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Why Our Approach To Chronic Pain Is Flawed

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CHRONIC PAIN TREATMENT
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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.

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