According to the CDC, there are approximately 50 million people in the US living in chronic pain. We all know about the opioid crisis, and this knowledge has done nothing to help alleviate pain many are suffering. While we may all prescribe these addicting medications less often, opioids are rarely indicated to treat chronic pain anyway.
We Aren’t Doing a Good Job
As a medical profession, we are not doing a good job managing chronic pain. Patients are often stigmatized when seeking treatment. Not all patients asking for pain medications are drug seekers. Sure, there are some, but we fail our patients with chronic pain with the knee-jerk reaction of assuming “drug-seeker” when we hear a request for opioids. We should hear what our patients are saying and try to determine the source of their pain.
One of the first problems we need to overcome when treating chronic pain is recognizing that pain is a symptom, not a disease. Instead of instinctively reaching for that prescription pad or e-prescribing tab, we need to ask why the patient is in pain: what is its cause?
Back pain is a common problem we see for which patients are often given medications like NSAIDs or muscle relaxants without a search to determine the underlying etiology. Not so long ago, I saw a patient who saw several doctors and was prescribed medications to treat “sciatica.” Nothing helped the pain. It turned out that he had cancer that had metastasized to his hip bone and once he started cancer treatment, the pain got much better. We need to always be able to answer the question “Why is there pain?”
Managing Expectations
Another hurdle we need to address is unrealistic expectations. Patients see ads for all kinds of things, from CBD oil to Himalayan salt massage, that promise to make them pain free. In reality, they may never become free of pain. The goal should be to maximize function while minimizing pain. We need to help patients understand that this is the attainable goal. Physical and occupational therapy are great tools to reach these goals, and we should be prescribing them. Helping patients make list of goals is also helpful.
The emotional burden of chronic pain is often ignored. It is quite devastating to patients to not be able to do the things they used to. A grandmother no longer able to carry her newborn grandchild because of shoulder pain is horrifying to that patient. We need to treat the mental health consequences that often accompany these diseases.
Pain management doctors and PM&R doctors are also underutilized. These colleagues are experts in the field, and they’re to whom we e should refer patients with complicated or chronic pain. I rarely prescribe opioid pain medications. That doesn’t mean that some e patients may benefit from them. However, I feel they will benefit more from the expertise of someone with more experience in the field.
Broaden the Horizon
We often fail to use all modalities when treating chronic pain. While acupuncture and chiropractic care have little evidence, they are often worth trying to see if the patient will benefit, especially when nothing else has helped.
One of the biggest problems when treating pain is that we just don’t have enough good non-opioid pain medications. When a patient fails NSAIDs or is allergic, there is not much else to prescribe. Pharmaceutical companies need to research new medications that are not addictive.
As the population ages, the problem with chronic pain will only intensify. Older people these days are more active and at a whole slew of injury risks. We need to broaden our understanding of pain and address all the aspects—functional and emotional, as well as physical, symptoms. And we need to be always asking why there is pain, why a treatment is not working, or how we can help the patient increase functioning. With chronic pain, only prescribing medications is not helping our patients.
PWeekly