Chronic Pain

[Guest guest]

Chronic

Pain In America:

Roadblocks To Relief

Conclusions

Important

Note

Throughout

this report 'chronic pain sufferers' are individuals with moderate to severe

chronic pain.

Size

of the chronic pain population segment

It

is estimated that 9% of the U.S. adult population are suffer from moderate to

severe non-cancer related chronic pain.

What

is the nature of this pain?

Chronic

pain as defined by this study is a severe and ever present problem. It can be

as much of a problem to middle age adults as seniors and is one women are more

likely to face than men. The majority of chronic pain sufferers have been

living with their pain for over 5 years. Although the more common type is pain

that flares up frequently versus being constant, it is still present on average

almost 6 days in a typical week.

About

one third of all chronic sufferers describe their pain as being almost the

worst pain one can possibly imagine. Their pain is more likely to be constant

than flaring up frequently and two-thirds of them have been living with it for

over 5 years.

Can

they get their pain under control?

Just

over one-half of chronic pain sufferers say their pain is pretty much under

control. But, this can be attributed primarily to those with moderate pain. The

majority of those with the most severe pain do not have it under control and

among those who do, it took almost half of them over a year to reach that

point. In contrast, 7 of every 10 with moderate pain say they have it under

control and it took the majority less than a year to reach that point. Pain can

become more severe even when it is under control. Among those with very severe

pain, 4 of every 10 said their pain was moderate or severe before getting their

pain under control.

What

is the impact of their pain on their quality of life?

Untreated

pain or pain not under control has a significant unfavorable impact on the

sufferer's quality of life. It affects their ability to concentrate, do their

job, exercise, socialize, get a good night's sleep, do leisure time activities,

perform chores around home and have sex. The impact emotionally is also

significant. Untreated pain or pain not under control makes people more

depressed, irritable, listless and feeling useless and unable to cope.

Overall,

when pain comes under control there is significant improvement in what they can

do and how they feel. There is an exception to this. Those with severe or very

severe pain still have a significantly less favorable quality of life and

emotional well-being than is the case among moderate pain sufferers.

How

effective is the medical profession in meeting the need for pain relief?

Almost

all chronic pain sufferers have gone to a doctor for relief of their pain at

one time or another. Almost 4 of every 10 are not currently doing so, since

they think either there is nothing more a doctor can do or in one way or

another their pain is under control or they can deal with it themselves.

This

is not the case with those having very severe pain; over 7 of every 10 are

currently going to a doctor for pain relief. In addition, significant numbers

of those with very severe pain are significantly more likely to require

emergency room visits, hospitalization and even psychological counseling or

therapy to treat their pain.

A

significant proportion (over one-fourth) of all chronic pain sufferers wait for

at least 6 months before going to a doctor for relief of their pain because

they underestimate the seriousness of it and think they can tough it out.

Chronic

pain sufferers are having difficulty in finding doctors who can effectively treat

their pain, since almost one half have changed doctors since their pain began;

almost a fourth have made at least 3 changes. The primary reasons for a change

are the doctor not taking their pain seriously enough, the doctor's

unwillingness to treat it aggressively, the doctor's lack of knowledge about

pain and the fact they still had too much pain. This level of frustration is

significantly higher among those with very severe pain where the majority have

changed doctors at least once and almost of every 3 have done it 3 or more

times. Their primary reason for changing was still having too much pain after

treatment.

Doctors

are not a major barrier when a patient asks for a medicine they saw or heard

about; in the majority of instances the doctor prescribes it. Similarly, in the

majority of instances when a sufferer has been referred to a program or clinic

for relief, in the great majority of referrals their managed care or workman's

comp program permitted access.

What

medicines do they perceive to be effective in providing relief and what are

they taking for their pain?

The

majority of chronic pain sufferers believe that OTCs, narcotic pain relievers

and prescription NSAIDs can be effective in relieving moderate to severe pain.

Those with moderate pain are the most likely to say this about OTCs, while

those with very severe pain are most likely to say this about narcotic pain

relievers.

The

more common medicines used for chronic pain are OTCs and Rx NSAIDs regardless

of pain severity. However, among those with very severe pain the current use of

narcotic pain relievers almost equals that of Rx NSAIDs.

