Chronic Pain - Overview

My earliest memories of pain was as a little leaguer in West Scranton. I remember being hit by a ball in the back. I remember the coach saying to me, "just walk it off”. Pain was to be dealt with like a man and your ability to handle the pain was a reflection of your character I walked it off but later learned that not everyone could.

After graduating from Penn State’s Hershey Medical Center, I became a resident in psychiatry. Many of the patients who were referred to us from the neurology and medical services Physicians concluded the pain was out of proportion to what the patients physical examinations revealed. Subsequently the patient had a psychiatrist evaluation and were classified as being hypochondriacs. The internists and the medical department felt relieved because it was no longer their problem. Unfortunately the patient was not helped.

When I became a medical/neurology resident, we would evaluate these patients who have chronic pain for various reasons. We would identify the source of the pain, explain it to the patient, try some conservative measures such as physical therapy, biofeedback, give them advice on exercise, diet, weight loss. We would try a few medications which were “benign” non-addictive and if it did not work, then we told them that they would have to learn to live with it. Stronger medications were felt to be inappropriate. You could give individuals opiate medications for a brief Period of time but you certainly did not want them to become hooked on them or even worse turn them into a “drug addict”. However if you were faced with a person who was dying or older in their 70’s and 80’s perhaps it might be OK. The problem arose in the individual who was “younger”, not terminal and who had severe non-remitting chronic pain. The pain made their life miserable, every waking hour was excruciating and affected every aspect of their life. Many times this resulted in divorce, impaired relationship, despair and depression and at times suicide. These poor souls would have to live or die With the consequences related to chronic pain.

Statistically 15-20 percent of the American public lives with the various conditions which would fit into a category of chronic intractable, non-remitting pain. Furthermore this statistic continues to grow as medicine in general eradicates various types of diseases and allows people to live longer lives. In many cases these individuals although “healthy” end up with various types of chronic degenerative conditions which result in daily pain.

When pain becomes chronic, it dominates every aspect of ones mental life. All activities become viewed with this mind. Pain leads to anxiety and depression which then increases the perception of pain. It is a never ending circular process.

With this in mind there has been a change in philosophy. The management of pain in the United States has become an extremely high priority, especially as the baby boomers age and want to enjoy their later years. Many of the previously held beliefs are changing or modified. This is especially true as it pertains to the addiction potential with the use of opiate medications. It has been learned that only 5 percent, a very small percentage of individuals will run into difficulties. The vast majority can utilize these medications without any problems. The medications relieve their pain to allow them to function appropriately and enjoy their life to the fullest. State and Federal policies are evolving as well. In the past there were strict prohibitions against treating pain aggressively.

More and more it is realized that aggressive management of pain has a legitimate place in the practice of medicine. There are principles and steps which need to be followed, but they can easily be incorporated into a comprehensive treatment plan.

In the next article in this series, we will explore the use of anti-inflammatory medications as the first step in the treatment of chronic pain. There appropriate use, side affects and alternatives in this particular category.