The Path Out of Pain: How New Approaches Help Providers Tackle Pain Management

Think about the last time you experienced pain. Was it fast, as in stubbing a toe, or did it last – a day-long migraine, for example? Doctors have long tried to understand pain, including where it comes from and why it lasts. Pain, especially the chronic kind, is a problem that affects quality of life and leads to emotional, social and psychological problems. According to the National Institutes of Health, about one in every four Americans suffers from chronic pain, at a cost of about $500 billion. Pain, unfortunately, is here to stay, but doctors are hard at work on better ways to help people regain full, healthy and pain free lives.

Types of pain

Doctors divide pain into two areas: acute (shorter duration) and chronic (longer duration).

“Acute pain signals danger,” says Dr. Robert W. Hurley, professor and vice-chair, department of anesthesiology; director, MCW Pain Management Centers, Medical College of Wisconsin; and an American Academy of Pain Medicine board member. “If you step on a nail, you want to move your foot away as quickly as possible. It hurts, but that hurt has a helpful warning function.”

Chronic pain is different in both length and purpose. For starters, chronic pain may have no preventive function. “It’s not the type of pain that signals that you need to change something about what you are doing in that moment,” Dr. Hurley says.

Chronic pain persists more than three months, says Dr. David D. Kim, a pain management specialist with the Henry Ford Health System. Unfortunately, there’s no way to predict if pain will turn from acute to chronic.

Both types affect body functions, but chronic pain can also lead to changes in the nervous system, including the brain. “Chronic pain can literally be hardwired into the nerve structure and brain,” says Dr. Kim.

The treatment of pain

Each of us experiences pain differently. Poke 100 people with a pin, and their description of the pain will vary widely. Doctors often ask patients to rate their pain on a numeric scale and describe the feeling in their own words. A doctor also wants to know what makes it worse and what provides relief. But regardless of the type, the more intense the pain, the more negatively it affects a person’s ability to function on a day-to-day basis, says Dr. Hurley.

Like all medical interventions, pain treatments carry the risk of worrisome side effects. That’s why pain specialists such as Dr. Kim and Dr. Hurley start with “safer” treatments like over-the-counter meds, non-opioid pain medications, injections and physical therapy. Only after those treatments have failed will doctors move to more “aggressive” treatments like opioid medication in select cases. Pain patients may also be surprised at the ever-increasing range of options, which include spinal cord stimulation, peripheral nerve ablation, cognitive behavior therapy, acupuncture and chiropractic care.

Chronic pain may also have mental and social effects, such as depression, anxiety and isolation from friends and family. That’s where pain psychologists come in. They can offer coping skills, biofeedback, cognitive therapy and mindfulness meditation. “It’s a staged process that works with the patient,” says Dr. Hurley. “Imagine you had a headache that was blisteringly bad. Then imagine the way you would feel about everything in life if you had it seven days a week, 365 days a year. When you deal with family and friends, you might be a little grumpy, and that would be completely normal.”

The future of pain relief

With the bill for treating pain in the U.S. now at $500 billion a year, and so many people suffering, there are many reasons for developing new treatments. Researchers are hopeful about therapies tailored to each individual. Technology may help us understand better how pain develops in the brain. Until then, there are a number of tools pain specialists can use. “The key thing to understand when working with a chronic pain specialist is to decrease pain to a certain degree,” says Dr. Kim. “The goal is to make people happier, more functional and to minimize the use of addictive opioids.”

Pain and opioids

Pain specialists agree that opioids have a place in chronic pain relief, but not as a first response. That’s because opioids create changes in the brain, making a patient less able to adapt to chronic pain and increasing the risk of addiction.

Long-term, opioid prescriptions may not be effective at remedying chronic pain. Some patients can benefit, but there’s no guarantee of a functional outcome, says Dr. Hurley. Patients must be monitored and tapered off. "The goal is to help people return back to things they want to do in their lives and work,” he says. “The future of pain treatment is not opioid-centric. Pain does not equal opioids, and opioids don’t equal pain treatment.”

Categories: Get Healthy

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