Managing Chronic Pain

Jody Gardner had joints in her feet removed to reduce the painand enable her to walk "more like normal."She had a hot tub installed at home to supplement thewarm-water exercise she enjoys and needs.She watches what she eats, exercises regularly and hasdeveloped a close working relationship with her doctor.When you have chronic pain, as she does, you keep tryingthings until something brings relief.Gardner was diagnosed with rheumatoid arthritis when she was22; doctors figure she'd already had it for some time even then. Fortyyears later, chronic pain is just one aspect of the woman's activelife. "I do so much better now than I ever did when I was young. I doknow how to manage it," she said.Others are still learning to live with pain. The AmericanChronic Pain Association says people in the United States are living a"lifestyle of pain." Headaches, back injuries, arthritis, fibromyalgia,Parkinson's disease, neuropathy and many other medical problems orinjuries can be associated with chronic pain. There are also cases ofreal pain with no clear medical cause.The Joint Commission on the Accreditation of HealthcareOrganizations says that nearly a third of Americans will experiencechronic pain sometime. It's estimated that about 50 million Americanslive with chronic pain, the No. 1 cause of adult disability in theUnited States, JCAHO says, adding that chronic pain accounts for about$100 billion in lost productivity and is the major cause of workerabsenteeism. Dr. Lynn Webster, president of the Utah Academy of PainMedicine (a local chapter of the American Academy), who also directsLifetree Clinical Research and Pain Clinic, said the numbers areprobably higher. About half of us will experience chronic pain at somepoint, he said. And he warns that the pain itself can become adebilitating disease if it's not controlled or people don't learn tocope with it. "As it exists over time, it changes the central nervoussystem in ways that contribute to the problem."

Meanwhile, many of the medications used for chronic pain suchas Vioxx have either been pulled from the shelves or warnings issuedabout potential complications and side effects, some as serious asincreased risk of heart attack.Because chronic pain can emanate from or be felt in so manydifferent parts of the body, it's hard to give a simple definition."Chronic pain persists," according to a National Institute ofNeurological Disorders and Stroke description. "Pain signals keepfiring in the nervous system for weeks, months, even years. There mayhave been an initial mishap -- sprained back, serious infection, orthere may be an ongoing cause of pain -- arthritis, cancer or earinfection, but some people suffer chronic pain in the absence of anypast injury or evidence of body damage. Many chronic pain conditionsaffect older adults. Common chronic pain complaints include headache,low back pain, cancer pain, arthritis pain, neurogenic pain (painresulting from damage to the peripheral nerves or to the centralnervous system itself) and psychogenic pain (pain not due to pastdisease or injury or any visible sign of damage)."The goal of treatment, Webster said, is to "allow people tofunction at the highest possible level and maximize quality of life."

Treatment options vary. The National Institutes of Healthlists medications, acupuncture, local electrical stimulation and brainstimulation, as well as surgery, as treatments. It also notes that somephysicians give a placebo that may, in some cases, lessen or eliminatepain. Psychotherapy, relaxation and medication therapies, biofeedbackand behavior modification are used to treat chronic pain. For manypatients, it's a try-everything buffet.The use of placebo as a successful treatment doesn't mean thepain is imaginary, the experts say. It simply underscores the fact thatfeelings like hope or despair can have a direct impact on pain.The key to chronic pain, said Dr. Jason Theodosakis, author ofthe bestseller TheArthritis Cure (St. Martin's Press, 2004), is getting aproper diagnosis. "Too often, we treat symptoms and actually treat thewrong disease," he said in a phone interview with the Morning News."Say there's a middle-aged woman with hip pain. We think osteoarthritiswhen it's actually bursitis or tendinitis and requires a totallydifferent treatment."You should also ask how it happened, he said. "Maybe you can'tfind a reason, but it helps to look, and you might uncover a secondarycause. I might have parathyroid problems that broke down the cartilage.Don't just treat the symptoms."

