Pain wears a thousand faces: it can be sharp, stabbing, burning, dull or throbbing. It can be short lived–the result of an accident or surgery; or it can be chronic and persist for years. Pain is a common human experience, so common in fact that it is the cause of half of all visits to the doctor each year. Aching muscles, a stubbed toe or a tension headache are the stuff of every day life, and we usually self treat with rest or an over-the-counter painkiller. More serious acute pain, such as that encountered while recovering from surgery or a dental procedure, can be treated with prescription medications strong enough to relieve discomfort and gradually lessened within days as the body heals.
Pain can even play a positive role. The pain that comes from touching a hot stove or from a broken arm sends warning signals to quit doing what we are doing and to protect our bodies from further harm. But many Americans suffer daily from more serious, long-term pain that does not always seem to have our best interests in mind. Rheumatoid arthritis, osteoarthritis, lower back pain, fibromyalgia, recurring migraine, shingles, and pain related to cancer or diabetes can have a unbearable effect and offer a challenge for both patients and their doctors.
Finding the Cause
Pain serious enough to bring you into the doctor’s office needs to be evaluated on a number of levels. Pain that has an clear cause–one that shows up on a test or is evident in a physical exam–can usually be treated successfully. A swollen or inflamed joint, a broken toe, an infected finger all can be dealt with using medical treatments and prescription medications. Even pain that does not show up on tests, such as migraine headaches or facial nerve pain (trigeminal neuralgia), usually has symptoms that are readily recognizable and treatable.
Serious back pain such as that caused by degenerative disc disease may prompt people to seek treatment options such as surgery to replace damaged discs with artificial ones or to combine vertebrae together. In many cases, however, more conservative treatment such as antiinflammatory medication to relieve swelling, pain-killing meds and physical therapy may be the best solution.
The chronic pain of arthritis–either rheumatoid or osteoarthritis–does not seem to serve any useful purpose and can be unbearable. A treatment plan usually includes pain-killing medication that has the fewest negative side effects for that individual plus exercise or physical therapy that will keep the joints mobile and the patient able to stay engaged in work and life.
Severe pain that persists for months or even years is seen as a damaging process in its own right. The pain of shingles, for example, is severe. If treated quickly and aggressively, it can often be limited. If not diagnosed in the early stages, it can take hold and cause severe pain that might last for years.
Some types of pain involving stress and unknown factors–such as those associated with migraines, fibromyalgia and other conditions–can cause frustration and confusion for both doctor and patient. The physical aspects of pain are often tangled with psychological symptoms such as depression or a history of emotional, physical or sexual abuse. A first step for you and your doctor in these cases is to acknowledge that the pain is real while trying to identify the exact trigger and reliable ways of providing pain relief.
Expanding Role For Opioids
Opioids have long been used for short periods to treat post-surgical pain and often for longer periods to treat cancer pain. This class of drugs includes morphine, codeine and meperidine (Demerol). More recently, opioids are being used to treat patients with chronic non-cancer pain, including arthritis, back pain and fibromyalgia. Although not used as a first-line treatment, opioids can offer a safe and effective option when other treatments fail to provide relief.
While this expanded use is considered controversial by many, studies show that many side effects and the risk of addiction can be minimized if the patient is carefully monitored and the med is started at a low dose and gradually increased until it is effective in reducing pain. As one doctor put it, “There are many myths about opioids, but generally speaking the fear is not supported by experience.”
Although side effects include nausea, sedation and constipation, opioids do not pose a risk to the body’s organs and are not associated with gastrointestinal bleeding (as NSAIDs are) or with toxicity to kidneys. A meta-analysis of studies of opioid use for chronic pain caused by arthritis, neuropathy and fibromyalgia found that, when used as part of a supervised treatment plan in patients with no history of substance abuse, opioids rarely resulted in addiction.
In addition to meds aimed at pain pathways, physicians may prescribe antidepressants, antianxiety and antiseizure medications or other meds commonly used for psychiatric problems. It is important for patients to understand the interconnectedness of mind and body and the need to address difficult pain problems from multiple angles.
Clinics that specialize in chronic pain management stress the role of the patient in gaining control over his/her physical and psychological well being. Rather than seeing himself/herself as a victim of pain, he/she learns daily coping strategies and ways of regaining control over his/her life.
Coping strategies include relaxation techniques such as yoga and meditation. Pain triggers muscle tension, which can in turn increase pain signals. Relaxation techniques can break up this cycle.
Biofeedback is another valuable tool that teaches you to control muscle tension, blood pressure, heart rate and other physical responses. Although the solution may be hard to find, there is never a good reason to live with pain. A visit to your physician is the first step in understanding the cause of your misery and finding a path that gives you relief.
By: Kerri Musselman, Pharm.D.
