Treating Chronic Pain as a Disease, Not a Symptom

The treatment of chronic pain has significantly improved over the last decade. Common types of chronic pain include back pain, headaches, arthritis, cancer pain, and pain from injury to nerves (called neuropathic pain).

The old thinking: Use narcotics to treat patients who are really hurting and hope they escape addiction, or avoid such complications by limiting pain treatment.

The new thinking:

  • The diagnosis and active treatment of any underlying causes of pain. 

  • Treat chronic pain as a disease, not merely a symptom.

  • Use a team approach, with pain specialists determining which patients need which types of help.

  • Involve patients in their treatment and teach them to help themselves.

Fifth 'vital' sign

Among those calling for pain-treatment standards is the Veterans Health Administration (VHA). In 1998, the VHA adopted pain as a fifth vital sign to be "measured" along with blood pressure, heart rate, breathing rate, and temperature.

Countless conditions can cause chronic pain, but these are the major offenders: arthritis, cancer, headache, low back pain, pelvic pain, peripheral neuropathy (a condition of the nerves to the extremities), reflex sympathetic dystrophy (a degenerative condition that can arise after a simple injury), sickle cell anemia, and shingles.

When is pain considered "chronic"? It's chronic when it extends beyond the expected healing period.

Lengthy healing

"Normal" pain benefits us by acting as a warning. Acute chest pain, for instance, can signal a heart attack. But, when pain is chronic it no longer is warning of a problem; it no longer serves a real purpose.

Measuring pain is not as clear-cut as taking someone's temperature. Treatment, too, requires certain training.

Are you in pain?

Communication is vital in treating chronic pain, but it's not just communication between doctor and patient that's important. Communication among physicians must come first. The trend is to teach patients how to help control pain.

Experts offer patients these tips:

  • Be consistent in explaining your pain.

  • Be specific about where it hurts and exactly how it feels.

  • Describe what, if anything, brings on the pain, makes it worse or makes it better.

Choices in treatment

To treat chronic pain, patients may need several professionals using several approaches—some standard, some not. Research has found that the most successful pain treatment combines a broad range of physical and behavioral therapies. The goal of treatment is optimal pain control, improved function, and improved quality of life.  

Pain treatment falls into three categories:

  • Medication. This ranges from acetaminophen to narcotics, such as morphine and other adjuvant (supplemental) pain medications designed to treat inflammation and nerve damage. For some patients, anesthetic injections can also be very effective.

  • Surgery. Surgery, for example, can ease the pressure that vertebral discs place on spinal nerves. Surgery can also implant a pump to deliver medication where it's needed.

  • Alternative treatment. This includes a variety of physical and behavioral approaches that range from acupuncture to massage therapy.