Sunday, 12 June 2011

The Pain Problem

Even if you've only ever seen a few Oprah Winfrey shows, you'll probably recognise the name Dr. Oz. Like him or loathe him, he rarely exaggerates or sugar coats issues. His article here for Time magazine, addresses the problem of pain in a structured and recognisable way. He understands that a patient with chronic pain is not the only one affected - that the patient's family and friends are part of the equation too. It's an optimistic article but I fear that most people with neuropathic pain will still feel that they're up against a brick wall in trying to convince both doctors and others, of the extent of the problem. Hopefully he is right that there is a coming renaissance in the area of pain treatment.

The End of Ouch?

My mission is to help people live the longest and happiest lives possible, and that means lives that are pain-free. But Americans don't do pain well. Historically, if people were not in immediate medical danger, their pain was considered an unfortunate side effect or a collateral consequence of solving a greater problem. I was told my job as a cardiac surgeon was to keep a heart beating by any means. Any pain the patient had later was not my focus.

But all that is changing. I am here to tell anyone who suffers from pain each day, whose life is circumscribed and whose goals are slipping out of reach, that you are at last being heard. We are in a pain renaissance.
First, the biology: Pain is actually an intricate interplay along neurotransmitters in the brain and spinal cord. The body produces natural painkillers like serotonin, norepinephrine and opioid-like chemicals. Chronic pain is any pain that persists beyond the usual healing period. Continuous or intermittent, it can consume all aspects of a person's life.

Second, the numbers: Chronic pain is one of the costliest health problems in the U.S., with an estimated annual price tag of close to $50 billion. Lower-back pain is by far the most common complaint, affecting 70% to 85% of adults at some point and leaving 7 million either partially or severely disabled. Lower-back pain accounts for 93 million workdays lost every year and consumes over $5 billion in health care costs. Arthritis pain affects 40 million Americans, and 45 million suffer from chronic headaches.

But it's not just about your bad back or arthritic knee. People with chronic pain are twice as likely to suffer from depression and anxiety as those without. What starts in your lower back eventually eats away at your soul. You enjoy your loved ones less, and you are less enjoyable to them. If pain affects body, mind and spirit, then treatment must address these three pillars of the human condition.
Unless there is acute nerve damage, pain can't be measured by traditional diagnostic tools. Physicians can predict a pain diagnosis related to injury but are otherwise working largely in the dark, reliant on patient narrative. If you're seeing a doctor for your pain and the problem has not been resolved after six months of treatment, get a second opinion from a specialist. All doctors learn rudimentary pain management in medical school, but few are trained fully or well at it. Prepare for the appointment so you can ask educated questions. The American Chronic Pain Association has a great list of communication tools to help you better verbalize your pain.

Exercise and stretching can often help alleviate pain. Medications such as anti-inflammatories (the ibuprofen family), opioids and antidepressants are effective in the short term, but there are worries about long-term use. Pain-relief medication is one of the most abused areas of the pharmacopoeia. More extreme interventions — surgery, cortisone shots, nerve blockers and local anaesthetics — should be explored as a last resort.

One of the best imports from Eastern medicine — acupuncture — comes from a time before ibuprofen and Bengay. Not everyone agrees on how acupuncture works, but physicians believe it activates endorphin systems, and many consider it a highly effective complementary therapy.
So what does the future hold? Some researchers are exploring the pain-control power of mind quieting and focusing techniques that athletes use to improve performance and that Buddhists preached thousands of years ago. Meditation may benefit chronic-pain sufferers by reducing the emotional impact of their condition. A settling, transcendent state puts the pain in perspective and helps it dwindle in importance. The American Chronic Pain Association ( has a five-minute relaxation exercise that can be effective at helping you let go of the physical stress that exacerbates pain.

As recently as 20 years ago, chronic pain was dismissed as purely psychological — a symptom of a greater mental problem — and it was treated with a terrible blitheness. But today we recognize that pain is a disease. I'm sure 20 years from now; increased understanding will result in even greater advances — and even greater relief. I love a good renaissance.

Mehmet Oz is vice chairman and professor of surgery at the New York Presbyterian Columbia University Medical Center, a best-selling author and the host of the nationally syndicated television talk show The Dr. Oz Show
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