According to the American Pain Society, the cost of pain, including medical bills and lost workdays, is estimated at $100 billion per year in the U.S. Back pain alone produces chronic disability in one percent of the U.S. population and is the leading cause of disability in Americans under 45 years old. As our population ages, the already significant problem of chronic pain in the elderly will increase. Richard Rosenquist, MD, director of the Center for Pain Medicine and Regional Anesthesia at University of Iowa Hospitals and Clinics, talks about chronic pain:
First tell us – what is chronic pain?
Chronic pain is pain that persists beyond the expected duration of pain. It can be pain of any type, but something that lasts a long time. In some situations it has been defined as pain lasting longer than three or six months; but these are relatively arbitrary time periods and the concept of pain lasting longer than expected is a much more workable definition.
What part of the population is most likely to develop chronic pain?
The truth be spoken, anyone can develop chronic pain. In general, when you look at the pain clinic population, women present with reports of chronic pain more commonly than men. But if you look at a broader sense:
- People who are sedentary and deconditioned
- People that have disease processes that produce nerve injury
- Accelerated degeneration of body structures
- Who have cancer are most likely to develop pain.
People who have had multiple traumas or major surgical procedures can often develop chronic pain, as well. But things that would fall in this category include things such as myofascial pain, osteoporosis, diabetes, shingles, metastatic cancer, and others.
What sorts of injuries may result in chronic pain?
There are a wide variety of injuries that can result in chronic pain. These include but are not limited to muscular injuries, spinal chord injuries, spine fractures, various peripheral nerve injuries, and multiple traumas. It’s also quite common to develop chronic pain after some surgical interventions, such as inguinal hernia repair, thoracotomy, and in some situations, back surgery.
Do people with chronic pain often try to self-medicate or use alternative medicines to relieve their pain?
Absolutely! This happens over and over. In many cases someone may take an excessive amount of over-the-counter pain killers to try to reduce pain. If a little is good then a lot has to be better. Sometimes people get in trouble with toxicity related to overdosing on pain medications they get over the counter because they’re looking for some benefit. In addition, when you start looking at alternative therapies, the use of alternative medications or treatments now exceeds the annual dollar amount spent on traditional allopathic medicine. So people are really out there looking for a wide variety of other forms of treatment.
Chronic pain affect affects not only the person in pain. Does it also affect their families and lifestyles?
Pain has the uncanny ability to affect not only the individual involved, but their families as well. This is something people live with on a 24-hour a day, seven-day a week basis with no relief, no let-up, no release. It affects things that relate to their spouses, their significant others, and their families on a daily basis. It frequently causes loss of job, house, personal affects, and may produce excessive stress on the relationships and function of an entire family.
In many cases, family members have never spoken about the effects on the family or are afraid to say something because they don’t want to hurt or bother the person in pain, or they may have never asked. It’s very common to begin to ask about these things at a clinic visit and quickly end up with a flood of emotions and tears as patients and their families realize they are not alone. They are not unique in the effects that pain is having on their family and they are entitled to have these feelings and to talk about them.
When should a person dealing with daily chronic pain seek medical attention at a place like the Center for Pain Medicine and Regional Anesthesia?
It becomes a chronic situation when:
Pain persists beyond the expected duration
- Simple therapies prescribed by primary care physicians are unsuccessful in treating pain
- Pain persists and the cause remains unclear and no diagnosis has been made
- Advanced treatments are needed such as various technical injections, or devices such as intrathecal pumps or spinal chord stimulation are the next logical step
- A multidisciplinary treatment plan is needed to produce a better outcome
Is there one treatment plan for chronic pain?
Unfortunately no. It would be nice to come up with one treatment plan that would work for all people in all situations. In the real world, each patient requires an individualized treatment plan. There are numerous factors that play into the development of a treatment plan that include but are not limited to:
- Actual diagnosis
- Patient’s genetic makeup
- Prior treatments
- Patient’s willingness to accept or participate in a given treatment plan
- Expectations are—personally and of their family
There are a lot of things that go into developing a treatment plan that will hopefully be successful for the patient.
How is chronic pain treated?
There is a wide variety of treatment used. These might include things such as
- physical therapy
- medications
- psychological interventions
- biofeedback or imagery
- massage therapy
- injections
- neuro ablative therapies, interrupt the ability of a nerve to transmit a pain message
- intrathecal drug delivery
- spinal chord stimulation
Who is included in the team that works with patients in chronic pain?
Absolutely, it is clearly demonstrated that using a multidisciplinary or team approach is much more successful. If you start looking, the people and specialties involved are diverse. It’s not uncommon to include a wide variety—and I’m just going to go through a small list, but I want to note that the first person in the team has to be the patient—so you end up with the patient, physicians, surgeons, nurses, psychologists, pharmacists, physical therapists, massage therapists, social workers, and many others.
I have to reiterate that if the patient doesn’t take an active role as a member of the treatment team, they are unlikely to have a successful treatment outcome. They are part and parcel of the treatment team, just as much as anybody else.
Can chronic pain be cured?
In some cases it can be cured. If you can identify the source of the problem and treat the problem, the patient can get better and eliminate the chronic pain condition. In others, it may be reduced, limited, controlled, modified, modulated, or refrained so that it no longer has control of the patient and the patient is able to improve their function and quality of life. In many cases we end up working with a patient to manage the pain instead of having the pain manage the patient. |
