, etc.
Exercise, even a little, is a must. More movement equals less pain. The rationale is twofold: endorphins are released that improve mood and decrease pain. Studies consistently show that sedentary lifestyles exacerbate pain. 

Physical therapy and massage can help strengthen bones, ligaments, tendons and fascia, the fibrous tissue that surrounds muscles. 

Chiropractic therapy is based on the premise that musculoskeletal dysfunction stems from misalignment of the spine. Clinical trials have shown chiropractic treatment to be superior to placebo and medication in the relief of low back pain. 

Acupuncture has been around for thousands of years in Asia. It has been proven effective in hundreds of clinical trials and is now used in many hospitals and pain clinics to treat pain.

Mind-body medicine, yoga
Most people with chronic pain also end up suffering from depression. Clinical trials have shown that craniosacral therapy, talk therapy or counseling can reduce depression as well as pain and help decrease dependence on medications. Yoga can help with balance, stress, pain and the insomnia that usually accompany chronic pain.

Homeopathy
Homeopathy is considered an “energetic” medicine that does not interact with other medications, supplements or herbs. Much like naturopathy, it takes a person’s physical, mental and emotional picture and matches them to one of about 5,000 remedies. Constitutional homeopathy also uses this philosophy, but is different in that it doesn’t target just the pain. 

Botanics
Herbs really win over pharmaceuticals. This is because there are so many that cover different actions and types of pain. Botanicals include anti-spasmodics, anodynes, analgesics, adaptogens  to enable the body to better adapt to stress, nervines to calm the nerves, anti-inflammatory, inflammation modulating herbs, etc. They have affinities for certain organs and tissues, but can be combined to effectively treat all different types of pain. 

Supplements
Calcium and magnesium are vitally important. Both are involved in muscle contraction and relaxation; calcium more so in the former, magnesium in the latter. Calcium and magnesium compete for binding sites of absorption. In the body they are found in a two-to-one ratio, and that’s the way they should be taken in supplements. 

Omega-3 essential fatty acids, mostly derived from fish oils, are crucial in pain management. To be effective, they must be taken in very high doses. This can cause easy bruising and bleeding, and therefore should be supervised by a physician. Furthermore, the oils should be molecularly distilled to be free of contaminants and heavy metals. 

Vitamin D plays a pivotal role as an anti-inflammatory, and it helps the body absorb and utilize calcium and magnesium properly. However, too much vitamin D can lead to kidney stones, bladder stones and arteriosclerosis (hardening of the arteries).

A home remedy that is often overlooked is Epsom salts. Using them in a warm bath for 20 minutes can help. The magnesium in the salts goes to the muscles for relaxation. The sulfate from the salts can donate a sulphur amino acid to aid in liver detoxification.

There are many, many more options. With naturopathic medicine tailored to the individual patient and the specific cause or causes of the pain much can be done for this complex condition.