Treating Chronic Pain as a Disease, Not a Symptom
The treatment of chronic pain has significantly improved over the last decade. Common types of chronic pain include back pain, headaches, arthritis, cancer pain, and pain from injury to nerves (called neuropathic pain).
The old thinking: Rely on narcotics for treating severe pain despite their side effects and the potential for addiction, or avoid use of these medications and indicate to patients that there is not a great deal to offer them.
The new thinking:
Make all efforts to diagnose and treat any underlying causes of pain.
Treat chronic pain as a disease, not merely a symptom.
Use a team approach, with pain specialists determining which patients need which types of help.
Involve patients in their treatment and teach them to help themselves.
Fifth 'vital' sign
Among those calling for pain-treatment standards is the Veterans Health Administration (VHA). In 1998, the VHA adopted pain as a fifth vital sign to be "measured" along with blood pressure, heart rate, breathing rate, and temperature.
Countless diseases can cause chronic pain. Some of the major offenders are arthritis (including arthritis of the spine), cancer, peripheral neuropathy (a condition of the nerves to the extremities), complex regional pain syndrome (a chronic pain condition that can arise after a seemingly minor injury), sickle cell anemia, and shingles (usually from postherpetic neuralgia, a potential complication of shingles). Chronic low back pain and headache are 2 of the most common forms of persistent pain.
When is pain considered "chronic"? It's chronic when it extends beyond the expected healing period, and affects a person's level of function and quality of life.
"Normal" pain benefits us by acting as a warning. Acute chest pain, for instance, can signal a heart attack. When pain is chronic it no longer is warning of an underlying problem and no longer serves a real purpose.
Measuring pain is not as clear-cut as taking someone's temperature. Treatment, too, requires specialized training.
Are you in pain?
Communication is vital in treating chronic pain, but it's not just communication between doctor and patient that's important. Communication among doctors is essential. One trend in the treatment of pain is teaching patients how to help control their pain.
Experts offer patients these tips:
Be consistent in explaining your pain.
Be specific about where it hurts and exactly how it feels.
Describe what, if anything, brings on the pain, makes it worse or makes it better.
Choices in treatment
To treat chronic pain, patients may need several professionals using several approaches. Research has found that the most successful pain treatment combines a broad range of medical, physical, and behavioral therapies. The goal of treatment is optimal pain control, improved function, and improved quality of life.
Pain treatment generally falls into these categories:
Medication. This ranges from acetaminophen to narcotics (such as morphine) and other adjuvant (supplemental) pain medications designed to treat inflammation and nerve damage. For some patients, injection therapies can be very effective.
Surgery. Surgery, for example, can ease the pressure that vertebral discs place on spinal nerves. Surgery may be used to implant a pump to deliver medication directly to the spinal cord.
Alternative treatment. This includes a variety of physical and behavioral approaches that range from acupuncture to massage therapy.
Behavior/cognitive therapy. Approaches to help manage pain, including meditation and yoga.
Lifestyle changes. For example, quitting smoking and getting a good night's sleep can be an important component of a chronic pain treatment plan.