Date: Fri 20-Oct-1995

Publication: Hea

Author: SHANNO

Quick Words:

chronic-pain-Peck-

Full Text:

HEALTH MONITOR : Chronic pain: What Do You Do When There Is No Cure?

B Y S HANNON H ICKS

Pain comes in many forms from many sources, but for the most part it is an

inconvenience. "Acute pain" comes from an injury; the injury heals, the pain

goes away.

Chronic pain is different. For one reason or another, injuries - from simple

bumps to severe burns - can result in a lifetime of abnormal pain, what

doctors call "chronic pain." While acute pain can be cured, chronic pain is

almost incurable. It can only be made more bearable to live with.

Yet according to Brian Peck, MD, medical director of the Arthritis Center of

Connecticut in Waterbury, the treatment of chronic pain is a "very satisfying

experience."

Dr Peck has 20 years experience in treating acute and chronic pain, and he was

recently certified by the American Academy of Pain Management, a newly-created

credential that requires a combination of experience, formal lecture and

materials study, and a comprehensive examination.

Acute pain is a natural protective mechanism in our bodies, according to Dr

Peck. It has a purpose: it warns of injury. If you put your fingers too close

to fire, for instance, the message of pain tells your brain to pull your

finger away before it becomes burned.

If an injury has already occurred, pain is also a body's defense mechanism.

The pain of a twisted ankle, for instance, prevents you from using your ankle

so you won't cause further damage. Tendons and muscles tighten up and cause

pain by going into spasms, which in turn prevents you from using that area

until it has time to heal itself. This is the primary function of pain.

Chronic pain, however, is pain that serves no purpose. It is abnormal pain. It

is a frustrating pain, not only for the sufferer but also for the physician

trying to help a patient.

Chronic pain can be caused by anything that causes damage to one or more parts

of the nervous system, because a normally-functioning nervous system will not

send out the message of pain all the time.

Chronic pain can be brought on by either injury or disease. It is not

congenital, or inherited. Diseases such as diabetes, arthritis, poor

circulation, osteoporosis, alcoholism and poisoning are the more common causes

of chronic pain; arthritis and osteoporosis are the most common culprits of

chronic pain.

So what do patients have to look forward to once chronic pain has set in? Why

do doctors even try to treat patients, knowing that with all its advances,

today's medical establishment can only rarely cure patients living with

chronic pain.

If It's Incurable,

Why Keep Going?

Once a doctor and patient come to realize that a specific pain is not going to

go away completely, it is time to develop a strategy to deal with it.

By the time a patient walks into the office of a chronic pain specialist, he

or she has been suffering for quite some time. There may have already been

surgery performed, various tried and failed treatments, and, almost

guaranteed, some form of prescription pain-killers have been attempted.

Because of the limits chronic pain can place on lifestyle, depression is often

a complicating factor.

Chronic pain management calls for multiple forms of therapy to reduce tha

pain; improve function; prevent or avoid disability; avoid drug toxicities;

and avoid depression.

"It's real easy to throw some narcotics at someone, because that works, right

away," said Dr Peck. "They make you feel good mentally, too, because of the

narcotic effect.

"But that leads to real problems [in long-term patients]," he continued. "And

that's the difference between the forms of treatment." The first job of a

doctor in this case, then, is to step in and find the way to work around a

narcotics dependency.

Pain management usually begins with taking charge and regulating any narcotics

patients are already on. This does not mean stopping their use completely,

just using better control.

Using coanalgesics - drugs that will interact better with what is already in

the patient's system - the physician will then introduce anti-depressants

and/or anti-inflammatories (to reduce swelling). Most people have significant

relief once this level of treatment is introduced.

Around this time, patients are also introduced to physical therapy.

"Probably the single most important treatment for all forms of

muscular-skeletal disease and pain is exercise," Dr Peck said. Exercise will

prevent atrophy of any muscles, which causes even more pain. Physical therapy

is always part of the plan.

For patients with even stronger pain, management next introduces anti-seizure

medicines. For people who suffer fits or convulsions, this medication

decreases nerve impulse. Injections can also come into play. Nerve blocks can

reach places where nerves are malfunctioning, and "re-set" the nerve.

"Patients are being taught to change their lifestyle," says Dr Peck. "They are

not going to come in here and have me cut something out, throw it away, and

it's all better. That's not how it works."

Patients are going to go through some tough times, but working with their

caregiver and building a trusting relationship is what ultimately leads to a

pain that may be ongoing, but much more manageable.

"People say `How can you treat things that don't get better?'" Dr Peck said.

But the doctors and their patients already know the answer.

It is very satisfying to have someone enter an office on a walker or crutches,

or with fingers that can no longer button a blouse, to have a procedure

performed - most of which is relatively simple - and see the patient leave the

building holding the cane under their arm. The pain is lessened; confidence

has returned.

"That makes your day," he said. "To see their faces after a mildly painful

procedure, to walk out happy and do all of the things most of us take for

granted... that's why we keep going."