When Karen Brannen moved to Central Oregon four years ago, she was just about ready to throw in the towel. A series of car accidents over 25 years left her with severe, debilitating pain. She had been on disability for at least six weeks three times in the previous six years.

“I was considering going on permanent disability and just giving up,” the 54-year-old La Pine woman said. “My strategy with pain was always to ignore it until it got to the point that I couldn't get out of bed. I just didn't know what else to do.”

According to the National Institute of Neurological Disorders and Stroke, Brannen is not alone. Some 90 million Americans experience chronic pain, and many struggle daily to find any relief. Researchers now understand that chronic pain is a completely different animal from the acute pain experienced when you stub a toe or burn yourself. That understanding is helping health practitioners find new ways to help people cope with their chronic pain.

Brannen found her way to Allison Suran, owner of Healing Bridge Physical Therapy and a physical therapist who has shifted much of her practice toward the management of chronic pain. Suran taught her how to better mitigate the pain cycle when it starts and how to avoid letting the pain take over her life.

“Pain is no longer an enemy. It's kind of a friend. It's the thing that I pay attention to that tells me that something else is out of whack,” Brannen said. “She really taught me to recognize the kinds of things that make it better and the kinds of things that make it worse.”

Brannen has started to exercise regularly again, even though it does cause her some pain. And she's learned that when she gets stressed or doesn't get enough sleep, the pain worsens, which in turn leads to more stress or more disrupted sleep. That's when it spirals out of control.

She now works for herself, as an independent insurance agent, allowing her more flexibility if she needs to get more sleep or back off of a hectic schedule.

“Some minor tweaking has made a huge difference,” Brannen said. Indeed, her chronic pain hasn't forced her back on disability in the past four years. And she's cut her medication use in half, mostly taking only sleep aids to make sure she gets enough rest.

Limited options

Experts maintain that one of the difficulties in treating chronic pain patients is that few good drug therapies exist for them. Brannen said she went through “drug roulette” for years with her doctors trying to find an effective solution. Some drugs simply don't work as well for chronic pain as they do for acute pain, and others have significant side effects, especially addiction, with long term use.

Researchers have discovered that chronic pain follows different pathways than acute pain. If you are poked with a needle, for example, receptors on the skin trigger an electrical impulse that travels along a nerve fiber to the spinal cord. The fiber connects with a nerve cell that passes the pain signal up the spinal cord to the brain, crossing various junctions, or synapses, along the way.

Opioid drugs, which are commonly used to treat severe pain, prevent the signals from crossing those synapses, thus blocking the pain.

Chronic pain, on the other hand, activates what researchers call silent synapses in the nervous system, finding a new path to the brain. These synapses, researchers say, transmit pain signals even when no apparent cause of the pain is present.

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