Almost a Great Time for Pain
I know what you’re thinking: “There’s never a great time to be in pain.” But hang tight. Science is blowing away the boundaries that have limited our understanding of pain – not just why it happens but how it starts, how the brain interprets it and how it can be reduced. Researchers have glimpsed the inner workings of a system so sophisticated yet so primal – the nervous system.
It’s been there all along, but sometimes the nervous system gives many of us not-so-gentle reminders that it’s the boss. An estimated 20 percent of people in the United States live with chronic pain – now the country’s number one health problem with a cost of more than $100 billion a year, according to the American Pain Society (APS). Yet despite the number of people it affects and the staggering costs it generates, pain has been largely under-treated.
Only 10 years ago, pain management was an almost incidental part of physician training. “When I was in training 25 years ago, pain wasn’t considered to be that important, probably because not enough was known about the biology of pain,” recalls rheumatologist Lee S. Simon, MD, associate professor of medicine at Harvard Medical School in Cambridge, Mass., and previous director of the Division of Analgesic, Anti-Inflammatory and Opthalmalogic Drug Products for the FDA in Bethesda, Md.
Pain now is explored in medical schools in basic science classes such as biochemistry and pharmacology, as well as in clinical courses such as psychiatry, rheumatology and surgery. In fact, the state Senate of Texas proposed a bill requiring Texas medical schools to review their pain curriculum to ensure training in aspects of pain management – including pain assessment and emotional impact of pain – is available to all students. Attitudes have changed not only in medical school but in practice and society, as well.
Narcotics blot out pain like no other drug, but their use has been tinged with controversy and approached with caution. “There was a general avoidance of narcotics for pain relief because it could be difficult for doctors to distinguish patients who really needed them from patients who were seeking them [to abuse],” says Dr. Simon. (See “Neurotic about Narcotics?”) What doctors are learning now from the growing body of pain research is helping to shape new ways of looking at – and treating – pain.
Changing Perspectives
In 2003, the APS published the first-ever Guidelines for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis and Juvenile Chronic Arthritis, signaling a turning point in the recognition of chronic joint pain. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) – a nonprofit organization that sets standards of care and evaluates health-care organizations every two to three years – requires health-care organizations to regularly assess and treat patients in acute or chronic pain or risk losing their JCAHO accreditation. So along with blood pressure, temperature, heart rate and breathing rate, pain – now considered the “fifth vital sign” – must be assessed by health-care personnel.
