Every now and then there’s something of interest posted on health in Time magazine. The following (Part 1) is mostly a précis of ‘Understanding Pain’ in the March 7 2011 edition. I have added a small amount of other information that I’ve been sitting on. Part 2 will continue with contemporary therapeutic ideas, but will include the bits that Time Magazine completely ignored; Myofascial Trigger Points.

Background

• 76 million people are affected by chronic pain in the US (National Center for Health Statistics)
  • Arthritis and Low Back Pain (LBP) account for 60% of this pain
  • Most of the sufferers are women
  • 20% of cancer sufferers end up with chronic pain after treatment
  • 10% post-op cases end up with chronic pain
  • 2% or 1.5 million people develop Chronic Regional Pain Syndrome (CRPS)
    • CRPS is diagnosed by exclusion or elimination of other symptoms

“As a clinician, I’m frustrated, and I’m sure many patients are, because we do a very poor job in terms of providing relief for chronic pain”

David Borsook of McLean Hospital and Harvard Medical School.

What is chronic pain?

• Chronic pain is pain that lasts beyond what would be considered normal for any actual or potential tissue damage; usually 3-6 months duration
• After a normal pain response some people keep sending pain signals
• With chronic pain quite often there’s no proximate cause or injury to treat
• Pain interpretation may depend in part on temperament and mental state
• Chronic pain is a disease that affects the sensory, motivational, cognitive and modulatory pathways
• Chronic pain may be self perpetuating and indeed may even enhance damage to the joints in the case of osteoarthritis
• Neural circuits can be altered – this means pain is an adaptive mechanism

“We don’t know much more about pain than we did 200 years ago. Pain is still pain.”

Dr Michel Dubois Chair of Pain Medicine and Palliative Care at New York University’s Langone Medical Center

Chronic pain is a pain

• Within the population there can be a genetically different component of numbers, density and type of receptors that detect pain, as well as the body’s ability to control chronic pain
• Patients with depression or anxiety often report a higher incidence of chronic pain
• According to the Centers for Disease Control and Prevention (CDC) one in 20 Americans are depressed. Of these, 80% say that they have functional impairment, and 27% have difficulty with ADLs.
• 230 million prescriptions are filled out for anti-depressants each year
• Anti-depressant drug use has doubled in one decade, from 13.3 million in 1996 to 27 million in 2005
• Opioids often don’t provide long-lasting relief and are consider “wholly unnecessary’ or “the enemy” by some.
• The psychiatric industry is a $330 billion dollar industry