Pain Can Be Tamed

By Ian K. Smith, M.D.

Although an estimated 50 million Americans suffer from chronic pain, only 26% of those battling moderate to severe pain are referred to the proper specialists. This doesn't mean other doctors can't treat pain effectively, but the complexity of diagnosing the condition and designing a treatment for a specific patient, especially prescribing possibly addictive narcotic-based painkillers, can make this a difficult and tedious task if a physician isn't well versed in pain management.

Chronic pain is generally defined as persistent pain, like daily migraines, or pain that continues after an injury heals or fails to heal. Everyday aches and pains don't count. "A patient's complaint of 'Oh, doctor, my aching back!' isn't enough to just pull out the prescription pad and write for conventional narcotic meds," says Dr. Russell Portenoy of New York City's Beth Israel Medical Center, president of the American Pain Society, a professional group. Instead, he urges a comprehensive assessment of the pain's characteristics, including its causes and impact on the patient's activity and quality of life. Such an analysis should be performed immediately. If doctors undertake one without prompting, that's fine. But if they're prescribing for you without a thorough exam, it should raise your suspicions.

Most chronic pain sufferers are all too familiar with different classes of medications. According to a poll taken for the American Pain Society, 91% of chronic pain sufferers have tried at least an over-the-counter medicine, 60% have been prescribed nonsteroidal anti-inflammatories, and 42% have used narcotics or opioids, the big guns of pain relief.

In the past decade, unconventional pain medications have exploded onto the scene. These drugs are considered adjuvant--that is, auxiliary--therapies because they're usually used in conjunction with conventional medications when the latter fail to provide relief. Occasionally they're prescribed alone. Among the more surprising new painkillers are antiseizure medications. A recent article in the Southern Medical Journal discusses anecdotal evidence that antiseizure drugs provide the best relief for neuropathic pain, associated with nerve problems. The newest and most successful has been gabapentin, which seems to relieve a wide range of nerve pain, including that often accompanying cancer and AIDS. Better yet, this class of drugs has a low level of side effects. Drowsiness, dizziness, nausea and unsteadiness, if they do occur, can usually be alleviated by adjusting the dosages of the drug, while more severe side effects, such as liver toxicity, blood disorders and disturbed vision, are relatively rare.

Antidepressants have been used for the past 20 years as adjuvants in pain relief. The most effective appear to be the tricyclics, and they're prescribed for a broad spectrum of pain, including headaches, arthritis, chronic low-back pain, fibromyalgia, cancer pain and diabetic nerve pain, though they can in some people lower blood pressure, create confusion and cause constipation and urine retention.

Chronic pain makes life miserable for millions, and not enough is being done to alleviate their misery. Fears of addiction are understandable, but evidence suggests that many of the older and newer medications can be safely prescribed. They won't work for everyone, but there's a strong chance, if you suffer from chronic pain, they'll make your life a lot more comfortable.

For more on pain, visit the American Pain Society at www.ampainsoc.org You can e-mail Dr. Ian at iksmith@aol.com