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January 21, 2014

Chronic Pain: New Research, New treatments

Excerpts from WebMD talks to Scott M. Fisherman, MD, president of the American Pain Foundation                                        

By Michael W. Smith, MD

WebMD the magazine – Feature, reviewed by Brunilda Nazario, MD

As recently as 20 years ago, people with chronic pain were too often dismissively told the problem was ‘in their heads’ or that they were hypochondriacs. But in the last decade, a handful of dedicated researchers learned that chronic pain is not simply a symptom of something else, such as anxiety, depression, or a need for attention, but a disease in its own right. A disease,  that can alter a person’s emotional, professional, and family life in profound and debilitating ways. Today, doctors have yet to fully apply this knowledge.

Some 50 million Americans suffer from chronic pain, and nearly half have trouble finding adequate relief. But the outlook is good: Among other things, research is revealing the promise of effective novel treatments such as acupuncture, biofeedback, and an all-encompassing mind/body approach.  The point? If patients’ whole lives are affected by pain, the treatment must address their whole lives.

The following contains excerpts from an interview with Scott M. Fisherman, MD, president of the American Pain Foundation, conducted by Michael W. Smith, MD.      

Q: About chronic pain: have researchers learned anything new about the origins of chronic pain that might lead to better diagnosis or treatment?

A: Absolutely. We’ve learned a great deal about how pain is produced and transmitted and perceived. Fifty years ago, when someone hurt, we thought it was just a symptom of something else. But we now know the symptom of pain can become a disease in and of itself, and that disease is similar to other chronic conditions that can damage all aspects of someone’s life.

New information has emerged in the last 10 years from one of the most active areas of pain research, neuroimaging. Functional MRI (magnetic resonance imaging) scans that look at brain activity when it’s in pain or when it’s receiving a pain reliever now tell us that when someone is in chronic pain, the emotion centers of the brain are more activated than the brain’s sensory centers, which are more involved in acute, not chronic, pain. That’s why pain is likely an emotional experience.

Q: How can these chronic pain discoveries effectively help patients?

A: We need to use the full treatments available, not just drugs and surgery but mind/body, alternative, and psychological therapies as well.

Usually, a person in chronic pain is not just suffering from one perspective. One has to understand what pain does. We’re designed so the alarm of pain grabs our attention and we prioritize that over other things. When your attention is absorbed and you can’t attend to all the other things that are meaningful in your life, a downward cycle sets in.

Say a person has a painful arm; before long, he may not be able to sleep, may not be able to exercise, and may become de-conditioned. This may lead to arthritis problems or obesity or sexual inactivity and a deterioration in his intimate relationship. He no longer can support his family. He becomes depressed and anxious and ultimately may become suicidal. Chronic pain undermines all aspects on quality of life.

Therefore, we have to attack the problem from more than one perspective. Often the patient in pain needs to be treated both medically and psychologically, socially and culturally. That’s really what I would call a holistic approach, not an alternative approach, one that addressed the whole person.

Q: What new chronic pain treatments are you excited about?

A: One has to do with teaching patients how to overcome their pain. We know that the human mind can create pain, but it also has enormous power to take it away; we can teach people skills that were known to Buddhists hundreds or thousands of years ago.

I tell my patients that pain psychologists are really coaches. They’re not there to diagnose an illness, but to help you learn techniques to use your brain better, just like you would go to a physical therapist to learn techniques to use your body better. It’s the same thing.

Q: You’re describing a mind/body way of dealing with chronic pain.

A: Yes. You can’t have pain without a mind, so it’s all connected. My patients are always afraid I’m going to think their pain is all in their head, and they have a mental illness rather than a physical illness, and ignore the real problem. I try to counsel them that it’s quite the opposite, that any pain requires a mind and you can’t have pain without a head; so recognizing that opens up all sorts of opportunities to help cope and reduce suffering.

I think of mind/body approaches as techniques that tap into the body’s own pharmacy. Things like mindfulness and biofeedback and cognitive behavioral retraining, or guided imagery, even hypnosis. Things like acupuncture and massage.

Q: About pain medication, are doctors being better educated about this in medical school?

A: Pain is the most common reason a patient goes to a doctor, and sadly, we train doctors, clinicians, and nurses very little on pain or pain care. We now recognize that we have a public health crisis of untreated pain, but we also have a public health crisis of prescription drug abuse. Some doctors overprescribe and some feel they [painkilling drugs] should never be prescribed. Frankly, neither of those situations should be allowed to exist and wouldn’t exist if doctors were trained up front.  They may be well trained today, but only marginally so, and we need to bring education back to the medical school and to practicing physicians as well.

Q: What about supplements for chronic pain? What works?

A: Supplements are interesting, and several do seem to help. Fish oils, for example, have omega-3 fatty acids, which have potent anti-inflammatory effects as well as other health benefits.

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