CHRONIC PAIN
Chronic pain afflicts more than 10% of Americans. The top three kinds of pain are joint pain, back pain and headaches. Chronic pain is a leading cause of work-related disability. People with chronic pain have an increased number of visits to health professionals in an effort to find and alleviate the cause of their pain.
Chronic pain can have both physical and psychological causes. Physical causes include trauma, cancer, inflammation (arthritis) and other diseases that damage tissues and nerves. Another type of chronic pain is neuropathic. Abnormal processing of pain signals in the spinal cord and brain causes this. Although the original physical cause of the pain has healed, the brain may continue to perceive painful stimuli. Psychogenic pain is without physical cause and is thought to be a way of coping with emotional distress. Malingering is when a person intentionally and consciously pretends to be having pain.
There are ten practical steps to take that can alleviate pain in 90% of cases. First, get a comprehensive medical evaluation with appropriate imaging and diagnostic tests as indicated by your history and physical exam. Appropriate treatment at this time will often take care of the problem. Second, use simple and relatively safe medications and treatments initially. Third, regular exercise and good nutrition can be very helpful in resisting the effects of chronic pain. Fourth, a trial of inexpensive and safe alternative therapies such as massage or acupuncture is frequently helpful. Fifth, NSAID’s (nonsteroidal anti-inflammatory drugs) such as ibuprofen can be used. These may have problems relating to ulcers, kidney damage or liver stress. Sixth, psychotherapy and other behavioral interventions can be very helpful. Seventh, other drugs such as antidepressants, gabapentin (a seizure medication) or muscle relaxants may be helpful. These drugs typically have a high incidence of side effects. Eighth, if unable to obtain pain relief over 3-6 months, consider seeing a chronic pain specialist. Ninth, surgery and other mechanical therapies such as a spinal cord stimulator can be considered. Tenth, use of chronic narcotic analgesics can be tried.
Further information about chronic pain and its management can be obtained from the American Pain Society – www.ampainsoc.org. An excellent book covering the above information in greater detail is “Chronic Pain: Biomedical and Spiritual Approaches” by Harold Koenig MD. Dr. Koenig has suffered chronic pain himself and has written an insightful book.
Daniel Blodgett MD