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Thursday, June 9, 2011

Chronic Pain and Management

No one likes discomfort or pain. Lingering pain is simply debilitating. According to the American Pain Foundation, an estimated 50 million Americans suffer from persistent pain each year. For these people, dealing with nagging pain can be a tedious and emotional concern. Yet, knowing more about pain management and various available treatments may help people alleviate their hurts and pains. Understanding methods of pain management can also help people avoid risky pain therapies.

"The Terrible Triad" of Pain

"Pain of such proportions overwhelms all other symptoms and becomes the problem. People so afflicted often cannot work. Their appetite falls off. Physical activity of any kind is exhausting and may aggravate the pain. Soon the person becomes the victim of a vicious circle in which total preoccupation with pain leads to irritability and depression. 

"The sufferer can't sleep at night and the next day's weariness compounds the problem -- leading to more irritability, depression, and pain. Specialists call that unhappy state the "terrible triad" of suffering, sleeplessness, and sadness, a calamity that is as hard on the family as it is on the victim. 

"The urge to do something -- anything -- to stop the pain makes some patients drug dependent, drives others to undergo repeated operations or worse, resort to questionable practitioners who promise quick and permanent 'cures.'

Of course, many who suffer terrible pain do resort to taking pain medications.When these patients are receiving proper, well-supervised treatment, they often find great relief. But, when questionable practitioners treat patients and when pain patients abuse their medications, they face considerable risks. From 1998 to 2008, the proportion of all substance abuse treatment admissions age 12 or older who reported any pain reliever abuse increased more than fourfold. ("Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008," SAMHSA, 2010)

What is Chronic Pain?

Just what is defined as "chronic pain"? Here is some information from The Chronic Pain Information Page, public liaison for the National Institute of Neurological Disorders and Stroke, National Institutes of Health.
"While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years.

"There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage.

"Many chronic pain conditions affect older adults.

"Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).

"A person may have two or more co-existing chronic pain conditions.  Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia.  It is not known whether these disorders share a common cause."

Is There Any Successful Treatment?

A relatively recent trend in chronic pain management has shown promise in breaking the ongoing cycle of pain and medical treatment for pain patients. This trend is shifting toward a more holistic, comprehensive, and multidisciplinary model. As a result, more and more helping professions, including the social work profession, are becoming directly involved in the treatment of chronic pain. (P.W. McAlary and G. Aronoff, "A Review of the Chronic Pain and Disability Syndrome: Prevalence, Contributing Factors, Detection, Prevention, and Treatment," Pain Centers: A Revolution in Health Care, 1988)

In fact, all of the following are used to treat chronic pain:

*  Medications
* Acupuncture
* Local Electrical Stimulation
* Brain Stimulation
* Surgery
* Placebos
* Psychotherapy
* Relaxation and Medical Therapies
* Biofeedback
* Behavior Modification

So what are some of the more popular options for pain management?

Massage is a favorite discomfort and stress buster for most individuals because it relaxes constricted muscles and assist in blood circulation.

Prescribed exercise from physical therapists and doctors can give people relief as they acquire a fitness regimen that can help muscles to be stretched and be loosened.

Cutaneous stimulation involves hot or cold packs application in areas of pain.

Natural discomfort remedies include aromatherapy, hydrotherapy, acupuncture, yoga, meditation, chiropractic.

Psychological therapies consist of cognitive therapy, hypnotic therapy, and biofeedback which may be more effective in dealing with emotional and psychological pain.

A host of new treatments for pain are becoming available. Granted, some treatments are controversial, and questions remain about the appropriateness of their use, but research continues. The Cleveland Clinic ( has information about occipital nerve stimulators, botox and nerve blocks, transdiscal biacuplasty (radio frequency waves), radiation therapy, intraspinal drug infusion systems, balloon kyphoplasty and cooled radiofrequency ablation.

New Attitudes Toward Pain

C.S. Hill and others conclude, "Pain is a complex perceptual phenomenon with both a sensory and an emotional or affective component; as such, it cannot be objectively verified. In managing chronic pain, it is essential to treat patients in a comprehensive manner that encompasses psychologic as well as physiologic factors." Some patients require concurrent efforts to manage pain as a symptom while the underlying cause is addressed. In many chronic conditions, pain may become the "disease" or focus of intervention when the pathophysiologic process cannot be identified or effectively removed. (C.S. Hill, W.S. Fields, D.M. Thorpe, "A Call to Action to Improve Relief of Cancer Pain, Advances in Pain Research and Therapy, 1989)

Effective management of long term pain frequently requires the coordinated efforts of the management team.

Here is a word of caution. S.A. King advises, "Physicians who prescribe opioids should integrate this treatment with any psychotherapeutic intervention the patient may be receiving. The guidelines also recommend monitoring not only the pain but also the level of functioning and the achievement of therapeutic goals. The prescribing physician should be suspicious of abuse when a patient reports a reduction in pain but has no accompanying improvement in function or progress in achieving identified goals." (S.A. King, "Guidelines for Prescribing Opioids for Chronic Pain," Psychiatric Times 27, 2010)

At a time when people are living longer and painful conditions abound, the scientists who study the brain have made landmark discoveries that are leading to a better understanding of pain and more effective treatments.

Encouraging positive thinking in pain patients may be the key to effective treatments, says Carla Rubingh, a pain management specialist and assistant professor of pharmacy practice at the University of Nebraska Medical Center in Omaha.

"(Research has told me) when we're talking to patients and presenting therapy, the more positive we are about how the therapy is going to impact them, the better outcomes we're going to have," says Rubingh. "And from the patients' point of view, this says the more positive and open-minded they are to different types of treatment, the better they're going to do." (Amanda Gardner, "Pessimistic? Pain Meds May Not Work,", February 16 2011)

Many people with chronic pain can be helped if they understand all the causes of pain and the many and varied steps that can be taken to undo what chronic pain has done. Scientists believe that advances in neuroscience will lead to more and better treatments for chronic pain in the years to come.

"Healing the Hurt," Time, Alice Park, March 4 2011:,8599,2057269,00.html

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