A study in 2009 found that 8.7% Singaporeans suffer from chronic pain (pain lasting for at least three months)[1], and this figure is set to increase as Singapore’s population ages with one in four Singaporeans expected to be 65 and above by 2030[2].
Moreover, in 2018, the effects of Migraine in Singapore was studied and it was found that migraine cost Singapore SGD$1.04 billion. Not only that, 80% of the total estimated cost was due to a loss of productivity, while the remaining 20% was attributed to healthcare costs, such as medical tests and consultations[3].
Evidently, the issue of pain is increasingly becoming a problem that we cannot avoid.
What is pain? Pain is an unpleasant feeling that one experiences. It is the body’s way of telling us that our body is hurting somewhere and it may be accompanied by actual tissue damage. Pain is a protective mechanism built into our body to alert us of any danger which may bring about injury. As pain results from signals sent to our own nervous system, it is a sensation that is experienced only by the individual, making it a subjective symptom. Thus, pain perception and tolerance will vary between individuals.
Types of Pain
Understanding the type of pain influences the type of treatment as well as treatment direction. Clinically, pain is often classified by its duration.
Acute Pain: Pain that lasts for a short duration, usually a few minutes to about 3 months. Typically, this type of pain arises from a soft tissue injury or a temporary illness. From TCM perspective, the mechanism of pain at this juncture is generally due to obstruction of Qi and blood flow (不通则痛). For example, jabbing your toe against a table leg. The general treatment principle at this stage involves reducing inflammation and swelling, improving blood circulation and pain relief. However, if not treated well, an acute pain can evolve to chronic pain.
Chronic Pain: Pain that persists for at least three months. This kind of pain can be persistent or recurrent. It is usually associated with long-term illnesses like osteoarthritis, fibromyalgia. In TCM, chronic pain tends to involve deficiencies in the body (不荣则痛), which will require nourishment as part of the treatment.
Different Sources of Pain
In modern sciences, pain is identified to arise from three broad areas:
Nociceptive Pain: Pain that is caused by actual or potential tissue damage. For example, when one accidentally touches a hot plate, the body is alerted of danger by sending pain signals. If the individual moves away quickly, it may not result in an injury (or actual tissue damage). When there is an injury to the tissue, a cascade of signals – including pain – are fired away to initiate inflammation and healing at the site of damage. From TCM perspective, nociceptive pain typically presents itself as achy or sharp pain, which will require the clearance of any stagnation and the improvement of blood circulation.
Neuropathic Pain: Pain that is associated with injury or disease of the nerves. Common conditions that see this type of pain include shingles, sciatica nerve pain, trigeminal neuralgia and diabetic neuropathy. Clinical presentations of this type of pain tend to be described as sharp, shooting, electric-like pain, or even numbness. As pain can be felt ‘travelling’ from one spot to another, TCM views this to be related to the wind pathogen. Other than treating underlying conditions, TCM treatment of neuropathic will often involve the clearing of the wind pathogen.
Nociplastic Pain: Pain that arises from altered pain perception, meaning that there is no clear evidence of tissue damage or nerve disease found. Such pain is often caused or exacerbated by psychiatric disorders. A common type of nociplastic pain is tension headache. Tension headache is pain caused by the contraction of neck and scalp muscles, often in response to stress, depression or anxiety. Clinically, pain that falls in this category often does not respond well to typical over-the-counter painkillers. In TCM, individuals with nociplastic pain tend to present with a ‘stringy-like’ or taut pulse, and may experience other accompanying symptoms like sleep disorders, appetite reduction and bowel inconsistencies. Other than pain relief, TCM treatment will involve treating the root condition.
As pain can present itself in different ways in each person, there is no one size fits all solution. Common approaches in TCM’s management of pain are: acupuncture, herbal medication, cupping, tuina massage (推拿), and moxibustion. Other TCM at-home methods of pain relief include medicated plaster and herbal ointment. Chong Hoe’s home brand medicated plasters contain notoginseng (田七) which is prized for its ability to soothe aches by promoting blood circulation and reducing inflammation. Depending on the type of pain and your medical history, our TCM physicians will assess your condition and work with you on an individualised treatment plan.
References:
[1]Yeo, S. N., & Tay, K. H. (2009). Pain prevalence in Singapore. Annals Academy of Medicine Singapore, 38(11), 937–942. https://doi.org/10.47102/annals-acadmedsg.v38n11p937
[2]Koh, Y. S. (2023, April 11). PM Lee Hsien Loong at the “Singapore Ageing: Issues and Challenges Ahead” book launch. Prime Minister’s Office Singapore. https://www.pmo.gov.sg/Newsroom/PM-Lee-Hsien-Loong-at-the-Singapore-Ageing-Issues-and-Challenges-Ahead-Book-Launch#:~:text=Our%20population%20is%20not%20just,in%204%20Singaporeans%20over%2065
[3]Ong, J. J. Y., Patnaik, D., Chan, Y. C., Simon, O., & Finkelstein, E. A. (2020). Economic burden of migraine in Singapore. Cephalalgia Reports. https://doi.org/10.1177/2515816320908241
Author: Physician Aw Ching Yi Eunice
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