A SALVE FOR AMERICA'S CHRONIC PAIN?: Despite prevalent pain across the U.S., most treatments have remained the same for decades.
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Chronic pain affects at least one in three adults in the U.S., which is more than the sum total of those with heart disease, cancer and diabetes combined. For many of these 116 million Americans, their pain is severe and eludes available treatments. In addition to the human suffering, the monetary cost of medical treatment and lost productivity has reached $635 billion a year.
The U.S. needs "a cultural transformation" in the way we view pain, treat it and conduct research on its causes and treatments, says a new report released June 29 by the Institute of Medicine (IOM).
Pain can be protective. Acute pain tells us to pull a finger back from a hot stove, stop walking on a blistered foot or allow a fevered body to rest. It is a warning that bodily injury needs attention and time to heal. But when the pain signal continues for an extended period, "it can become a disease in its own right," Philip Pizzo, dean of the Stanford University School of Medicine and chair of the committee that wrote the IOM report said at the news conference where the report was released.
Pain can actually rewire nerve and brain pathways. In much the same way that memories are created, it can become a self-perpetuating loop that continues to feed back on itself long after the original cause for the pain has resolved.
Chronic pain can shrink the volume of the brain's gray matter, the portion of the brain devoted to thought. Researchers speculate that this decrease results in part from a limited pattern of stimulation of circuits that are preoccupied with a continuous pain loop that crowds out other activity. In addition to that, continuously stimulating the pathway releases more of the neurotransmitter glutamate, an excess of which can be toxic.
The IOM's new report describes chronic pain as a major public health challenge and one that requires aggressive action and a more comprehensive strategy.
The U.S. Department of Health and Human Services should develop "a public population-based approach to dealing with pain as the singularly important integrating factor," Pizzo said. That includes boosting education for doctors and patients, improving research efforts to discover the various roots of chronic pain, and helping government agencies work together better to ensure that people can get access to medications that they need—as well as improve the odds that new ones will be available in the future.
A variable condition
One major challenge of understanding and treating pain is its huge variability. In working with mice, researcher Jeffrey Mogil, at McGill University's Pain Genetics Lab, has found that the response to pain can vary tremendously by breed and by gender. Some of those differences also have been observed in humans. Caucasians appear to be more tolerant of pain than those of African descent. And it is now well established that women on average are more sensitive to pain than are men, although they also have better coping mechanisms for acute pain such as the estrogen receptor–based response that kicks in during childbirth.
Individual differences also are reflected in wide range of responses to painkilling medicines. The treatment of pain has turned out to be one of the most variable and idiosyncratic of all of the fields of medicine, with perhaps hundreds of genes influencing a person's pain reaction and response to therapy.
These factors reinforce the fact that "care for pain begins with the individual and recognizes that it is broadly undefined and that there is no single prescription for dealing with pain," Pizzo said, adding that because of these vast difference, it is also largely self-managed. And as the report committee found, there is a distinct shortage of data about how people in different demographic groups might experience pain, access treatment and respond to it.
Treatment
Pain often has taken a backseat to more observable and quantifiable physical ailments in medical practice and training. "In medical education pain generally has received little attention, which has contributed to the problem of undertreatment," the authors of the new report noted. "The need for improved education about pain is especially acute for primary care providers, the front-line clinicians for most people's acute or chronic pain problems." The report says only five of the nation's 133 medical schools have required courses on pain, and just 17 offer such courses as an elective.
Opioids carry a risk for addiction and abuse, which has drawn the attention of law enforcement and led to investigations and prosecutions that some physicians and patients say has inhibited access to effective pain relief.
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20 Comments
Add CommentOne thing the government could do is loosen up the screws on medical marijuana use. Its use has been proven to ease the symptoms of a number of debilitating diseases. But with the head-up-the-butt attitude of our political hacks and bureaucrats, true research on the use of medical pot is virtually impossible. I don't think the government will fund any marijuana study unless the group guarantees beforehand that their conclusions will show that any use of pot is harmful. Some years ago, I read about a study that "proved" that continual use of marijuana caused hypertension. Towards the end of the article, they mentioned that the subjects of the study did not actually smoke pot, but got doses of THC. And they mentioned that the daily doses were the equivalent of smoking, and I quote, "thity San Francisco size joints per day". Now where's any since of reality here? Thirty joints per day? It seem that the bureaucrats who make the governmental decisions on marijuana are still relying on sources like Reefer Madness for their information on the weed.
Reply | Report Abuse | Link to thisXoxcatpl -- Big Tobacco and Big Pharma, which, among several other multi-billion dollar corporations, run more and more of our government daily, fight very hard to ensure we will never see the use of Medical Marijuana -- maily because it's cheap (you can grow it yourself for peanuts) and it truly works, with fewer side effects than anything made in a laboratory -- and is much safer than cigarettes could ever possibly be.