Among

those ever using them, narcotic pain relievers are rated significantly higher

in providing pain relief than other medicine types among their respective

users. Concerns about addiction and side effects, not stigma, are barriers to

wider usage.

What

role do non-medicinal therapies play?

Medical

therapies are not providing sufficient relief, since the majority of chronic

pain sufferers, especially those with severe pain, have also turned to

non-medicinal therapies. The primary one is a hot/cold pack. Surprisingly,

almost all of the major non-medicinal therapies currently used are perceived as

providing more relief by their users than OTCs, the most widely used medicines;

the one exception are herbs/dietary supplements/vitamins which are perceived as

offering the least amount of relief than any medicines or other major

non-medicinal therapies.

The

overall favorable perceptions of non-medicinal therapies are driven by those

with moderate pain. Although those with very severe pain are more likely to use

them, they have a significantly lower opinion of their efficacy versus

medicinal therapies.

A

small, but significant, percent of chronic pain sufferers have at one time or

another turned to alcohol for relief; this occurred more often among middle age

adults and men.

Are

dosage regimens a problem?

The

majority take their medicine at the times prescribed by their doctor and

relatively few have a problem in doing so. This is more the case with moderate

pain sufferers than among those with more severe pain. This occurs because

those with moderate pain are taking their medicine fewer times a day and fewer

pills a day than those with the most severe pain.

Among

those who do not follow their doctor's dosage regimen, there is a strong

feeling of wanting to control the amount of medicine they take and only take it

when needed. This carries over to their concept of the ideal regimen.

Is

the delivery system a problem?

Almost

all chronic pain sufferers take their medicine in pill form and the great

majority believe the pill form is the ideal way. This preference can be

attributed in part to the fact that few have had experience with alternate

methods of taking medicine. Also, there is an underlying desire to be able to

control the amount of medicine they take, especially a predisposition to take

medicine only when needed.

Are

chronic pain sufferers receiving universal support?

As

to be expected, chronic pain sufferers report that their closest family members

and friends provide very strong positive support. Doctors are perceived as

being equally supportive taking into account their different relationship with

patients; however, among those employed, there is the perception that their

employers are significantly less supportive.

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[Guest guest]

Chronic pain. Pain that goes from bad to worse to unbearable. Pain that lives with you every day of your life, never ceasing, not even long enough to get a night's sleep, is one of the worst things about having lupus.Because lupus primarily affects women, I found it interesting that the National Institute of Health noted that women report more severe and chronic pain than men, and urged doctors to factor sex into diagnosing, treating, and researching chronic pain management. (JAMA, 280:120-124. 1988)The NIH Revitalization Act of 1993 mandated that women and minorities be included in clinical research. Previously, pain research had been male-oriented because of (get this) "The alleged rationale has been that the estrus cycle in women would confuse the results."It may be true that women react to pain differently than men do. Dr. Lesche of NIH states, "Pain may arise in women with differences in anatomy or physiology of neural systems, perception of pain, and the cognitive and emotional ways of dealing with pain." If pain may "arise" in women, then more research is needed focusing solely on chronic pain in women! Simply ignoring women's pain is not a viable solution, and more therapies for the relief of chronic pain must be found.The first line of defense against chronic pain in inflammatory diseases like lupus and arthritis has always been pharmacological. Non-steroidal anti-inflammatories (also called NSAIDs) such as aspirin and ibuprofen (Advil or Motrin) have been used to treat mild cases with success. For more intense pain that does not respond to NSAIDs, narcotic analgesics, such as demerol and morphine may be used. However, for some patients with chronic pain, the addictive effects of narcotics may be too much for them to be used on a long-term basis.This is where alternative therapies have stepped in. Pain relieving techniques like hypnosis and magnetic stimulation therapy have given patients a non-medicinal alternative that may be more beneficial in the long term.Dr. P. Logue, of Duke University Medical Center's Department of Psychiatry and Behavioral Sciences, made some statements regarding hypnosis: "It is known that a patient's cognitive and emotional state can influence their physiological system. Changes in their physiological state can affect their overall function. This intimate mind/body relationship can be used to treat painful states via hypnosis. Enhancing the nervous systems inhibitory process can modify pain...Hypnosis can induce a state of relaxation, calmness and peacefulness, even in the midst of external distress. This temporary state of calm can effectively reduce a patient's subjective experience of pain." Dr. Logue also stated, "Why would any clinician want to use a procedure that must be explained and justified to the 'outside' world? Because it works. Not always in a spectacular fashion, not with every patient, and not with every condition, but it does work." (NC Medical Journal, 53[3]:176-179, 1988.). In NIH studies, 75-80% of patients had a positive reaction to hypnosis.Another fairly new type of therapy for chronic pain is magnetic stimulation. According to Dr. J. Pujol of the Magnetic Resonance Center of Pedralbas in Spain, a study using magnetic stimulation to localized pain reduced pain 29 (out of 101) points in patients. In a sham situation, patient's pain was only reduced 8 points. In a test using a sham stimulation, and then using magnetic stimulation, patient's perception of pain dropped 30 points after magnetic stimulation. The effects can last up to a few days, as opposed to a few hours for medicinal therapies. (NeuroReport 9[8] 1745-1748, 1998.)Perception of pain is as individual as each person. What works for one person may not work for another. It may be helpful for the person living with chronic pain to experiment with different therapies. It is advisable to start with the least invasive, or least expensive, therapies and go on from there. Try using ice packs before taking medication, and try medication before seeing a surgeon. The main thing to remember is that no one needs to suffer needlessly, and to keep looking until you find the pain relief that works for you!

