Waging War on Chronic Pain
Brown, Norman, VFW Magazine
Sonne 57% of adults experienced chronic pain in 2003. This is what you need to know about the new rules for treating pain.
Pain will propel most people to a doctor's office faster than just about any other complaint. But doctors can't measure pain objectively the way they can blood pressure or cholesterol levels. So when pain doesn't respond to treatment, physicians and patients often accept it wrongly as a symptom that must be lived with.
That confusion is lifting, however, thanks to the pain chart you'll now find in your doctor's office. The chart, produced by the Joint Commission on Accreditation of Healthcare Organizations, helps patients rate their pain on a scale of 1 to 10 and allows for more effective treatment, especially among baby boomers.
"Patients have low expectations for pain treatment," says Dr. James Campbell, director of the Pain Treatment Center at Johns Hopkins Hospital in Baltimore. "But that is changing as more of the population moves into the years where chronic pain from arthritis and other sources becomes more common."
Campbell says that for people 50 and older, the best management approaches for arthritis and back pain, which together afflict some 70 million, should start according to intensity and duration. "Having constant pain is not good," he says. "It influences all aspects of life including mood, motor performance, sleep and social relations."
But surveys indicate that fewer than 26% of those battling moderate to severe pain are referred to the proper specialists. This doesn't mean other doctors can't treat pain effectively, but the complexity of diagnosis and treatment can be a difficult task.
Dr. Russell Portenoy, pain specialist at Beth Israel Hospital in New York City, says, "Doctors must learn to listen to the patient and take complaints of pain seriously before pulling out the prescription pad for narcotic meds." Too many rely solely on pills and ignore lifestyle changes-like exercise and losing weight-that can alleviate pain in the joints and back.
Chronic pain is generally defined as persistent pain (everyday aches don't count). Examples include daily migraines or pain that continues after an injury heals. (Pain signals can keep firing in the brain for weeks, months, even years.) There may be an ongoing cause like cancer or infection. But some suffer pain in the absence of any past injury or body damage.
What can you do to decide what's best for you? Find out what treatment options are available as well as their side effects-and choose the one that suits you best. Don't just assume that your doctor or anyone else will take care of it. And if current treatment isn't controlling your pain, say so. Increasingly, pain experts are convinced that prompt treatment is imperative to prevent chronic pain from becoming irreversible.
Chronic pain can be extremely difficult to treat. Patients with constant neck pain or lingering pain from shingles (herpes zoster) often try many different therapies without finding relief. But there are specific treatments to reduce pain, improve physical functioning and return to normal daily activities, says Dr. Portenoy.
These treatments include nonsteroidal anti-inflammatory drugs (ibuprofen, aspirin, naproxen) or narcotic painkillers (morphine), antidepressants or anticonvulsants. And despite what people say, such medications have very little risk of addiction.
"It's a misperception," says Dr. Marc Hahn, president of the American Academy of Pain Medicine. "It's untreated pain that can lead to abuse of alcohol or other substances that dull the sensation. …