A basic definition of pain is an “unpleasant physical senstation.” However, as physicians and people with pain can attest, the scope of pain and its treatments are complex and unique to the individual.
In a society that often emphasizes the quickest fix, pain management can be a treatment conundrum for health care providers. Patients frequently have difficulty explaining their pain to doctors, physicians may not always have time to listen well and insurance carriers don’t always offer coverage for recommended treatments. Yet despite the challenges, leaders in the pain management field say that long-held tenets are being replaced by a new way of diagnosing and treating chronic pain.
THE CURRENT STATE OF PAIN
“Health care professionals are trained to cure, but when it comes to pain, they are never taught how to help people manage it,” says Penney Cowan, founder of the American Chronic Pain Association. “The expectation is to ‘fix it.’ But a silver bullet doesn’t always exist.”
While there may not be a quick fix for chronic pain, there have been major advances in understanding it. “A few decades ago, pain was only considered as a symptom of a disease, not as a disease itself,” says Serdar Erdine, MD, FIPP, medical faculty of Istanbul University in Turkey and founder, past president, and current board member of the World Institute of Pain, and chief executive officer of the World Institute of Pain Foundation. “Now, pain medicine is recognized as its own discipline and pain is considered a chronic disease, not just a symptom related to a disease.”
James North, MD, assistant professor of anesthesiology and pain medicine at Wake Forest University Baptist Medical Center, agrees, although both doctors recognize the lag between cutting-edge thinking and widespread practice. “There is a growing awareness that chronic, non-malignant pain can become its own disease, but there is still very little education directed toward pain management in medical schools,” says Dr. North. “On the positive side, pain transmission is understood better than 20 years ago, and we’ve seen huge advances in understanding the mechanisms of chronic pain.”
Another improvement has been in the area of technology, for both treatment and diagnosis. “Advances in imaging quality allow us to see things we couldn’t accurately see before,” says Dr. North. “For example, there are now weight-bearing MRIs that allow the patients to sit or stand and that show the parts of the body under stress.”
Paul Gileno, founder and president of the U.S. Pain Foundation, says that while diagnosis has improved, it still has a long way to go. He attributes much of the progress to changes in patient attitudes. “Treatments have improved mostly because patients are more educated about their pain and are looking to the medical community not as the only answer but as one of many approaches,” he says.
THE EVOLUTION OF PAIN MANAGEMENT
The acceptance of chronic pain as its own disease has led to a greater acceptance of pain management options. For many years, opioids were the first line of defense in pain management. While these medications are still a necessity for many people, advances in technology offer new choices. For instance, spinal cord stimulators have provided life-altering results for many individuals.
“Stimulators were used very sparingly until the late 1990s, when the systems became fairly robust,” says Dr. North. “As the technology has improved, the patient outcomes have dramatically improved, and the companies that develop these devices continue to push the envelope in creating an effective, non-pharmaceutical pain management tool.”
Of course, there is no single solution that addresses all pain conditions.
“Everyone’s response to pain and pain treatment is different, and every human has specific brain architecture,” Dr. Ermine says. “Patients are now studying their diseases and coming to their physicians with information, and today’s medical community must revise itself and see each patient as a human being instead of a disease. Physicians must have good communication with their patients and treat both physical and psychological factors.”
In addition to pharmaceuticals and new technology, many people use integrative or complementary medicine as a pain management tool. Acupuncture, guided imagery, biofeedback and other techniques unite the mind and body for a more effective, customized approach.
“As patients, we realize that we need a whole mind, body and spirit approach to living with pain,” says Gileno, who lives with chronic pain. “Medicines and the medical community can only take us so far; it is up to the patient to go the rest of the way. In fact, there has been a drastic change in the past five years as more and more of the medical community have adopted a multidisciplinary approach.”
“Complementary medicine can be a significant part of pain management,” Cowan says. “It depends on where the person is in their pain journey and if the health care provider is supportive. “Unfortunately, opioids have overshadowed many other methods of pain management, but [the outcome is] more often management, not eradication, when it comes to pain. The main goal is to improve the quality of life,” Cowan explains.
The medical community and people in pain are becoming more aware of the connection between pain and lifestyle. “There has been tremendous growth in our understanding of the inflammatory cascade that occurs with chronic pain,” Dr. North says. “We tell our patients to try to take some control of this cascade through low-inflammatory diets, exercise and weight control. Losing just 10 to 15 pounds of extra weight can transform a diabetic into a non-diabetic, and diabetes can make the nerves more sensitive, so diet and exercise make a difference and even affect the brain’s ability to modulate pain.”
THE FUTURE OF PAIN MANAGEMENT
Experts agrees that pain medicine will be an increasingly important component of 21st-century health care. As research continues, providers and people with pain will become more aware of the intricacies of pain and the specific management tools that can be used to address each individual’s diagnosis.
“I know that industry is working extremely hard to come up with solutions for people with pain,” Gileno says. “Biologics and assessments have improved, and there’s better education for primary care doctors. Realizing that pain is a disease itself is key, and I think it will be treated with urgency and care in the future. Change is happening and we’re working hard to make sure patients are aware of everything that is available.”
“We take people out of the role of ‘pain patient’ and instead refer to them as ‘people with pain,’” Cowan says. “We want to help them move forward and understand that although they may not be able to completely fix their pain, they can learn to live with it. One of our biggest efforts is to bring health care providers and people with pain to the middle of the road, and help individuals become active participants in their own health care. I want people to realize there is hope, for them to realize that life’s not over when you have pain.”
“Our understanding of neuropathways will continue to improve, and that will result in better treatment options,” Dr. North says. “Again, the growing acceptance among physicians that pain is its own disease means that more people will be referred to pain specialists. There is a lot of research still to be done, but we’re making tremendous strides.”
“Patients should know that a new discipline is emerging all over the world: pain medicine,” Dr. Erdine says. “They should find pain doctors who will treat both the physical and psychological aspects of their pain and, most important, they should understand that chronic pain isn’t their fate. It can be treated.”