If you peered over your child's shoulder while they were doing their homework and saw that they were doing it all wrong, what would you do? My guess is you would be livid if teachers had your kid coming home thinking 2+2=5, and you would want to get to the bottom of why things weren't being taught correctly at your school. Well folks, despite all of our new technology and flashy treatments, I can tell you that the way chronic pain is being treated in our society is basically just as flawed as 2 plus 2 equals 5.
In other words, we know the right answers, but nobody is standing up to deliver them and try to right this ship. With so many millions of lives devastated by such a vexing problem as chronic pain, why do you think this is happening? As is usually the case, there are a lot of special interests influencing what is happening.
First of all, chronic pain is big business. Odds are that if you are in pain, then you are probably helping make somebody a lot of money. I bet you never thought that your pain was the focus of bonuses, corporate takeovers, kickbacks and expensive advertising campaigns, but it absolutely is. The latest data from the Institute of Medicine estimates that more than 100 million Americans experience chronic pain. That is a big target, and one that is desperate for help.
According to IMS Health, a company that tracks sales for drug companies, Vicoden, an opioid-based pain killer, is the most commonly prescribed medication in the country, and almost 20 percent of all doctor visits involve a prescription for opioids. Drug companies know that the prescription of opioid-based pills is "the gift that keeps on giving" because once folks start taking them they won't stop because of the physical dependence they create. I think it is fair to say that there have been some pretty successful business plans out there!
Shouldn't the fact that chronic pain sufferers are now getting more access to the strongest pain killers on the planet and at higher dosages mean that we are now doing a better job helping them manage their pain? Guess again. In my 15 years of practice, I have yet to see a scientifically sound study that can show significant benefit from the long-term use of opioid medications for chronic pain in a large patient population.
There are many reasons for this including problems with tolerance, addiction and a newer discovery known as opioid-induced hyperalgesia (OIH) -- where opioid medications eventually cause some to get even more sensitive to pain. That would be akin to insulin shots making your glucose go up instead of down. If you have never heard of OIH, then my guess you is will get an earful about it once a drug company comes up with a supposed pill to treat it. Did you ever hear of ED before Viagra? Unfortunately, statistics can't describe the heartache I see every day from the over-dependence on medications.
Certainly, doctors are up to date on all of this stuff and can put things in the right perspective? When you consider that Wall Street-driven companies sponsor our medical conferences, journals, research and dinners (basically our education) then you can see how jaded the decision making can quickly become. Unfortunately, we are now seeing a sharp rise in abuse and deaths from prescription pain killers. According to the National Institute on Drug Abuse, the abuse of prescription pain medications is the fastest growing type of substance abuse among teens, and it is now the second leading cause of accidental deaths in the U.S.
In no way are the problems with pain management strictly limited to the misguided use of pills. For example, over the last two decades there has been an exponential rise in the use of spine surgery and interventional procedures for the treatment of lower back pain. Rapid growth has taken place in the use of more complex and costly spinal fusion surgeries, and there is cut-throat competition among the manufacturers of the hardware used in these procedures. Medtronic alone makes $3 billion annually off of its spinal device unit. Again, research has consistently shown that such treatments are no more effective for low back pain than much lower cost alternatives such as aggressive rehabilitation. What the data can't describe is what some patients and their families go through for months and years trying to recover and get their lives back after having these types of surgeries.
For years now, evidence-based medicine and scientific outcome studies have consistently shown that the most effective way to treat chronic pain is through comprehensive interdisciplinary pain programs. In 2006 the American Pain Society's Journal of Pain published the most comprehensive and thorough review of all chronic pain treatments to date. No matter what criteria they looked at, including improved pain levels, function, return-to-work rates and cost-containment, outcome studies demonstrated that such programs gave the best long-term results. The authors concluded that "the only therapeutic approach that has shown efficacy and cost-effectiveness is a chronic pain program" and "there is unequivocal evidence for chronic pain programs." Sadly, there are very few of these types of programs out there. Having run this type of treatment for ten years now, I could bore you with the details of all of the challenges I have faced trying to "do the right thing," but instead let me focus on the rewards.
What does a program like this entail? Interdisciplinary treatment means different specialists (like doctors, physical therapists, psychologists as well as yoga instructors, art therapists and life coaches) working together as a cohesive and well-organized team to teach patients as many tools as possible to help them better manage their pain and improve the quality of their lives. It is really like going to an intensive school for several weeks for patients debilitated by pain to learn how to move, breathe, communicate, process and overcome one of the biggest challenges they have ever faced in their lives. Think about the hit TV show "The Biggest Loser" -- but for those suffering from pain, not obesity -- taking place at my center every day.
The great news here is that when pain patients learn how to adopt healthy lifestyle habits and start exercising regularly, connect better with others and become less dependent on external resources like heavy medications, then they start to feel a whole lot better. Once you look at the new research being done on the brain in pain, you start to see why this holistic approach works better than drugs and surgeries. The time for doctors, insurance companies and patients to come together and figure out how to make this readily available to the millions of folks out there who seem to need it is long over do. It's time that we do the right thing for everyone.
Peter Abaci, M.D.: The Lesson We Can All Take Away From Chronic Pain
Chronic Pain-Treatment Overview
Chronic Pain Relief: New Treatments
Chronic Pain Management, Treatment, and Relief on MedicineNet.com
Chronic Pain Treatment Continuum, Steps to Chronic Pain Treatment
New Photo Contest Gives People with Chronic Pain a Chance to Share Their ...
Chronic pain coupled with addiction can be difficult to treat
I am a 29 year old man who had a very rare case of bi lateral Osteo Chondritis Dessicanse at age 14. Long story short I've had 20 knee surgeries on both knees. I had both of my knees replaced five years ago however, the left one failed and I had to have it replaced again. So from 14 until then I had been taking heavy pain medication. I still have significant pain in my legs and lower back. and I'm tried.
