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Treating Chronic Pain

Posted Aug 24 2008 1:49pm

ANNOUNCER: It's estimated that over fifty million Americans suffer from chronic pain. Experts define chronic pain as pain lasting more than three months or past the normal healing time for an injury or illness.

RUSSELL PORTENOY, MD: Chronic pain has no biological function. Chronic pain is an illness in its own right. When pain persists beyond the healing of an -- of an injury or it occurs in the absence of an injury, then pain becomes the problem for the patient.

ANNOUNCER: Chronic pain has been associated with a variety of medical conditions.

RUSSELL PORTENOY, MD: The most common type of chronic pain is chronic joint pain which is becoming more common as our population ages. It's typically a disease of the elderly and is what most people call osteoarthritis; affects the hips, the low back, the neck, the shoulders, the hands. Cancer is a cause of chronic pain.

Another very common cause of pain is headache. Other common causes of chronic pain include low back pain, chronic neck pain, fibromyalgia and some specific types of what is known as neuropathic pain, like diabetic nerve pain or diabetic painful neuropathy or postherpetic neuralgia, which is also known as shingles.

ANNOUNCER: The pain often persists twenty-four hours a day and can affect a patient's quality of life.

RUSSELL PORTENOY, MD: Pain can interfere with a person's ability to function physically, it can interfere with a person's psychological functioning, cause depression or anxiety, produces a sleep disturbance, chronic fatigue.

ANNOUNCER: And it's often undertreated by health care providers.

BILL H. MCCARBERG, MD: Unfortunately, we don't have enough pain experts to treat chronic pain, so most of the burden for treatment falls on the primary care provider -- the internist, the family medicine doctor, the pediatrician, the OB/GYN doctor. And unfortunately, many of these doctors aren't trained to treat it, and they tend to depreciate the patient's complaint of pain.

ANNOUNCER: Chronic pain can also prove difficult to diagnose.

RUSSELL PORTENOY, MD: Pain is inherently subjective and what we mean by that is there is no test that can determine whether or not a person's experiencing pain. There is no laboratory test, there's no X-ray, there is no test that can tell a doctor or -- or any other person that another human being has pain. The only way that we can tell if a person has pain is that they report it verbally or they show it in the way they move.

ANNOUNCER: There are different types of medications used to treat chronic pain. A group of medications called non-steroidal anti-inflammatory drugs, or NSAIDs, provide pain relief by reducing swelling and inflammation.

RICHARD PAYNE, MD: So, these are medications that can be quite effective in relieving pain in which there is an inflammatory component. So some arthritic pains can be very well-managed. A pain that's from acute strain of muscle or even a more chronic musculoskeletal condition can be managed with NSAIDs.

ANNOUNCER: Common NSAIDs include over-the- counter products like ibuprofen, or aspirin, and prescription drugs like celecoxib and diclofenac. These products are effective pain medications, but there are serious risk factors associated with all NSAIDs.

RUSSELL PORTENOY, MD: All of these drugs can produce kidney problems and all of these drugs can produce high blood pressure. So doctors who prescribe these drugs are supposed to be monitoring the kidney function and measuring the blood pressure.

ANNOUNCER: For moderate to severe pain, doctors often turn to powerful pain-relieving prescription drugs called opioids.

Common opioids prescribed in the U.S. are codeine, hydrocodone, oxycodone, morphine, tramadol and fentanyl.

RUSSELL PORTENOY, MD: Without any question at all, opioids are the strongest and most reliable painkillers we have. And, because of that, these drugs have become considered the mainstay approach, the most important approach for the treatment of pain related to cancer, to HIV disease and to other advanced medical illnesses.

ANNOUNCER: Opioids, however, can be addictive, and potentially abused.

RICHARD PAYNE, MD: Opioid drugs, as a class, have a property that the NSAIDs don't have in that they can cause -- be associated with compulsive use or with what is commonly called addiction. The other property of opioid drugs is that, when they are taken over a long period of time, the body becomes used to the medication and so, if it's stopped abruptly, it can cause a withdrawal symptom.

BILL H. MCCARBERG, MD: Now, who shouldn't get the opioids? Well, there are a particular population of patients who are more at risk for developing problems with the opioids, and that is people who have had a history of addiction.

ANNOUNCER: Although medication can help manage chronic pain, it's not the only way to treat it.

BILL H. MCCARBERG, MD: We have biofeedback. Self-hypnosis is particularly good. We all know about heat and ice and rest. Those are all very effective for certain types of chronic pain conditions. They don't work in everybody, but they certainly work in a lot of patients.

And that's why it's so important to use multiple different therapies -- the medications, the non-medications -- and to control it as long as the patient has the pain, which would be 24 hours a day for some patients.

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