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Treating Chronic Pain as a Disease, Not a Symptom

By Bramnick, Jeffrey

Changes are coming in the treatment of chronic pain. Common types of chronic pain include back pain, headaches, arthritis, cancer pain, and pain from injury to nerves (called neuropathic pain).

The old thinking: Use narcotics to treat patients who are really hurting and hope they escape addiction, or avoid such complications by limiting pain treatment.

The new thinking:

  • Treat chronic pain as a disease, not merely a symptom.

  • Use a team approach, with pain specialists determining which patients need which types of help.

  • Involve patients in their treatment and teach them to help themselves.

Fifth 'vital' sign

Those calling for pain-treatment standards include the Health Care Financing Administration (which runs Medicare), the Joint Commission on the Accreditation of Healthcare Organizations, and the Veterans Health Administration (VHA). The VHA has adopted pain as a fifth vital sign to be "measured" along with blood pressure, heart rate, breathing rate, and temperature.

Pain experts say that 20 to 30 percent of Americans suffer chronic pain. "After upper respiratory infections, pain is the next most common problem seen by primary care providers," says Dennis C. Turk, Ph.D., a prominent pain researcher in Seattle.

The rate rises with age. At 65, half of us have some chronic pain. Women are also three times more likely to suffer pain than are men. "We're not sure why," Dr. Turk says.

Countless conditions can cause chronic pain, but these are the major offenders: arthritis, cancer, headache, low back pain, pelvic pain, peripheral neuropathy (a condition of the nerves to the extremities), reflex sympathetic dystrophy (a degenerative condition that can arise after a simple injury), sickle cell anemia, and shingles.

When is pain considered "chronic"? It's chronic when it extends beyond the expected healing period.

Lengthy healing

"If we know it takes two or three weeks for a particular injury to heal and for pain to lessen, and three or four months later there's still pain, then that's chronic pain," says Dr. Turk.

"Normal" pain benefits us by acting as a warning. Acute chest pain, for instance, can signal a heart attack.

"When pain is chronic it no longer is warning of a problem; it no longer serves a real purpose," says Nagy A. Mekhail, M.D., Ph.D., a Cleveland pain management specialist.

In fact, pain alone can worsen your health. "Studies have shown that pain can weaken your immune system," explains Evan D. Frank, M.D., Ph.D., a Philadelphia anesthesiologist. With less pain after surgery, patients exhibit less infection, fewer blood clots, and more mobility, he says.

Measuring pain is not as clear-cut as taking someone's temperature. Treatment, too, requires certain training.

"Most family practitioners don't have a good handle on treating pain because it's not really a part of medical school," says Dr. Frank. "That's just beginning now."

Are you in pain?

Communication is vital in treating chronic pain, but it's not just communication between doctor and patient that's important. Communication among physicians must come first.

Fred N. Davis, M.D., a pain specialist in Grand Rapids, Mich., teaches doctors and patients about chronic pain.

"We need to do a better job of teaching doctors and of teaching patients how to help themselves," Dr. Davis says. "For instance, lifestyle choices can have an impact on pain."

The trend is to teach patients how to help control pain.

"The great majority of patients live with chronic pain for one year or longer before they think in terms of managing their pain," says John Kraus, M.D., a pain specialist in Malvern, Pa.

Dr. Kraus says it's important for patients and health care providers to establish trust. "Many of these patients are not believed by co-workers and others," he says. "People don't see a cast on their arm or other obvious signs of pain."

Experts offer patients these tips:

  • Be consistent in explaining your pain.

  • Be specific about where it hurts and exactly how it feels.

  • Describe what, if anything, brings on the pain, makes it worse or makes it better.

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