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What Is Chronic Pain?

Posted Aug 24 2008 1:49pm
ANNOUNCER: According to the American Chronic Pain Association, chronic pain is pain that continues a month or more beyond the usual recovery period for an injury or illness, or that goes on for months or years due to a chronic condition.

BILL McCARBERG, MD: The most common types of pain that I see in my practice are low back pain, is very common. Neck and upper back pain is the next most common. Osteoarthritis affects the hands and the feet and the hips and the knees and all of these other areas. Fibromyalgia and another condition called myofascial pain is a very common condition as well.

ANNOUNCER: Chronic pain is persistent and can degrade health and daily function.

SCOTT FISHMAN, MD: When someone's in pain all the time, they've really lost their ability to concentrate on all of the things they need to do in their lives, because, as an alarm system, the purpose of pain is to grab your attention.

BILL McCARBERG, MD: The people that are suffering pain-and this is most often the elderly, believe it or not-don't complain to their doctors about it. So what patients do is they have a lot of pain, but they don't complain about it very much. They don't let their provider know how much this is affecting their life.

ZORBA PASTER, MD: We cannot test for chronic pain. There is no way that we have a meter. There is no pain-o-meter. We can test for blood pressure, pulse, respiration, temperature, but we can't test for pain.

ANNOUNCER: And chronic pain often affects people day and night.

ZORBA PASTER, MD: Chronic pain is an important cause of insomnia. If you're trying to go to sleep and you hurt, it's hard to get to sleep. If you do get to sleep and you hurt, you're much more likely to wake up.

ANNOUNCER: Patients can find non-prescription pain relief at the local drug store, in the form of ice packs and over-the-counter medications like acetaminophen. A group of medications called nonsteroidal anti-inflammatory drugs, or NSAIDs can also help provide pain relief. Common older NSAIDs include ibuprofen and aspirin.

But most NSAIDs may cause serious gastrointestinal problems, especially with long-term use.

ZORBA PASTER, MD: The side effects of anti-inflammatories include GI bleeds, bleeding from the stomach.

ANNOUNCER: Once patients are diagnosed with chronic pain, doctors may turn to prescription NSAIDs. One type of prescription NSAID, called a COX-2 inhibitor, is thought to be less likely to cause intestinal bleeding than older NSAIDs.

ZORBA PASTER, MD: They were developed to reduce the risk of GI bleeds. Now, do they carry a risk of GI bleeds? Yes. They are better on the gut. They're a little bit easier. They're not as likely to cause a GI bleed.

ANNOUNCER: COX-2s have been associated with serious heart complications in patients and some have been taken off the market.

DENNIS TURK, PhD: Unfortunately, data has come out saying that although they do reduce some of the GI problems, they can lead to cardiac problems. So you have an interesting balance here. What would you prefer to have, stomach bleeding or coronary problems? Several of these drugs have been taken off the market for concern about the effect they have on the heart function.

ANNOUNCER: When over-the-counter medications and prescription anti-inflammatories are no longer effective in treating patients with chronic pain, or if patients cannot tolerate the side effects of these medications doctors may turn to powerful prescription medications called opioids.

BILL McCARBERG, MD: The opioids are some of the most effective painkillers that we know.

SCOTT FISHMAN, MD: The opioids are the morphine class of drugs, they -- they're some of the oldest-known analgesics.

ANNOUNCER: Like most medications, there can be side effects associated with opioids.

BILL McCARBERG, MD: There are many, many other side effects that people have. The most common in constipation. They get skin rash and irritation from it. They talk about getting itchy from it. They may get a little sleepy. They may get groggy in the morning from it. They may have memory lapses from their medication. But, believe it or not, almost all of those side effects go away.

ANNOUNCER: Opioids, however, can be abused to varying degrees. As a result, the majority of opioids are regulated by the government by a system called scheduling.

SCOTT FISHMAN, MD: The schedule is anywhere from I to V, I is the most severe and aren't available for use. They're drugs like marijuana and -- and heroin, etc. Schedule II are the most abusable drugs that are available for therapeutic use and they would include the stronger opioids. III tends to be drugs that are less abusable; and then IV and V are drugs with -- with far less abuse potential.

ANNOUNCER: Because it has been determined to have low abuse potential, one opioid, tramadol, is not a federally controlled substance.

ZORBA PASTER, MD: Once again, you have to be careful with abuse, because it's an opioid derivative.

ANNOUNCER: Many pain medications provide relief for just a few hours, and there can be a downside to taking them.

ZORBA PASTER, MD: If you have to take a tablet three to four times a day because it's every six hours, your pain goes up and down. So, here it is, my pain is high, I take a tablet, my pain gets better. Lo and behold, a few hours later, my pain gets worse, I have to take a tablet, my pain gets better. How does that feel? Nobody wants to be in pain intermittently throughout the day.

ANNOUNCER: Some opioids come in extended-release formulations that are taken once or twice a daily. These medications may be appropriate for patients whose pain is persistent and who require ongoing daily treatment for their pain.

BILL MCCARBERG, MD: There are multiple methods of taking medication such that it lasts a long time and, believe me, this is the way to take painkillers. Take them so you don't have to take 'em over and over and over again.

ANNOUNCER: Chronic pain can be a lifelong condition, but doctors say that patients' lives can greatly improve with treatment.

ZORBA PASTER, MD: There's always hope for people with chronic pain. There are new drugs, there are new treatments, there are new medications, you can change your life. There's always hope. Hope is the wellspring of wellness.

Ask Your Doctor about chronic pain.

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