I'm Tried of pain. I'm tried of having my life revolve around getting out of pain. It become extremely dressing to see that I'm prob gonna be in pain for the rest of my life. It's been 15 years since all of this started and I'm living a 'normal' life job, college so on.
But the older I get the more terrified I get because I know that this is never going away. I also don't have health ins through my job and I pay out of pocket. So it's really expensive for me to do all of the things you suggested.
Do you have any advice for me!? I don't know what to do and I would like to just have ONE Day, one day completely without pain. I've been here so long that I don't even know what that feels like.
I hope to hear back from you soon.
Thanks,
Ohin
While I can't come up with a way to guarantee you can have one day without pain, I can say that you have the potential to experience lots of great days even with this problem. Here are some things to consider while you try to come up with an affordable plan to manage your long-term pain management needs:
Prescription medications can be very expensive. Getting to a point where you can be on as little medication as possible may have a number of long-term health benefits as well as free up some cash for other treatments. Some of the newer research on different types of chronic pain conditions have shown different types of mind/body approaches to be fairly effective in improving pain control. For example, community centers sometimes offer affordable tai chi or gentle yoga classes, and these approaches can really improve the way you feel (honest!). Research is also showing very positive results with the effective use of meditation, which only requires your time, not your money. To help with that consider signing up for a Mindfulness Based Stress Reduction course. Finding some friends who are motivated to overcome their pain challenges can be a great source of support if talking to health professionals about some of these issues is too costly. To dive deeper in understanding chronic pain and how you can succeed in overcoming it, consider finding a few valuable books that can help guide you.
I use pain killers ( Vicodin ) only on real bad pain days, and only with a comprehensive management approach and colse monitoring with my primary care doctor.
The pain on some days is just tremendous, but you get through it to the better days. It's not the easiest thing to live with, but I'd rather take the most conservative approach first before the major surgery. As one of the neuros said when I turned him down for a 2 level lumbar disc option..."Good decision, you'll know if and when you'll really need it. I wish more people were as informed as you." Knowledge is power, use it, know it.....and keep expectations realistic and reasonable.
probably experienced very little pain in their lifetime.
no breakfast can cause afternoon headache.
low blood suger, Potassium and bad postures can cause headaches any time.
cold morning air cause shoulder and arm pain and lost ROM
Sigmoid colon megaly can cause side of hip pain, inside knee pain and low back pain, can even cause femor head to turn white.
and many many others...........
Peter already frankly expressed the Chronic pain is a big B......
so,what etiologies...............
While I agree that in-general opioids are overused and do not result in functional improvement, unfortunately, I have not seen the FRP results claimed by a lot of FRP programs. As for the opioids, like other meds, it is important that the one looks at the ultimate outcome (which should be improved function and not just pain relief). If this end-point was aimed at by all MDs prescribing narcotics, we would not have this problem of narc. overuse.
As for the Spinal Cord Stimulator implants, there are various studies published. For every "unsuccessful" study, there is one which touts "success". Every specialty involved in chronic pain management touts their "success". Physical therapist tout PT, spine surgeons tout fusion, chiropractors tout chiro and so on. Pain treatment is not without a bias - and it never will be - as after all - treating pain patients is a business and not a charity. Sad, but true.
I would like to add clarity to a few points that you have raised, though. I did state in this article that for ten years now I have been running the type of treatment that I am advocating for, and all of my affiliations are clearly outlined in my biography. I fully agree that isolated success stories with positive outcomes exist for every pain treatment imaginable. But what is the point of outlining where evidence-based guidelines exist with respect to outcomes and cost-effectiveness if our health care system, including its providers, simply ignore them? Lastly, one of the salient points of my post is that there is a lack of insurance coverage, across the board, for structured interdisciplinary programs. It is highly unfortunate that, in some cases, only patients in a work comp system get access to this type of treatment when the majority of those significantly impaired by chronic pain do not. Instead of criticizing programs for treating injured workers, I would suggest criticizing the other insurance systems that don't offer this type of care to those who need it.
Chronic pain is a big business. Traditional doctors are 'trained' into the drug system from the time they're in medical school. But, the question that haunts me is: Why are alternative doctors just as reluctant as MDs, to look at research and clinical findings that prove chronic musculoskeletal pain can be permanently eliminated using a nondrug/non surgical therapy?
For years, I've been publishing (in peer review medical journals) on two inherited, abnormal foot structures that are a common source of chronic musculoskeletal pain and the therapy I've developed that permanently eliminates chronic pain. This therapy can be learned by any healthcare professional and used in their own practice to permanently eliminate their patient's pain. That is, when the patient's therapy is finished, they no longer have need for chronic pain treatment.
My question is - Why isn't this being done? When it boils down to it, could it be that even alternative doctors and healthcare practitioners only see the bottom line? Let's be honest, managing pain (whether through drugs or interdisciplinary therapies) means return business.
Professor/Dr. Rothbart http://rothbartsite.com/Publications.html
I've been on pain management for 10 years now following complications of cancer surgeries. My docs told me of other techniques and I use them as far as they work. On my good days I don't take the pain meds and have always taken breaks from it anytime I am able. I did this mainly because I know the meds can be either addictive or cause dependence or even, as the article says, become ineffective.
By using my meds in combination with the alternative techniques I've kept myself out of the downward cycle that so many fall into so easily. It is my responsibility to myself. As a result, my pain meds have decreased over this past decade to where I use only 1/3 of the dosage I had used back when this all started. It can be doe but one must be willing to do it.
p.s. My appreciation to all the folks at the H. Lee Moffitt Cancer Center in Tampa.