Reply | Report Abuse | Link to thisIn fact, the only thing keeping this country from it's acceptance is that Medical Marijuanna doesn't spend billions on TV advertising -- because there is no BIG Medical Marijuanna corporation.
Thnk about it -- if you could make aspirin in your bathtub, Beyer would still be a mom and pop shop in Berlin.
"a cultural transformation" in the way we view pain is the key. Chronic pain is insidious, invisible, debilitating and widespread. Those suffering from it are treated as if their life draining conditions are just a trivial nuisance. They are perceived to be complainers or perpetrating a 'scam', denied disability and handed addictive narcotics as a treatment. One of modern medicines complete failures.
Reply | Report Abuse | Link to thisGrovewest: " One of modern medicines complete failures."
Reply | Report Abuse | Link to thisWrong. I'm in my 50's and keep very fit. I have one pain issue that my neurologist has helped me cope with quite well. Otherwise life would be hell.
Hundreds of millions of people receive pain relief from modern medicine. Everything from a tooth abscess to gout to hernias to bad knees to 'whatever'
There is a growing body of evidence of drag-free treatments effectiveness.
Reply | Report Abuse | Link to thisThere is hope :)
http://www.sciencedaily.com/releases/2007/09/070910144556.htm
http://www.jneurosci.org/content/31/14/5540
http://www.ncbi.nlm.nih.gov/pubmed/16951585
http://www.ncbi.nlm.nih.gov/pubmed/19073756
and my best one
http://www.openfocustraining.co.uk/exercise.html
This "study" is a disgrace, except for the AMA admitting "they need a new approach". Painkillers are well documented to cause major liver and kidney problems, and only attempts to cure the symptoms, not the cause.
Reply | Report Abuse | Link to thisChiropractic is the only major doctrine that attempts to address the causes, NOT the symptoms.
My parents practiced Chiropractic from 1941-1993, and documented, along with others, that 70% of their practice was of orthodox medicine's failures. My brother, now in his 30th year in practice believes that percent has dropped slightly to about 60%.
In the 1980's the AMA was found guilty under the Rico Act in the Chicago US Appeals Court for abusing their power to discredit Chiropractic, and paid a fine of millions of US$.
Yes, absolutely, they need a new approach... to address the root causes... as Chiropractic has done for circa 115 years. Finding new "painkillers" will never address the causes
Mentioning pain relief without mentioning cannabis in this context is nothing short of perverse. Cannabis is the most effective medicine for chronic pain, bar none; the evidence is in... marijuana is non-toxic, non-addictive, aids the destruction of damaged cells, protects neurons from damage and the indica strains of the plant are perfect for relieving chronic pain. Experienced users are able to function perfectly well and endocannabinoids are involved in the control of all mammalian body systems: supplementing the natural function of cannabinoids in our bodies is clearly the way forward & Scientific American is a joke for not mentioning cannabis in this article!
Reply | Report Abuse | Link to thischiropractics cure only certain pains though; cannabis on the other hand dulls the reception of pain at the source, alters the transmission of pain to the brain, and dulls the perception of pain in the brain... it supplements the bodies endocannabinoids (which are massively important regulators) with the phytocannabinoids it produces. Cannabis is the best treatment for chronic pain; chiropractors can not 'massage the brain', like marijuana does, although they can help with certain muscle aches (even watching massage can help relieve pain a little bit!)
Reply | Report Abuse | Link to thisHave you got any evidence to back up your claims? Why don't you point us to a few studies supporting the effectiveness of chiropractic so that we can evaluate your opinion?
Reply | Report Abuse | Link to thisCannabis is simply another brand of "Snake Oil" that does nothing to address the root cause of the problem. It may be the best, safest, etc etc, but is does nothing for the cause.
Reply | Report Abuse | Link to thisOnly serious attempts to address the cause, can result in long term relief without serious side effects. I hope this is/will be the AMA's "New Approach"
Colllateral damage is putting it mildly. The DEA's use of Gestoppo tactics such as threating physicians with jail if they do not surrender their DEA number on the spot when if The DEA had any real grievance they could just suspend or take the DEA number and the physician's prescription writing priledges without such coersion. When a physican surrenders his DEA number he never gets it reinstated. If the Dr. cannont write for controlled substances he is effectively out of business and cannont earn a living practicing medicine. Add to this, the DEA uses these same tactics on the wholesale drug distributors and terrroize pharmacists and State Pharmacy Boards as well as State Medical Boards and patients. It is like Nazi Germany.
Reply | Report Abuse | Link to thisWhat ultimately happens is that pain patients whether they are cancer patients, HIV patients, Chronic pain patients and others cannont obtain their pain medicine legally they go to the black market; making them criminals. This process also creates more IV drug abuse leading to more HIV patients and more heroine addicts and more crime. And who is subsidising the Poppy Fields in Afganistan...the United States Government. What a coincidence. The DEA fuels the illegal drug business creating more jobs in the government.. the judges get paid as do the jailers, the policemen, the jails (it cost the taxpayer about $45K to house someone in jail for one year), the juries, the parole officers, the probation officers, the court clerks, the ballif, the court reporter, on and on and on.
