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"Pain remains one of the most undertreated ailments in society and very often pain complaints are swept under the rug," says Mark Allen Young, M.D., a physical medicine and rehabilitation specialist in Baltimore, author of Women and Pain and former editor-in-chief of the Journal of Practical Pain Management. That's because both doctors and patients tend to dismiss pain as the natural result of an injury or illness, which will end when they recover.
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But keeping a stiff upper lip can be disastrous: Recent studies show that pain that lingers untreated for more than three months can actually change the hard wiring in the brain, triggering permanent changes in the way the body responds to pain signals. This both intensifies the experience of pain and risks making the condition chronic. "If pain is not nipped in the bud with aggressive treatment, it becomes much more difficult to treat," Dr. Young says.
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Fortunately, a growing number of doctors recognize that pain is a debilitating medical condition in itself and sometimes must be treated separately from what triggered it What's more, some insurance companies may cover the costs of pain-management programs. And in California, to get their license renewed, physicians need to take a course in pain management, which enhances their ability to keep acute pain from becoming chronic.
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If you sense that you might be developing a chronic pain problem that your current pain regimen hasn't been able to stave off, start by asking your primary-care physician to refer you to a pain specialist or clinic. If your doctor doesn't know one, look for a pain-treatment center at local hospitals or medical centers.
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Although there is not one magic pill that will vanquish acute, recurrent or chronic pain, doctors now have a broad array of options that blend alternative therapies with traditional medicine. "We can't cure chronic pain," says Anthony H Guarino, M.D., a pain management specialist at the Washington University School of Medicine, in St. Louis, "but we can manage it and greatly improve a patient's quality of life."
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How Pain Can Become Permanent
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Once the wiring of the nervous system changes in response to prolonged pain, "the pain you feel doesn't correspond to what is going on in your body," says James N. Dillard, M.D., a rehabilitation medicine specialist in New York City and author of The Chronic Pain Solution. A few become so hypersensitive that even the slightest touch or vibration can be excruciating. "Fifteen years ago, people who had these complaints were sent to psychiatrists," says Dr. Dillard. "But now we know that the nervous system is very adaptable, and that the pain pathways can ramp up and amplify the signals."
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Every person has a unique susceptibility to pain. Some people can be seriously hurt yet recover quickly, while others are incapacitated by a relatively minor mishap. "People may be genetically predisposed, or a past history of injuries may make them more susceptible," says Linda LeResche, Sc.D., an epidemiologist and professor at the University of Washington in Seattle.
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Unrelenting pain can erode health and age people prematurely. The release of stress hormones in reaction to pain weakens the immune system, which compromises our ability to fight disease, A year or more of chronic pain can cause brain shrinkage that's 5 to 11 percent beyond what normal aging would take away, according to a 2004 Northwestern University study. Researchers suspect that the cumulative stress of coping with pain wears out brain nerve cells. "The long-term damage can trigger a self-perpetuating cycle of pain, making the condition more intractable," says A. Vania Apkarian, Ph.D., a pain specialist at the Northwestern University Feinberg School of Medicine, in Chicago.
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Chronic pain also spawns an escalating cascade of psychological and emotional problems. Pain sufferers can't sleep, which makes them irritable, anxious, and depressed. One-third report they can't function normally and sometimes feel so bad they want to die.
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To view information on another disease, click on SOD and Pancreatitis Library, or continue on with me in our study of Chronic or Recurrent Pain.
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