Daren Brooks, founder and president of The Bridge HealthRecovery Center in Rockville, Utah, adds another twist to thesometimes-complicated search for diagnosis. "One thing it's sometimeshard to get your arms around is that pain is interpreted in the brain,whether it's a broken back or depression or a failed relationship. Thebody sometimes will pick and choose spots and yell in those particularspots."That may be one reason, he said, that doctors can't alwaysfind a clear diagnosis when they look at an X-ray or MRI scan. "I'veseen people get rid of lower back pain when they've forgiven theirfather." But the father doesn't show up on the MRI.Most experts agree that medications ease symptoms but do notby themselves offer a cure for most chronic pain. That takes differentsteps and a willingness to try different things, say Webster, Brooksand Theodosakis.The most common underlying condition for chronic pain isarthritis in some form, while lower back pain accounts for the mostpain-related visits to the doctor. (The two overlap; lower back painmay be caused by degeneration in the spine.) There are more than 100different types of arthritis and related conditions, affecting 70million Americans. And that's just arthritis."Some patients get immense relief from prescriptions, whileothers don't get much," said Webster.

To the list of what's valuable, arthritis expert Theodosakisadds nutritional supplements, carefully selected for quality, such aschondroitin and glucosamine, to not only ease arthritis inflammationand pain, but to improve the joints themselves. "Many of them," hesaid, "are safer than the popular anti-inflammatory medicationstypically used." He also likes ASU, a supplement that is made ofavocado or soy oil and is used as a drug in France.But he warns that "too often people emphasize treatment thatmay not be ready for prime time. We need to focus on what we knowworks," including remedies proven in controlled studies in othercountries. "Ninety percent of the products, I wouldn't give to my dog.But you don't want to throw the baby out with the bath water.Supplements can be made in facilities that manufacture over-the-counterdrugs and each batch tested." In all cases, proper doses andconcentrations must be used to be effective, and all instructionsfollowed.Exercise is immensely helpful with nearly all chronic pain,although many patients resist at first because it may hurt to move. Butthe more someone does -- as long as it's done correctly to avoidworsening the condition -- the better the body responds and the more itcan do. "We try to achieve as much as possible," Webster said, notingthat for some patients that's building up to walking three miles a dayand for another "huge success" might be the ability to sit at thedinner table with the family.

Every movement has a proper form to it, Theodosakis said, andimproper form leads to cartilage damage and pain. Patients may need a"prescription for exercise, a trainer, exercise physiologist, physicaltherapist, a chiropractor sometimes, training about motion sobiomechanics improve."Proper diet contributes not only essential vitamins andminerals to the body, but also helps control weight, a factor in manypainful conditions. Obese people, for instance, get more fingerarthritis than lean people. They are more prone to diabetes and therisk of painful neuropathy. The list goes on.Nearly anyone with chronic pain can get at least some reliefusing multiple approaches, Webster said. "We may need to coordinate thephysical, medicinal and mental element in treating the more severeproblems." Doctors may prescribe physical therapy or an exerciseprogram such as low-impact aquatic therapy, which Gardner loves. "Somepatients need help from a behavioral psychologist," not because theyhave a mental illness, but because "there's a tremendous impact on allaspects of life, and they need to learn how to deal with that and keepit in perspective so psychological pain doesn't drown us."Through it all, patients must recognize that symptoms anddisease process may not match. With arthritis and the popular Cox-2drugs like Vioxx, for instance, it stops the pain, but the cartilagedegeneration continues, Theodosakis said. And the reverse is true. Youcan help the cartilage and still have pain. That happens sometimes withglucosamine, where "you may not have significant pain relief, butX-rays show the joint is significantly, statistically better."

Insurance coverage is another issue for chronic pain, Websterand Brooks said. If an X-ray doesn't show a clear-cut source of pain,it may be "placed in a category as more of a behavioral issue anddismissed or at least lessened," said Webster. Insurance may not coversome of the complementary treatments."There is an undertreatment of pain. There are usuallytreatment options if people are persistent. At the same time, not alltreatments are successful, and there's risk to all procedures. Andover-the-counter remedies can be dangerous or potentially harmful,"Webster said.The very good news, he adds, is "there's a lot in the pipelinethat's going to be available in the next few years." Source: Deseret News. Powered byYellowbrix.