di Enrico Colmi, medico chirurgo ed esperto di Medicina Tradizionale Cinese
PAIN IN COLLECTIVE PERCEPTION
If we pay attention to messages that we receive through advertisements and other informative channels, we can realize which is the main topic: PAIN. The most advertised products are actually painkillers, presented as the solution to all the illness (in spite of "serious expected adverse reactions"). This offer is the answer to a growing demand of just canceling everything that can be annoying, without asking ourselves what is the meaning of what is happening to us and to our body. Every time we feel pain, we have the right pill which will make us feeling well, even if this implies adverse reactions or even transformation of the original pathology in chronic.
PAIN IS A SYMPTOM, NOT AN ILLNESS
In fact we can say that pain plays a specific role which we must discover and analyze in order to manage our body and the problems we have to face every day. Pain is an alarm signal which warns us about dysfunctions of our body. In physiology, "pain is a symptom, not an illness". If we fight the symptom, we won't cure the illness.
AN APPROACH TO PAIN IN TRADITIONAL CHINESE MEDICINE (TCM)
TCM has an interesting approach to pain.
Firstly, pain is one of the signals to be interpreted together with the others, in order to understand the pathology as a whole, issue a diagnosis and consequently start an appropriate therapy (following the TCM methods). It's important to define the characteristics of the symptom of pain. One of the toughest problems in the approach with the patient is the difficulty in understanding the characteristics of the pain itself (it's usually described just as a "pain, a pain not easy to describe").
In my experience, it has been very interesting to see how in China patients can define the pain in a very precise way, using a specific word. It was incredible also to see their threshold of pain, which allows a Chinese patient to bear a pain way more higher than the pain a patient can bear in the western world.
The TCM has a dual approach:
From one side, the practitioner tries to ease the symptom of pain through a local symptomatic treatment, using the pain-killing actions of acupuncture and massage (occasionally supported by herbalist products). In this way, he takes action on the specific pain symptom and on the related signs (muscular tensions, inflammatory states, circulation problems, adhesions, swellings…).
In a second moment the practitioner study the whole situation and treat it as soon as possible, following the TCM principles and setting up a therapy essentially based on rebalancing (yin-yang, 5 organs, …) using specific points of acupuncture. The therapy is then completed and supported by other typical treatments (moxa, massage, auriculotherapy, dietetics, herbalism, …). This is an etiological treatment, which tends to the definitive solution of the problem.
PAIN DURING THE TCM TREATMENT
There is another aspect to consider: the pain that the patient feels during the TCM treatment. We have to deal with two facts:
The treatment itself is usually painful: the Chinese massage, the tuina, as all the traditional massages, can't be considered as light and painless, and since it's usually applied to body parts which are already subjected to pain, it's not very appreciated by western patients. In China acupuncture and massage are common practices even in youth: this involve this kind of pain to be a routine and prevents the pain as a symptom.
For what concerns acupuncture, it's necessary to debunk some myths. Acupuncture itself is not painful, but neither painless. Everything depends on specific situations: when we treat points which are already subjected to pain, then acupuncture can increase the sensation of pain. Generally, in this case, the pain is a prelude to a progress in the pathological condition and in the pain symptom itself.
In the end, the most important thing is the attitude of the patient involved. When I was in China, I saw patients guiding the doctor, indicating by themselves which point to treat, in some case removing a needle because it wasn't operating in the right way.
One of the biggest obstacle to the use of TCM in western world can be the emergence of a painful situation on a patient who didn't feel it before.
It could be a real worsening of the situation, due to an incorrect interpretation of the problem and to a wrong treatment. In this case the practitioner has to acknowledge the problem and modify the approach, even if sometimes we have to admit that not every illness could be easily managed and cured.
On the contrary, it could result as a temporary worsening, which should be accepted in the overall recovery process. Since pain is always associated to a negative situation, it's difficult that the patient unconditionally accept it. The right thing to do is to previously warn the patient of a possible worsening and describe to him the possible appearance of other negative symptoms, and then explain that it's a normal condition in order to see some progress. This is not an easy task to perform, and it requires a big sensibility and good emotional and communicative qualities from the practitioner; the patient, on his side, has to accept a different approach, more aware of his health problems.