Are you suffering from chronic pain?
Chronic pain is defined as pain that lasts or recurs for more than three months. It has been reported that chronic pain affects around 20% of people worldwide. While most people think chronic pain is something that only exists in elderly people as one ages, there is a rising trend of our younger population complaining of aches and pain that is persistent and recurrent. These aches and pain are commonly seen in our clinic with patients as young as 21 years old, some in the prime of their life (thirties to forties), and many who are our seniors of the Merdeka and Pioneer generation. Chronic pain is not gender specific and non-biased.
As the saying goes: Knowing is half the battle won. Knowing how chronic pain comes about and mitigating the aggravating factors goes a long way in the management of chronic pain. Depending on the age and type of condition, some can even rid themselves of their pain baggage with proper treatment and care.
Traditional Chinese Medicine (TCM) has been backed by much research to be effective in pain management. For example, a National Institutes of Health study on chronic fascial pain suggests that Traditional Chinese Medicine is safe and frequently efficacious alone or subsequent to standard psycho-social interventions.  TCM is widely available and provide patients with an alternative to other forms of therapy.
The following list includes some medical conditions (not exhaustive) commonly associated with chronic pain:
Back pain and sciatica
Tennis elbow (Epicondylitis): Tightness and pain at elbow and forearm which can result in weakness when gripping
Carpal Tunnel Syndrome: Numbness/pain at palm and first three and half fingers, with possible tightness and ache at forearm or muscle wastage in the palm if severe
Mechanical back syndrome, Rotator cuff tendonitis: Pain and ache at the neck, back and shoulders which can vary among different individuals in area and severity
Trigger finger, DeQuervain’s syndrome/Mother’s thumb: Pain with difficulty when flexing or extending the finger joints; feeling as though fingers are ‘locked’
Common causes of chronic pain and pain relief methods
Below are some common causes and methods to relieve chronic musculoskeletal pain from both biomedical and TCM perspectives.
(Please Note: All words in Italics refer to the TCM organ-system and not the anatomical organ referenced in western medicine.)
1) Repetitive strain
This usually occurs due to repetitive movements and over-usage of muscles. You can sustain repetitive strain injury when at work, during exercise, doing housework (such as washing dishes, cooking or cleaning the floor), or even at rest (when bending your head down to look at your phone or play mobile games on your tablet). Some of the specific common pains due to repetitive strain include tennis elbow, carpal tunnel syndrome, trigger finger and ‘Mother’s thumb’.
Besides taking pain killers, anti-inflammatory medicine and applying pain relief plasters, those who prefer the conservative approach rather than steroid injections or surgeries achieve good results in their pain management with a combination of TCM treatments that will be mentioned further in the article.
2) Poor posture and lack of exercise
Due to many city dwellers’ sedentary and stressful lifestyle, we are often not just in a bad posture, but we are in it for prolonged periods because we are focused on other tasks at hand. When we move and exercise less, the disuse of our bodies leads to a deterioration of many bodily functions. Disuse syndrome has received much attention in relation to back pain problems, chronic pain disorders, and other illnesses. It has been generalized beyond chronic pain problems and some feel it is related to “the base of much human ill-being.”
At work, office workers should always ensure that their sitting postures do not strain their neck, back and wrists. They should take short breaks at roughly 1-hour intervals to prevent stagnation in Qi and Blood, which can result in stiffness and aches. Additional attention should be made to avoid a forward head posture, which is the result of bending over and looking downwards too often (in the case of mobile phone usage). When sleeping, a good pillow of appropriate height and firmness should be used so that neck muscles are relaxed and that the cervical joints are well supported.
3) Energy blockages and exposure to pathogens
From TCM perspective, the body is seen as a holistic whole. This means that pain is the body’s way of signalling a warning alarm. There is a Chinese saying that goes – “不通则痛, 痛则不通” which literally translates to “if there are blockages in your body, you will feel pain.”. If you ignore your body’s warning, akin to ignoring a fire alarm in your house, one can expect serious problems and consequences. More often than not, when we meet with patients with serious conditions, they experienced chronic pain at certain body locations over a prolonged period of time but chose to dismiss it.
Body functions are dependent on the life force energy or qi. Qi and blood flow through the meridian network, nourishing body tissues and ensuring optimal body functions. When a meridian is blocked due to pathogens, injury or even excessive emotions, qi and blood are unable to move smoothly. As such, the affected area will not be able to get enough blood circulation and nutrients. Thereafter, the patient begins to feel pain, stiffness, bloating and even numbness. Because meridians correspond to specific organs, prolonged blockage of the meridian can affect other parts of the body. Hence, when treating a pain condition, our TCM physician will typically not only focus on the localized pain but more importantly, focus to restore harmony in the whole body.
Prolonged exposure to TCM pathogens such as cold, wind and dampness impedes circulation to affected body parts, which in turn can cause pain, aches, stiffness and cramps. Therefore, avoid blowing of a fan directly to the body especially when you are perspiring and feeling hot. Air-conditioning in the room should be kept at around 25 degrees Celsius and any moisture on the body should be wiped off promptly.