[Guest guest]

Chronic pain. Pain that goes from bad to worse to unbearable. Pain that lives with you every day of your life, never ceasing, not even long enough to get a night's sleep, is one of the worst things about having lupus.Because lupus primarily affects women, I found it interesting that the National Institute of Health noted that women report more severe and chronic pain than men, and urged doctors to factor sex into diagnosing, treating, and researching chronic pain management. (JAMA, 280:120-124. 1988)The NIH Revitalization Act of 1993 mandated that women and minorities be included in clinical research. Previously, pain research had been male-oriented because of (get this) "The alleged rationale has been that the estrus cycle in women would confuse the results."It may be true that women react to pain differently than men do. Dr. Lesche of NIH states, "Pain may arise in women with differences in anatomy or physiology of neural systems, perception of pain, and the cognitive and emotional ways of dealing with pain." If pain may "arise" in women, then more research is needed focusing solely on chronic pain in women! Simply ignoring women's pain is not a viable solution, and more therapies for the relief of chronic pain must be found.The first line of defense against chronic pain in inflammatory diseases like lupus and arthritis has always been pharmacological. Non-steroidal anti-inflammatories (also called NSAIDs) such as aspirin and ibuprofen (Advil or Motrin) have been used to treat mild cases with success. For more intense pain that does not respond to NSAIDs, narcotic analgesics, such as demerol and morphine may be used. However, for some patients with chronic pain, the addictive effects of narcotics may be too much for them to be used on a long-term basis.This is where alternative therapies have stepped in. Pain relieving techniques like hypnosis and magnetic stimulation therapy have given patients a non-medicinal alternative that may be more beneficial in the long term.Dr. P. Logue, of Duke University Medical Center's Department of Psychiatry and Behavioral Sciences, made some statements regarding hypnosis: "It is known that a patient's cognitive and emotional state can influence their physiological system. Changes in their physiological state can affect their overall function. This intimate mind/body relationship can be used to treat painful states via hypnosis. Enhancing the nervous systems inhibitory process can modify pain...Hypnosis can induce a state of relaxation, calmness and peacefulness, even in the midst of external distress. This temporary state of calm can effectively reduce a patient's subjective experience of pain." Dr. Logue also stated, "Why would any clinician want to use a procedure that must be explained and justified to the 'outside' world? Because it works. Not always in a spectacular fashion, not with every patient, and not with every condition, but it does work." (NC Medical Journal, 53[3]:176-179, 1988.). In NIH studies, 75-80% of patients had a positive reaction to hypnosis.Another fairly new type of therapy for chronic pain is magnetic stimulation. According to Dr. J. Pujol of the Magnetic Resonance Center of Pedralbas in Spain, a study using magnetic stimulation to localized pain reduced pain 29 (out of 101) points in patients. In a sham situation, patient's pain was only reduced 8 points. In a test using a sham stimulation, and then using magnetic stimulation, patient's perception of pain dropped 30 points after magnetic stimulation. The effects can last up to a few days, as opposed to a few hours for medicinal therapies. (NeuroReport 9[8] 1745-1748, 1998.)Perception of pain is as individual as each person. What works for one person may not work for another. It may be helpful for the person living with chronic pain to experiment with different therapies. It is advisable to start with the least invasive, or least expensive, therapies and go on from there. Try using ice packs before taking medication, and try medication before seeing a surgeon. The main thing to remember is that no one needs to suffer needlessly, and to keep looking until you find the pain relief that works for you!

