Chronic pain is a relentless affliction that has the power to disable the body and mind. Some experience immobilizing lower back or neck pain. Others suffer blinding headaches and migraines or facial aches.
These are the most common forms of pain, according to a 2006 survey by the National Institute of Health Statistics. Such conditions affect 76 million Americans and cost an estimated $100 billion each year in health care, litigation and compensation.
In many cases, chronic pain is the result of physical trauma and can be easily diagnosed. But as other patients can attest, the source can be elusive and difficult to treat.
Dr. Gilbert Fanciullo, director of Dartmouth University's Pain Management Center, says breakthroughs in this field are rare. At a recent gathering of the American Pain Society in San Diego, Calif., Fanciullo joined fellow researchers to discuss new developments, such as recent efforts to create more powerful painkillers.
It's a promising field, particularly since commonly used opioids like morphine reduce pain by only 30 per cent. But these drugs won't reach the market for at least five years and may cost 10 to 20 times more than cheaply available methadone, according to Fanciullo.
Such caveats are why it's important for pain sufferers not rest their hopes on any one treatment. Instead, they must pursue several strategies based on four principles: medication, operations and injections, physical therapy and counseling.
This is the approach that Fanciullo uses with his patients. And though evidence supporting the use of complementary and alternative treatments like acupuncture is limited, Fanciullo will incorporate them for patients who experience high success rates. He's also careful to warn patients of the risks and benefits associated with each treatment.
is a mistake."
Dr. Jack Stern, a neurosurgeon at White Plains Hospital in New York and clinical associate professor at Yale's School of Medicine, has a treatment philosophy similar to Dr. Fanciullo's.
He first tries to identify the "pain generators," which may be as obvious as a sagging mattress or uncomfortable chair. Other sources of pain — like uneven leg lengths — can be treated simply with shoe inserts or lifts.
Stern then attempts to alleviate the pain through non-invasive strategies like ergonomic furniture, massage therapy, physical therapy and medication. If those fail, he may try more invasive procedures like corrective surgery or nerve blocking, which uses electric impulses to help mask pain. He also refers patients to counselors who can help identify emotional trauma that may have led to physical pain, a phenomenon that has been studied in academic and research settings.
Weighing the Risks
At Spine Options, a pain clinic in White Plains, N.Y., co-founded by Dr. Stern, patients are told treatment will lead to one of three outcomes: quick recovery, steady but slow progress or rapid deterioration.
Though such advice seems obvious, Dr. Bradley Cash, the center's medical director, wants patients to have realistic expectations about their treatment — especially when risks and benefits are concerned. For example, patients may need narcotic medication to manage chronic pain, but this increases the risk of narcotic drug dependency. For those considering invasive procedures like nerve-blocking therapy, it means weighing complications like paralysis against the possibility of pain relief.
There's much less risk — and cost — associated with non-invasive techniques like yoga and physical therapy, but some patients report experiencing little to no change as a result.
That's why Cash and other pain experts try to develop treatment plans that aim to eliminate chronic pain as well as prevent its recurrence.
To achieve this goal, Stern recommends that patients seek treatment at multi-disciplinary pain centers where various options are offered.
"Right now most everybody who deals with pain is like a carpenter and only sees their specific hammer," says Stern. "In general, I send my patients to someone who is a carpenter, plumber and electrician."