About Chronic Pain

Why is treating chronic pain important?
When chronic pain is properly treated, most patients objectively demonstrate benefit by working full time, enjoying their families, being more active, and predictably suffering less stress and a more active lifestyle such that life expectancy is enhanced.

What is the danger of clinicians not treating chronic pain?
Patients may unwillingly harm themselves by self treating with potential toxins such as excessive acetaminophen with consequent liver failure, excessive anti-inflammatories with death from GI bleeding, renal damage, cancer, and heart attacks as well as self treatment will alcohol toxin or illegal drugs.  Patients may also seek harm to themselves deliberately if chronic pain is not addressed.

Also, patients who suffer untreated chronic pain are less active, predisposing to obesity with consequent diabetes, stroke, heart attacks, obstructive sleep apnea, a host of malignancies, and numerous other diseases.

Can chronic pain be cured?
Unfortunately, classic teaching is that chronic pain cannot be cured.  Though this is true in the vast majority of cases, superficial local anesthetic nerve blocks sometimes cure chronic pain, deep sympathetic nerve blocks may cure reflex sympathetic dystrophy, a brief course of nonsteroidal anti-inflammatories may terminate a cycle of years of auto-immune related inflammation related pain as with Crohn's disease, and surgeons may decompress spinal cord compression areas to cure pain.

In the vast majority of cases, it is unreasonable to expect cure such that the logical course of optimal medical care is safe and effective conservative treatment.

How many patients in the United States suffer from chronic pain?
It has been published that there exists an "epidemic of untreated pain" of 100 million Americans suffering from chronic pain.(McCarberg B, Hahn K, Twillman RK, Hodgkiss-Harlow CJ.  A role for opioids in chronic pain management.  Arch Intern Med.  2012 May 28;172(10):824.)

It helps many patients to know that they are not alone and it is wise to seek professional treatment for chronic pain or any medical condition given the dangers of self treatment.

What is fibromyalgia?
Fibromyalgia is a chronic diffuse ache that is often accompanied by insomnia and fatigue.  Many patients also suffer from mood depression as a result of the chronic pain for which many clinicians inappropriately without opioids despite the fact that the opioids mitigate pain to facilitate continued full time work.

As fibromyalgia is much more common in patients working at sedentary job positions, many patients benefit from physical therapy to teach patients home exercise daily stretching programs.  

Also, patients enormously benefit from aerobic exercise to engage the endogenous endorphin system as well as increase blood flow to muscles which may be accumulating toxic metabolic wastes.

"Biomechanical perpetuating factors have long been known [since 1983] to cause persistent musculoskeletal pain."(Gerwin RD, Dommerholt J.  Treatment of Myofascial Pain Syndromes.  Ch. 18, pg 222.  In Pain Management:  A Practical Guide for Clinicians.,  5th ed., ed. Weiner RS.)

Neck pain as well as back pain, in particular, are associated with disc pathology which is associated with diffuse myofascial pain.(O'Neill S, Manniche C, Graven-Nielsen T, Arendt-Nielsen L.  Generalized deep-tissue hyperalgesia in patients with chronic low-back pain.  Eur J Pain. 2007 May;11(4):415-20.)

Often a work disc spine injury initiates a new sedentary lifestyle with evolution to diffuse myofascial pain.  Opioids and other treatments may help some patients return to a productive life.

What is the pain management philosophy that clinicians and patients should seek?
As with any medical condition, the most important concern is safety first followed by treatment  effectiveness.  

Initial treatment should not usually be with potentially dangerous treatment such as surgery given inhalational anesthesia and infection risks. 

Long term daily treatment should not be with dangerous options such as ibuprofen, naproxyn, celecoxib, or other anti-inflammatories given risks for bleeding, kidney damage, heart attacks,....

Benzodiazepine narcotics are not safe or effective treatments as they suppress breathing to markedly increase risks for death, increase risks for rebound anxiety, rebound insomnia, and dementia as well as increasing pain.(Vlexxides M. Pain Medicine News Primary Care Edition  2005;1,22.)(Rosland JH.  Benzodiazepine-induced antagonism of opioid antinociception may be abolished by spinalization or blockade of the benzodiazepine receptor.  Pharmacol Biochem Behav 1990;37(3):505-9.)(Pakulska W.  Effect of diazepam and midazolam on the antinociceptive effect of morphine, metamizol, and indomethacin in mice.  Pharmazie 2001;56(1):89-91.)(Rosland JH. Pharmacol Toxicol 1990;66(5):382-6.)(Boell R, Rubin J.  Benzodiazepines – contraindicated in the patient with chronic pain. SAMJ 1991 Jul;80:59.)(Ito K, et al.  Midazolam attenuates the antinociception induced by d-serine or morphine at the supraspinal level in rats.  Eur J Pharmacol. 2008 May 31;586(1-3):139-44.)(King SA.  Chronic pain control: What’s adequate – and appropriate?  10 Questions physicians often ask.  Consultant.  2011 Sept;51(9):605-617.)