[Guest guest]

Chronic pain. Pain that goes from bad to worse to unbearable. Pain that lives with you every day of your life, never ceasing, not even long enough to get a night's sleep, is one of the worst things about having lupus.Because lupus primarily affects women, I found it interesting that the National Institute of Health noted that women report more severe and chronic pain than men, and urged doctors to factor sex into diagnosing, treating, and researching chronic pain management. (JAMA, 280:120-124. 1988)The NIH Revitalization Act of 1993 mandated that women and minorities be included in clinical research. Previously, pain research had been male-oriented because of (get this) "The alleged rationale has been that the estrus cycle in women would confuse the results."It may be true that women react to pain differently than men do. Dr. Lesche of NIH states, "Pain may arise in women with differences in anatomy or physiology of neural systems, perception of pain, and the cognitive and emotional ways of dealing with pain." If pain may "arise" in women, then more research is needed focusing solely on chronic pain in women! Simply ignoring women's pain is not a viable solution, and more therapies for the relief of chronic pain must be found.The first line of defense against chronic pain in inflammatory diseases like lupus and arthritis has always been pharmacological. Non-steroidal anti-inflammatories (also called NSAIDs) such as aspirin and ibuprofen (Advil or Motrin) have been used to treat mild cases with success. For more intense pain that does not respond to NSAIDs, narcotic analgesics, such as demerol and morphine may be used. However, for some patients with chronic pain, the addictive effects of narcotics may be too much for them to be used on a long-term basis.This is where alternative therapies have stepped in. Pain relieving techniques like hypnosis and magnetic stimulation therapy have given patients a non-medicinal alternative that may be more beneficial in the long term.Dr. P. Logue, of Duke University Medical Center's Department of Psychiatry and Behavioral Sciences, made some statements regarding hypnosis: "It is known that a patient's cognitive and emotional state can influence their physiological system. Changes in their physiological state can affect their overall function. This intimate mind/body relationship can be used to treat painful states via hypnosis. Enhancing the nervous systems inhibitory process can modify pain...Hypnosis can induce a state of relaxation, calmness and peacefulness, even in the midst of external distress. This temporary state of calm can effectively reduce a patient's subjective experience of pain." Dr. Logue also stated, "Why would any clinician want to use a procedure that must be explained and justified to the 'outside' world? Because it works. Not always in a spectacular fashion, not with every patient, and not with every condition, but it does work." (NC Medical Journal, 53[3]:176-179, 1988.). In NIH studies, 75-80% of patients had a positive reaction to hypnosis.Another fairly new type of therapy for chronic pain is magnetic stimulation. According to Dr. J. Pujol of the Magnetic Resonance Center of Pedralbas in Spain, a study using magnetic stimulation to localized pain reduced pain 29 (out of 101) points in patients. In a sham situation, patient's pain was only reduced 8 points. In a test using a sham stimulation, and then using magnetic stimulation, patient's perception of pain dropped 30 points after magnetic stimulation. The effects can last up to a few days, as opposed to a few hours for medicinal therapies. (NeuroReport 9[8] 1745-1748, 1998.)Perception of pain is as individual as each person. What works for one person may not work for another. It may be helpful for the person living with chronic pain to experiment with different therapies. It is advisable to start with the least invasive, or least expensive, therapies and go on from there. Try using ice packs before taking medication, and try medication before seeing a surgeon. The main thing to remember is that no one needs to suffer needlessly, and to keep looking until you find the pain relief that works for you!