Why bother with internatonal drug enforcement when the US government can milk the American public. Americans have the money to pay for all of these peoples salary. What war on drugs. It is a $100 billion a year business just on the enforcement side and another $100 billion a year business on the criminal side. Who cares whether or not someone is in pain and suffering. Let's pursecute the sick and after the government has all of their money put them in jail and milk the taxpayer. Let's create more criminals. There ore over a million americans in jail for drug related offenses. Which of these were created by the DEA.
The report was issued by the Institute of Medicine; the AMA had nothing to do with it.
Reply | Report Abuse | Link to thisWell said.
Reply | Report Abuse | Link to thisI was involved in pain research in the 1980 and later and recall the same comments about the state of pian research. They have learned some interesting things since then but little new is shared with medical students except the old attitudes toward the chronic pain patient. They then decried the lack of pain management being taught in medical schools just as today, 25 years later. Unfortunately they have learned relatively little that can be applied clinically and no wonder. The major barriers to pain knowledge are the attitudes toward pain patients, the easy quick, and often disasterous remedy of a narcotic script, and lack of both basic and applied research. And in particular, as noted by the IOM report, lack studying the individual patient in his/her cultural and genetic context and understanding the concept multiple variables interacting.
Reply | Report Abuse | Link to thisThe signs of Vicodin addiction may be difficult to identify as they are closely related to other problems like mental illness or improper pain control. There are however as we mention Findrxonline in your blog certain signs which doctor looks for to identify addiction of Vicodin. One of these signs is "doctor shipping" where one shifts from one doctor to the other to obtain several vicodin prescriptions. People also start using Vicodin for reasons other than medical ones. Other than these, people repeatedly ask for early refill of the dosage in case of addiction. They also make excuses of their prescription being lost and also ask doctors for extra prescriptions due to vacation plans or some other reasons. People continuously use Vicodin despised losing their job and facing many kinds of family problems as well due to its addiction.
Reply | Report Abuse | Link to thisWhy is there no mention of CES (cranio electrical stimulation) which is approved by the FDA for efficacy and safety for treating pain, as well as depression and insomnia, which are often concomitant complaints. Approved devices like Alpha-Stim are effective in numerous pain syndromes, some of which are resistant to opiods and analgesics, have no significant adverse reactions or potential for dependency, and may also potentiate the effects of pain medications, chiropractic and other approaches to treat pain. CES is also more cost effective than opiates and much safer. These claims are supported by numerous publications in peer-reviewed journals.
Reply | Report Abuse | Link to thisThe chiropractic profession, unlike big pharma, does not have the deep pockets for long term studies. There are growing numbers though. You may be surprised to know that PTs are learning how to adjust now, in order for them to get a DPT. It doesn't work for everyone, just like big pharma, but we let people know this. In many instances the pain is the result of a long held habit that the patient refuses to change or that the repetitive stress of the activity has progressed to the point that the degeneration cannot be reversed and a more invasive approach is needed. Chiropractic works in the majority of cases when the patient co-operates and follows the protocol supplied. You can't just pop a pill and expect true health.
Reply | Report Abuse | Link to thisToo much is made of external chemical treatments without working the internal system. As a Physical Therapist our profession has made some strides in finding ways into chronic pain's cycles and the mental changes it brings to our clients.
Reply | Report Abuse | Link to thisA very good book to peruse: "Explain Pain"
Why is it that perhaps the most serious complication of chronic pain is completely ignored: FALLS with serious injuries. And don't blame medications for making pain sufferers drunk because falls happen in people who are not on medication! That is like trying to blame a car accident on ice when it occurs in Death Valley CA!
Reply | Report Abuse | Link to thisDDon;t blame the falls on age because they happen in people in their 30s, 40s, and 50s.
They happen suddenly and without warning and are probably the result of hyperactive reflexes triggered by the pain.
Patients feel too embarrassed to talk about them unless the doc opens the door. (Funny thing, it is now recommended that docs ask their older patients if they have fallen in order to find out more about the risks of falling. Same standard should apply to all patients with a chronic disease as well!) Maybe docs are too busy, or maybe they are too afraid to get involved in the real medical care of a chronic pain patient. (After all, earlier comments have described the terror invoked by the DEA and other regulators. Believe me, my colleagues are AFRAID of treating pain sufferers with anything more than a pat on the head and an OTC like ibuprofen.)
Enough said, the people who suffer from invisible intractable incurable daily chronic pain know what I am talking about. The real problem is that medical community is blind and deaf to the frequency of falls and injuries.
By the way the report from the Institute of Medicine did not even mention falls as a serious complication of chronic pain. Makes me wonder how much they really understand, other than text book tidbits.
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