Information » Diseases » Chronic Pain
There is an epidemic of untreated chronic pain in Canada, and only recently have doctors begun to understand what it is and learn to recognize it. Regardless of why your pain started or where you feel it, when you have pain that persists, it becomes a separate problem.
When your body feels pain for a long enough period of time, the nervous system changes the way you actually feel pain. Research has identified changes in the spinal cord, the nerves and the muscle tissues that actually make you more sensitive to pain. Changes in the brain also affect pain threshold, but other changes in the brain correlate with poor sleep, decreased memory and concentration, and even depression or anxiety.
In addition, pain is a major form of stress. The immune system and hormone systems of the body respond to this stress in many ways that can be damaging to virtually all of your tissues. Chronic pain can lead to problems with digestion, blood sugar control, obesity, heart disease and arthritis.
Yet for years, people with chronic pain have been told that it is all in their minds, that they should stop complaining, that there is nothing wrong with them, or that they will never get better. This unfortunate situation was simply due to a lack of understanding about these effects of chronic pain.
This is a young specialty that does not focus on the cause of the problem, but rather on treating the pain itself. The first step is to make sure that your diagnosis is correct and rule out serious illness. This involves reviewing previous CTs or MRIs when necessary, and previous specialist consultation letters and hospital reports when available. Sometimes patients have not had all the tests they need.
The pain management specialist's other job is to review your current medications and make changes that may yield better results. This may include reducing or eliminating drugs which are unnecessary or which may cause problems, changing the dose or formulation of medications if necessary, and adding new medications that have not been tried. This process involves a bit of trial and error, but usually yields good results.
A pain management specialist can also provide guidance about the many integrative therapies available for the treatment of chronic pain.
One part of the treatment usually involves medication. While some patients benefit from anti-inflammatories or other over-the-counter drugs, many need stronger pain killers. These are called opioids and include drugs like morphine, Demerol, codeine, oxycodone or hydromorphone. They are more effective, but doctors are often very reluctant to prescribe them because of the potential for abuse. This has been one of the main reasons for the epidemic of undertreated chronic pain.
Chronic pain often requires long-acting opioid medications that are slowly released over time. These can also cause addiction and abuse, but many patients find that their quality of life improves dramatically when they are switched from regular to long-acting opioids.
Other medications that have been useful in the treatment of chronic pain include antidepressants, topical creams, and even cannabinoid medications derived from marijuana.
Integrative pain management includes treatments other than medication. Research has demonstrated that many other kinds of treatment can improve chronic pain, including:
Most patients we see have already been to several doctors and have tried one or more of these treatments. You may find it difficult to decide which treatment to use, but this decision can be made logically based on your history and physical examination.
Our approach to treating pain is fundamentally different in one important way: we do not simply manage pain. What we aim to treat is every step in the chain of events that affect patients with chronic pain:
The aim is to help reduce the stress placed on the body so that it can do what normal bodies do heal itself.