By Dulce Zamora
Reviewed By Charlotte Grayson, MD
Donald Small feels like a new man. After years of enduring debilitating back pain, he's finally feeling well enough to coach his daughter's soccer team, to take his kids fishing and camping, and to go on a cruise with his wife. He said goodbye to sickness, short tempers, the heating pad, couch, sedating medication, and seemingly ineffective surgeries after he sought the services of a pain specialist.
"It's changed my whole life," says Small, who now wears a prescribed patch on his upper arm, which steadily administers a pain-killing medicine.
The 40-year-old registered nurse is resigned to the idea that he will probably be on drugs for the rest of his life because of permanent nerve damage. All the same, he's marveling at his renewed strength and capacity to think of something else besides pain.
Small is one of many who have turned to pain management experts for help with never-ending hurts. The specialty is relatively new and still suffers from misconceptions, but it is gradually earning the acceptance and respect of both health professionals and the general public.
With acknowledgement have come the pressing questions: What causes chronic pain? How is it diagnosed? How is it treated?
Unfortunately, the answers don't come so readily, for there could be several reasons for the same affliction; there is no one way to identify and measure the physical distress; and there is no magic bullet for treatment.
The good news is that doctors are now paying more attention to the issue of pain and, as a result, there are more ways than ever to tackle the problem.
Yet in the near future looms a darker picture: aging baby boomers are expected to ache for quick fixes, faster than the medical establishment can possibly provide.
Nevertheless, the optimistic search for reasons and relief continues.
Many doctors define chronic pain as a physical distress that persists at least six months. The pain specialists interviewed by WebMD listed back, neck, head, and musculoskeletal pain as the most common. The relentless misery is also known to plague people with certain diseases, such as diabetes, cancer, and fibromyalgia (which is marked by widespread aches, fatigue, and multiple tender points).
According to Small's specialist, Sanford Silverman, MD, of Comprehensive Pain Medicine in Pampano Beach, Fla., pain is the body's way of warning against greater injury (such as a sore thumb when hit by a hammer), or to indicate that something is wrong (such as chest pain for a heart attack). There is a point, though, when the suffering becomes unnecessary, such as when an injury has healed and damaged nerves continue to bombard the brain with messages of pain. At that stage, pain is a medical condition unto itself, a concept little recognized.
"There are a lot of people out there where pain is a disease, and it significantly affects their life; they have to live with it every single day," says Silverman. "For most other people, pain is a transient thing."
The result of this unawareness: Many patients and doctors think constant suffering is just something you have to live with, and, thus, little is done to try to relieve it.
Another common misconception -- many people, including doctors, believe that painkillers are addictive, so they avoid using them.
It may be obvious that someone is hurting, but measuring physical distress is far from being an exact science. Despite efforts to quantify pain, or to determine its biological history, the fact remains that it is subjective, and people have different tolerances to it.
"There isn't a machine that I can hook you up to that absolutely tells me the amount of discomfort you are having," says B. Eliot Cole, MD, director of education at the American Academy of Pain Management. "So we wind up looking at X-rays, at CT scans, at MRI scans for evidence [of disease] that we think correlates with causing pain."
Newer techniques reportedly include muscle imaging with ultrasound that can locate taut bands and trigger points, and EMG/NCS, a device using electrodes on the skin to identify trouble areas in muscles and nerves.
For his part, Silverman uses various methods to diagnose pain. He asks patients to give their discomfort a number from zero to 10 (zero representing no pain, and 10 being the worst), and to describe what they're feeling. The words patients use -- such as throbbing, shooting, squeezing, sharp, hot, cold, and itchy -- give him clues to what is wrong. He also uses his own eyes to spot apparent physical damage and X-ray equipment to detect any internal abnormalities. In addition, he tries to find out what else is going on in the patient's life.
"If [patients] do have a bona fide psychological problem -- not because of the pain, but it's a part of them -- that's going to affect the way ... that the pain is perceived," says Silverman, who notes that some people find it hard to separate physical pain from their emotional conflicts. A patient's problems with work, marriage, and sex, for instance, may affect the ability to cope with bodily distress.
Penney Cowan remembers all too well how terrible she felt the first six of the 30 years she's endured fibromyalgia. "I was completely nonfunctional," she says. "I was afraid, didn't know anything, and was blindly going forward hoping someone's got the magic bullet for me."
As Cowan realized, however, there is no perfect solution for her pain. So she decided to learn as much as she could about dealing with the discomfort. Her active involvement not only eased her misery, but also inspired her to establish the American Chronic Pain Association, a group dedicated to educating healthcare professionals and the general public about pain management.
From her experience, Cowan says people who take an active role in their treatment tend to have better quality of life, reduce their sense of suffering, and feel more empowered. Strategies she recommends for active learners include seeking a well-qualified pain specialist or program and looking up information about medication and treatment from reliable sources such as the Cleveland Clinic and Mayo Clinic.
Experts say it's also helpful to know that relief may come from one or a mix of strategies, which can include medication, physical therapy, surgery, and/or psychological therapy. Seeking a pain specialist is reportedly only one part of a comprehensive solution.
Originally published Jan 29, 2003.
Medically reviewed Oct. 8, 2004.
SOURCES: American Back Society Conference Highlights, David Fishbain, MD, Orlando, December 2001 • Donald Small, patient • Sanford Silverman, MD, Comprehensive Pain Medicine, Pampano Beach, Fla. • B. Eliot Cole, MD, director of education, American Academy of Pain Management • Penney Cowan, founder and executive director of the American Chronic Pain Association • WebMD Public Information with The National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Questions and Answers about Fibromyalgia."
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