The 5 MISSING PIECES of the Chronic Pain Puzzle


July 13, 2015 by Dr. Sana Keller


The numbers are truly staggering. A 2012 Gallup-Healthways survey reported that ChronicPainManagement47% of US adults live with chronic pain with back pain, headache/migraine, neck pain and facial pain ranked as most common. Aside from the obvious challenge of just making it through the day with hurt that doesn’t go away, the associated impact on relationships, work and overall health continues to grow as the statistics show below*:

Staggering Stats & A NEW FDA Warning for OTC Painkillers

  • Chronic pain affects at least 100 million Americans according to the Institute of Medicine.
  • Chronic pain is a significant public health problem that costs society at least $560-$635 billion annually.
  • Over 60% of chronic pain sufferers have sought basic medical attention.
  • 40% of chronic pain sufferers have sought medical specialist attention.
  • Almost two thirds reported a negative impact on their overall enjoyment of life.
  • Prescription drugs are the second most abused category of drugs in the US, following marijuana.
  • The new warning: A Consumer Update: The FDA is strengthening an existing warning in prescription drug labels and OTC Drug Facts labels to indicate that NSAIDs can increase the chance of a heart attack or stroke, either of which can lead to death. Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs. This warning includes Ibuprofen.


Chronic Pain: Your 2nd Job

For those of you who have worked a second job to make ends meet, you may relate to the feelings of near-exhaustion from the extra hours being worked, the increased personal time limitations working two jobs presented, and the growing frustration of trying to “keep all the plates spinning” in all the other areas of your life. In many ways, chronic, unresolved pain can be like a “second job” sucking the energy and enjoyment of life right out of the picture, leading to emotions of disappointment and defeat.

Typical Treatment of Chronic Pain 

The first line of treatment for chronic pain usually includes painkillers, whether over-the-counter (OTC) pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) or prescription narcotics, muscle relaxants, and antidepressants, followed by invasive procedures such as steroid injections, nerve blocks or surgery. This can be a positive, temporary first step if attention is then directed at the big picture of the chronic pain puzzle.That’s a BIG if, since this first line of treatment is all that is offered in many cases.

MISSING PIECES of the Chronic Pain Puzzle

Although the above measures can provide some relief, they also come with a price tag of numerous potential major side effects, including addiction, and the increasing chance that the current pain relief measure will become ineffective, thus requiring more medication, stronger medications and/or invasive procedures.                                               jigsaw in blue with five missing pieces

Reducing the pain with a chemical agent (drugs) or procedure is only ONE PIECE in the Chronic Pain Puzzle. Sadly, this piece is often the only piece offered to those seeking chronic pain relief.

The REST of the Chronic Pain Puzzle Pieces 


Fortunately, there are 5 other pieces of the puzzle that need to be addressed for best results in relief of chronic pain. Consider these 5 pieces (categories) as encouragement in your journey toward pain relief—there are safe and effective options out there!

Nutritional Supplementation

  • Turmeric
  • Fish Oil  omega-3’s
  • Resveratrol
  • Magnesium
  • Vitamin D
  • Ginger

CAMs-industry-ASEach of these are natural, food-based, and have been documented in studies as beneficial in reducing chronic pain. It may be challenging to consume adequate amounts of these powerful nutrients through the food we eat, making individualized supplementation appropriate at times. The goal is NOT to start taking all of these at once. Work with a health care professional who is knowledgeable in current nutritional science, such as a certified nutritional consultant or integrative health professional to determine what would work best for your individual condition.

Bodywork and Relaxation

  • Chiropractic
  • Acupuncture
  • Medical Massage
  • Deep Breathing
  • Quality Sleep
  • Epsom Salt Bath Soaks
  • Lavender, Geranium & Chamomile Essential Oils

Chiropractic-Adjustments-StressTrue relaxation looks different to each of us. Since poor quality sleep can accentuate pain, this is a key focus area. There are many effective ways to promote great quality sleep (and none of them involve sleeping pills!). Your integrative health professional can help you develop a plan that works for you, incorporating individualized measures, including some listed above, and providing referrals as needed.

Mind-Body Connection

  • Meditation
  • Creative Visualization
  • Positive Psychology & Mindset

MeditationTaking control of our thoughts is a powerful, effective (and FREE!) method that can be learned from a knowledgeable, integrative health professionalPositive Psychology is the scientific study of the strengths and virtues that enable individuals and communities to thrive, founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play. These skills can provide benefit in all areas of our lives. Integrative health professionals can be a key resource in providing education and direction in this area.

Eating Plan

  • Elimination diet: Avoiding gluten, dairy, eggs, soy, fast food and alcohol for 3 weeks
  • Anti-inflammatory eating: Mediterranean diet

mediterranean-diet-680x280The food choices we make can either help reduce inflammation (which is often a major component in chronic pain) or promote inflammation (which can reduce the effectiveness of other pain reduction measures). Working with a health care professional who is knowledgeable in current nutritional science, such as a certified nutritional consultant or integrative health professional can be a huge help during this time to help with food choices, meal planning and a long-term eating plan.


  • Regular, purposeful exercise
  • Yoga
  • Tai chi


Purposeful, intentional exercise releases natural pain-relieving endorphins, which can boost your mood. It also helpsTaiji girl fight inflammation. (Yard work, housecleaning, etc. don’t count.) Certified personal trainers can be of assistance in developing a regular workout plan that works for you.

Encouragement and Hope

These puzzle pieces are meant to provide encouragement and hope for those of you with chronic pain. Please consider these 5 categories as a great list of potential ways to minimize or get rid of chronic pain instead of a long, overwhelming list. And know that there are educated health professionals who can greatly assist you in this process. May your puzzle pieces fall back into their appropriate place so that you can once again enjoy life to the fullest…


I look forward to your questions and comments…Click here for additional information.

Sana Keller, PhD, RN, CNC (Certified Nutritional Consultant)  Health Unlimited LLC

*Stats from the American Academy of Pain Medicine:

Photo credits:,,,,,,,,,,,

2 thoughts on “The 5 MISSING PIECES of the Chronic Pain Puzzle

  1. Lotti says:

    This is really helpful Sana. I will have to show this to Craig who has lived with chronic pain since his surgery for the herniated disc in his neck.


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