MMS Physician Focus: March 2010
By Janet D. Pearl, M.D.
For most Americans, aches and pains come and go. However,
roughly ten percent of Americans experience chronic pain or pain
that lasts longer than the normal healing time of three months.
Often, they're caught in a vicious cycle of unrelenting pain and
sometimes depression. Because physical activity can seem
intolerable for those in pain, many avoid activity altogether. As a
result, they lose strength and flexibility-valuable assets that
could ultimately help improve their condition.
Persistent pain can also change sleep habits and mood, causing
people to withdraw from social situations and straining
relationships. Physical inactivity and emotional stress can lead
people to experience a higher degree of pain, perpetuating the
cycle. Moreover, the combination of physical pain, exhaustion and
depression can overwhelm a patient, making daily life
difficult.
Low back pain is one of the most common forms of chronic pain.
Despite the frustration it creates for patients and their families
and friends, chronic low back pain (and other types of chronic
pain) can be effectively managed by a multi-disciplinary team of
health care professionals experienced in the complex interplay
between the physical and emotional aspects of pain.
Contributing causes
Many factors can cause chronic low back pain. Congenital
conditions, like curvature of the spine; age-related degeneration
of the spine, where discs lose fluid and flexibility and joints
become arthritic; and traumatic injury are major causes. But, such
pain can also come from years of poor posture, smoking (which
causes discs to degenerate), improper lifting and carrying of heavy
objects, or obesity. Even sleeping on a poor mattress and wearing
high heels can be causes.
Coping with pain: blending body and mind
Chronic back pain usually has no cure, unlike acute back pain,
which lasts a few days to a few weeks. However, the pain can be
managed effectively by the right combination of health care
professionals, including a pain medicine physician, physical
therapist, primary care physician, psychologist or other mental
health practitioner, and, depending on the underlying problem,
other specialists like an orthopedist or a neurologist.
Communication and collaboration are important in diagnosing,
treating and monitoring the physical, social and psychological
aspects of pain.
The primary treatment goal is to enable patients to engage in as
healthy a level of physical and mental activity as possible.
Exercise can prevent or interrupt the vicious cycle of pain by
releasing the same type of brain chemicals that antidepressant
medications release. The results are a happier mood, better sleep,
and less pain. Physical therapists can adapt exercises to fit
the condition of specific patients so they can also improve their
strength, flexibility and physical functioning despite pain.
Psychologists and mental health practitioners help patients with
pain overcome psychological obstacles that make living with pain
especially difficult. They teach people methods to cope when the
pain is particularly severe, train patients to notice negative or
distorted thoughts that might color they way they experience pain,
and provide psychological counseling to reduce anxiety and
depression.
Pain Medicine physicians lead this multi-disciplinary approach.
After a careful evaluation of the patient, the physician develops a
treatment plan tailored to the patient with the goal of improving
function. Treatment may include injections that provide pain relief
and enable patients to live more active lifestyles. Physicians also
prescribe medications to decrease chronic pain and its effects,
monitoring patients closely for side effects and changes in
function. They communicate with the patient's other providers,
especially the primary care physician, who usually knows the
patient the longest. In addition to facilitating physical therapy,
Pain Medicine physicians can also recommend other types of care
such as chiropractics, acupuncture, and massage therapy to decrease
pain and reduce stress.
Coping with chronic pain is difficult, often taking six months
to figure out the right combination of treatments to manage the
pain. However, those who feel their pain is "in control" are also
likely to experience a significant improvement in their emotional
well-being. With the right help, most people can lead fulfilling
lives even with persistent and severe pain. For more information on
chronic back pain and its treatment, visit the National Institute
of Neurological Disorders and Stroke at www.ninds.nih.gov/disorders/backpain
or the American Society of Anesthesiologists at http://www.asahq.org/patientEducation/managepain.htm
Janet D. Pearl, M.D., M.Sc., is the founder and medical
director of Complete Pain Care, a pain medicine practice in
Framingham, Mass. Physician Focus is a public service of the
Massachusetts Medical Society. Readers should use their own
judgment when seeking medical care and consult their personal
physician for treatment. Comments are welcome atPhysicianFocus@mms.org
.
