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Everyone knows what pain is. You hit your thumb with a hammer, it's painful. We all experience pain. For some people, pain is constant, prolonged, and resistant to treatment.
Richard Rosenquist, MD, medical director of the Center for Pain Medicine and Regional Anesthesia with University of Iowa Health Care., talks about pain management:
What is chronic pain?
Chronic pain is pain of any cause that is associated with a chronic medical condition or any other disease process that extends beyond the expected time of normal tissue injury and healing; or adversely affects the function and wellbeing of the individual.
Are there certain events or circumstances that may cause chronic pain?
Chronic pain may begin for a wide variety of reasons. It can begin following:
- An injury
- A fracture
- A surgical procedure
- It may be the result of ongoing disease processes:
- Diabetes
- Cancer
- Arthritis
- Shingles
- Scoliosis
It may be the result of:
- A muscular strain or tear or even muscular weakness. It can also begin
- An injury of the nervous system, such as stroke, spinal chord injury, or peripheral nerve injury.
And then the very common thing is for people to have low back pain, and that may begin with a disk herniation, causing pressure on the spinal chord or nerve roots.
Does pain always have a cause?
Although the development of pain does not always have an apparent cause, careful evaluation can determine the cause of pain. It is critical to take care of people, that a real effort is made to make a diagnosis, because this improves the chances for successful treatment.
We know there are many things that contribute to the development of chronic pain; for example, poor diabetes control will accelerate the development of peripheral neuropathy and lead to pain. Smoking is also an independent risk factor for the development of chronic back pain. In some cases, despite extensive evaluation, the cause of an ongoing report of pain is not found and we are limited to trying to manage the symptoms alone.
How does chronic pain affect people's lives?
Chronic pain has a deleterious affect on people's lives and touches all aspects of their lives. It affects their ability to participate in activities of daily living; to concentrate and interact with their spouses, family, and friends; work; pay their bills; travel; and generally engage in life.
It may be associated with the development of depression and it never affects just the patient. It has devastating effects on entire families and their dreams. One of the common things—if I'm sitting in a room with a patient and begin to ask the spouse or other family members about what's going on with the pain and how it's touched the family—we'll end up with tears and sharing about how this person's pain has touched all aspects of their lives.
What is a multidisciplinary pain management program?
A multidisciplinary pain management program is one that uses multiple modalities and various specialists and health care providers to evaluate the patient and develop a multimodal treatment plan to control or minimize the effects of pain, and effects may be physiologic, sensory, affective, cognitive, behavioral, and social cultural events that are all part of the pain response. This often involves use of medications, physical therapy, psychological treatments, and other advanced interventional therapies.
Aside from medications, what other therapies are involved in pain management?
There are many therapies used to treat pain. People are accustomed to seeing pain medicines and may think of a pain medication they took after surgery, but there are many other ways.
They may include:
- Aggressive use of physical therapy, either as a direct treatment or to restore strength and function
- Psychological therapies to learn to cope with chronic pain or treat depression
- Injections to reduce inflammation such as those encountered with lumbar disk herniation Advanced interventional treatment, such as radiofrequency ablation, neurolytic blocks for cancer treatment, intrathecal drug infusions to deliver medications directly into the spinal fluid
- Spinal chord stimulation
When should someone consider finding a pain specialist for treatment?
They should consider finding a pain specialist when:
- They have pain that does not respond to routine treatments
- Pain persists beyond its expected duration
- They need advanced pain therapies.
Board certified pain specialists have completed fellowship training beyond their residency and have taken a certification examination to document their specialty training status. Physicians with board certification in the specialty of pain medicine may come from many different primary specialties.
They currently complete a one year ACGME-accredited pain medicine fellowship. The specialty is growing so rapidly and so much is being learned that the specialty is going to be expanding the fellowship training to two years in the near future to equip pain medicine specialists with the tools they need to provide good treatment.
Can pain be cured?
In many cases, pain can be "cured." We all encounter pain and typically expect that it will go away rapidly after a minor injury or surgical procedure and this happens in the vast majority of cases.
In some cases, however, the pain goes on to become chronic. In patients with chronic pain, they can often have their pain markedly reduced or eliminated with aggressive treatment programs so that they can return to normal function. In those patients for whom this has not happened, a successful pain management program can be developed with the time, patience, and the effort on the part of the patient, family, physician, and other members of the health care team to allow them to restore them to normal function and to re-engage in life as they would hope it would be. |