4) Poor diet and malnutrition
Most people usually do not associate poor diet to pain. However, diet and nutrition play an integral part in determining pain from a TCM perspective as well. A body that is malnourished will have weaker muscles that are less resilient and more susceptible to fatigue and injury. Therefore, it is important to have regular eating habits and a well-balanced diet that will be beneficial in strengthening the digestive function and fortifying your fundamental substances such as Qi and Blood.
5) Late-night sleep and insufficient rest
Some of you might have already noticed that insufficient rest or sleeping late causes your muscles to be stiffer and easily strained. It can also cause irritability, dryness in the throat and constipation, which are typical signs and symptoms of Yin deficiency and heatiness.
How can TCM help patients with chronic pain?
Besides taking pain killers, anti-inflammatory medicine and applying pain relief plasters, those who prefer conservative approach rather than steroid injections or surgeries achieve good results in their pain management with a combination of TCM treatments.
Cupping is commonly used to treat pain, ease scar tissue deep within muscles and connective tissues, and reduce swelling and muscle fascial knots. In a systematic review of 611 studies, cupping therapy has shown positive results on chronic back pain. 
National Institutes of Health shares that studies suggest that acupuncture may ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It may help reduce the frequency of tension headaches and prevent migraine headaches as well.
Acupuncture is the insertion of fine, thin needles through the skin at particular acupoints to help stimulate the body and promote self-healing. Acupuncture typically increases blood circulation to the area, promotes elasticity of muscle fibers and improves muscular contractility. The aim is to clear meridian blockages and correct the imbalances of Yin and Yang within the body so that self-healing can take place. More recently, modern physiologists have put forward the “neural hypothesis” stating that the clinical influence of acupuncture is primarily transmitted through stimulation of sensory nerves that provide signals to the brain, which processes this information and then causes clinical changes associated with treatment. 
Coincidentally, it has been clinically observed that acupuncture shows great results for the following pain (perceived by the brain) and disorders relating to the nervous system:
Pain conditions: Neck, back, shoulder, elbow and other musculoskeletal pain; facial pain, headache, arthritis, abdominal pain, hip and pelvic pain, knee pain, heel pain; sciatica/ other nerve pain and post-surgical pain
Post-stroke rehabilitation: Muscle spasms and spasticity, dysphagia, dysphasia, urinary and fecal incontinence, anxiety, insomnia, shoulder and arm pain
Neurological disorders: Insomnia, vertigo, Bell’s Palsy/other cranial nerve disorders, mood disorders
Gastrointestinal disorders: Poor appetite, nausea and vomiting, dyspepsia, constipation, reflux, irritable bowel syndrome
Respiratory disorders: Shortness of breath, cough, rhinitis, secretions
Wound management: Pressure sore, post-operative wounds
One of the most common TCM theories for the origin of pain is that of Qi or Blood stagnation (气滞/血瘀). Hence, herbs with properties to promote blood circulation and eliminating stasis (活血化瘀药) are often used to nourish joints and facilitate the flow of Qi and Blood.  For example, Corydalis (Scientific name: Corydalis yanhusuo/Corydalis ambigua; Chinese name: 延胡索) is a herb used for traumatic injuries and has good analgesic effect on many types of pain, including chest and gastric pain, as well as menstrual irregularities and dysmenorrhoea. 
Place of Practice: Oriental Remedies Group
Founded since 2013, Oriental Remedies Group has attracted a dedicated team of bilingual (English and Mandarin) physicians with combined more than 50 years of Traditional Chinese Medicine (TCM) experience and certified therapists, with the common goal of providing the best patient care to our patients by combining the best of TCM treatments as well as modern integrative protocols.
 J Pain. 2012 Nov; 13(11): 1075–1089. Comparative Effectiveness of Traditional Chinese Medicine (TCM) and Psychosocial Care in the Treatment of TMD-associated Chronic Facial Pain. By Cheryl Ritenbaugh, PhD, MPH, Richard Hammerschlag, PhD, Samuel F Dworkin, DDS, PhD, Mikel G Aickin, PhD, Scott D Mist, PhD, MAcOM, Charles Elder, MD, MPH, and Richard E Harris, PhD
 Rev Lat Am Enfermagem. 2018; 26: e3094. Cupping therapy and chronic back pain: systematic review and meta-analysis. By Caroline de Castro Moura, Érika de Cássia Lopes Chaves, Ana Carolina Lima Ramos Cardoso, Denismar Alves Nogueira, Hérica Pinheiro Corrêa, and Tânia Couto Machado Chianca
 J Acupunct Meridian Stud. 2010 Jun; 3(2): 67-74 Defining Meridians: A Modern Basis of Understanding. By John C.Loghurst
 Singapore Med J 2018; 59(5): 230-239. Traditional Chinese medicine: herb-drug interactions with aspirin. By Jia Wei Lim, MBBS, Siow Xian Chee, BSc, BMed, Wen Jun Wong, BMed, Qiu Ling He, BTCM, Tang Ching Lau, MMed