The human body has an expansive system of early warning detectors that constantly monitor for problems: the nervous system. Much like your home smoke alarm might start screeching at the first wisp of smoke from a burned dinner, nerve endings throughout the body alert us immediately when your hand slips and hits the hyper-hot pan while removing that charred meal from the stove. These pain signals tell you to STOP, which causes you to recoil quickly, hopefully before any lasting damage can be done.
This is how the system is supposed to work, but for many people, especially those who suffer from an autoimmune disease or those who have sustained injury, had surgery or developed a mobility issue, this pain system can go into overdrive and unrelentingly send the pain signals to your brain. This can lead to the development of a condition called chronic pain, and it can put an extreme damper on quality of life for some patients.
[See: On a Scale of 1 to 10: Most Painful Medical Conditions.]
Pain can be classified into two distinct types and it can come from a wide variety of sources. Dr. Asokumar Buvanendran, president of the American Society of Regional Anesthesia and Pain Medicine and an anesthesiologist at the Rush University Medical Center in Chicago, says that acute pain — the sort of feeling you’ll have when you burn your hand on the stove or right after surgery — is of shorter-term duration than chronic pain. Pain that lingers for more than three months is considered chronic pain, and it’s more than just a symptom of an underlying problem.
“You would expect acute pain to resolve over a period of time. If you have surgery — a knee replacement, a hernia repair or breast surgery, for example — you’d expect a recovery pattern to happen in a predictable timeframe. We know when patients should recover and what trajectory they follow over a period of time in the healing process,” Buvanendran says. “But chronic pain generally lasts longer than three months, and these patients, because of the chronic pain condition, have various physiological changes that happen. Chronic pain leads to changes in the hormones, the cardiovascular system and in the brain.”
The Cleveland Clinic reports that “chronic pain can lead to a chronic stress reaction that causes an increase in blood pressure and heart rate. This stress reaction can lead to harmful health effects, such as a reduced ability to fight off illnesses and diseases. It also can increase the risk for conditions such as heart disease.” Chronic pain can also cause profound emotional and psychological changes.
Considering how widely chronic pain can impact the body, Buvanendran says it should be considered an actual disease just like diabetes, hypertension or kidney disease, and not just a symptom. “In the past, it’s always been discussed as a symptom of the problem. But I think it’s important to consider this as a disease.”
In Pain? You’re Not Alone
Chronic pain is a widespread problem affecting millions of Americans, according to research by the National Center for Complementary and Integrative Health published in 2015. Based on data from the 2012 National Health Interview Survey, the NCCIH estimates that 25.3 million adults (11.2 percent of the population) experience chronic pain, meaning they had pain every day for the preceding three months. In addition, an estimated 126 million adults, or 55.7 percent of the population, reported some type of pain in the three months prior to the survey. Women, older adults and non-Hispanics were more likely to report having had pain. The Institute of Medicine puts the estimated number of Americans with chronic pain even higher at 100 million people. So there’s no doubt that a lot of people are dealing with this problem. And when they do, who should they turn to?
You should start with your primary care doctor, Buvanendran says. “He or she knows the patient and hopefully has an established relationship.” Your primary care physician will likely run some tests and then make a referral to the appropriate specialist, just like he or she would if you had a heart problem and needed a cardiologist. “This is no different than for someone with a cardiac problem. You’ll have an EKG before you send them to cardiology from primary care. Patients don’t just jump to a cardiologist,” he says.
[See: 11 Ways to Cope With Back Pain.]
But when your primary care physician makes this referral, you should still find out who you’ll be seeing and what his or her experience is, says Dr. James Lincer, president of the American Board of Pain Medicine, and a physical medicine and rehabilitation physician at Columbia St. Mary’s Hospital in Milwaukee. “You want to ask your specialist, ‘what’s your experience with treating my particular problem?'” This is because there are lots of different types of doctors (anesthesiologists and rehab physicians to name just two) who may treat pain for reasons ranging from cancer and migraines to injury, amputation, arthritis or other diseases. “You’ll also want to ask your specialist, ‘what kind of treatment approaches do you offer?'”
Lincer says one of the tough things about finding the right doctor for pain management is that “pain medicine at this time in this country is fragmented. There’s folks who do interdisciplinary chronic pain management, which has a team approach with physical therapy, occupational therapy, psychology and biofeedback.” Those, he says, are very effective but disappearing because they tend to be more expensive. Therefore, many patients end up with a more interventional approach — having a cortisone injection or a nerve ablation procedure to stop the pain — which he says isn’t always the best approach.
Part of the problem is that there is no primary specialty for pain management yet, something that Lincer hopes will change in the future. In the meantime, there are several subspecialty certificates offered by specialist boards within the American Board of Medical Specialties, including the American Board of Anesthesiology, the American Board of Emergency Medicine, the American Board of Family Medicine and the American Board of Physical Medicine and Rehabilitation. If physicians have a certificate in pain management from a recognized medical board, that may indicate they’ll be better equipped to help you with your condition. Lincer also says his organization, the American Board of Pain Medicine, “offers a broad certification test that I think is much more comprehensive and complete.”
The bottom line is, find out what specific training physicians have had in treating pain and whether their experience is applicable to the particular type of pain you’re experiencing.
Because pain management is an evolving field, Buvanendran says, “I think you’d want someone who’s current in medical knowledge who regularly attends large pain meetings and understands the new, emerging trends and understanding of the physiology and consequences of chronic pain so the patient can be treated appropriately with greater understanding.” For example, Buvanendran is helping organize the 2018 World Congress on Regional Anesthesia and Pain Medicine this April in New York City, the first time the meeting, which is expected to draw 2,500 attendees, will be held in the United States.
Lastly, no discussion of pain management would be complete without at least a brief mention of the opioid crisis. Lincer says it’s a problem that’s evolved from our changing understanding of how to best help people dealing with chronic pain: “The standard of care has changed dramatically in my lifetime.” When he first trained as a rehabilitative physician, Lincer says patients would be admitted to the hospital as an inpatient, where they’d be treated and then gradually eased off opioids while being taught other ways to manage their pain. “Then the pendulum switched,” and opioids became a more common prescription given to patients to take at home. “As doctors, we’re obligated to help them relieve the pain,” and it used to be that doctors could get in trouble for not doing enough to help ease pain. “But then the pendulum has swung back again,” as a result of over-prescription and abuse of these powerful pain killers.
[See: 10 Lessons From Empowered Patients.]
But preserving access to opioids is important for some patients, including advanced stage cancer patients, Buvanendran says. Still, these drugs need to be used carefully in all cases. Talk with your doctor if you have concerns about using opioids, and work with him or her to develop a safe treatment approach.
If you’ve been prescribed opioids, Buvanendran urges patient responsibility in following your doctor’s instructions and in being “very careful about where you keep your medications. These are very important medications,” and if they’re stored carelessly, that can have consequences. What can happen, he says, is “they’re left in cabinets and somebody else takes them and gives them to somebody else. This is where most of the deaths are occurring. So I think it’s very critical that patients take responsibility for that.” He also encourages patients to dispose of unused medications properly for the same reasons.
But not all of the burden falls to the patients “I think there should be patient responsibility, and physician responsibility and also some pharmacist responsibility, checking to make sure they’re dispensing appropriate medications in appropriate quantities,” Buvanendran says.
More from U.S. News
10 Lessons From Empowered Patients
11 Ways to Cope With Back Pain
On a Scale From 1 to 10: Most Painful Medical Conditions
Which Doctor Should I See for Chronic Pain? originally appeared on usnews.com
