December 18, 2014
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There is treatment: What chronic pain sufferers need to know
J. Donald Schumacher

Today and every day, 56 million Americans try to get by in a condition of chronic pain. That’s more than one of every five adults.

Yet in many cases, their suffering is undue. Those with chronic pain often do not receive medication or treatment that could safely alleviate their pain.

The simple truth is that pain today is that pain can be relieved in most cases. Afflicted patients and their families should insist that their healthcare providers control and treat their pain accordingly.

The vast majority of those with chronic pain are not terminally ill. Some suffer from severe back or neck pain or from debilitating migraines. Others may have arthritis, multiple sclerosis, fibromyalgia, shingles, or nerve damage.

The afflicted are of all ages. Those most affected by chronic lower back pain, for instance, are typically between 30 and 50 years old. And chronic pain isn’t just physical. Patients also have to grapple with feelings of despair and isolation.

Despite the scope of the pain epidemic, many doctors are wary of dispensing medication because they fear that patients will become addicted. Some point to the fact that one in five Americans reports misusing a prescription drug at least once in his or her lifetime.

But their fears are overblown. Just 4.5 percent of those without a predisposition toward alcohol or drug addiction who were prescribed painkillers developed a dependency.

Doctors also tend to look at pain as a symptom of an underlying problem – thinking that if they can find and treat that problem, the pain will go away. But according to a recent report from the Institute of Medicine, chronic pain itself can be the problem. Such pain can cause changes in the nervous system that worsen over time – even after the original source of the pain has gone away. Because many doctors are not properly trained in the study of chronic pain, patients often suffer unnecessarily. One study of nursing home residents with chronic pain found that 44 percent were not getting any treatment at all.

In some cases, the need for pain treatment may not be obvious. Older patients, especially those with dementia, often struggle to communicate their needs.

Yet according to a report from the Hartford Institute of Geriatric Nursing at New York University, the burden to communicate with patients who may be in pain does not rest with the patients. Clinicians must take on that duty. They can do so by learning to identify non-verbal behaviors, such as “agitation, restlessness, aggression, and combativeness,” which “are often an expression of unmet needs.” Old age must not become an excuse for the failure to pursue effective treatment for pain.

Of course, patients must assume some responsibility for treating their pain, too. Approximately 50 percent of patients do not take their medication as prescribed. Many mistakenly wait for pain to recur before administering another dose. Such on-again, off-again treatment just results in cycles of pain – rather than preventing it altogether by maintaining adequate levels of medication in the bloodstream.

Patients should also educate themselves about available treatment options and the risks of possible drug interactions. And they must talk candidly with their doctors about their needs and the effects of the treatment they are receiving. Too often, patients settle for a little bit of pain relief when more is possible.

Patients who are not getting adequate relief should ask their doctors about palliative care or availability of pain clinics, where specialists may be able to suggest more effective treatment options. Many patients have benefited from keeping a pain diary to which they and their doctors can refer when devising a treatment regimen.

Whatever the condition causing the pain, the person best equipped to take the lead in finding the proper treatment is the sufferer. People know their own bodies, and they can judge when medications are inducing unwanted side effects.

No one deserves to be incapacitated by chronic pain. The means to alleviate it are available. All that’s required is the will to find the right treatment.

J. Donald Schumacher is president and CEO of the National Hospice and Palliative Care Organization.


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