The Right (and Wrong) Way to Treat Pain

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"Studies have shown that patients who use a multidisciplinary program do better than patients who take medications only," says Dr. Pamela Palmer, medical director of the pain-management center at the University of California, San Francisco (UCSF). "The anxiety, the depression, the hopelessness that come with chronic pain really all have to be addressed"--as do the loss of mobility, hypersensitivity to touch and other effects that can destroy the quality of life. "It's not as if you can just take an anti-inflammatory drug and all those problems go away." To pain specialists like Palmer, the hand wringing and finger pointing over the COX-2 inhibitors are the result of expecting too much from these drugs and using them with unwise abandon. "No one's expecting a chemotherapeutic agent or a liver drug to be perfect for everyone, but because pain is so prevalent, we're all in search of that magic drug that works for everyone all the time. It's such an unrealistic burden to place on a drug."

WHAT CAUSES CHRONIC PAIN?

Before you can give pain the treatment it deserves, you have to understand what it is and why we have it. Nasty though it is, pain plays a valuable role in our overall health. Doctors liken it to an alarm system for the body. When skin, cartilage, muscle or other tissue is injured, peripheral nerves in the area send a shrieking signal to the spinal cord and brain. The immediate result, usually processed in the spinal cord: you pull your hand away from the stove, you shift your weight off the broken bone, you sit down. All pain signals ultimately land in the brain, where they trigger thought ("That was dumb!"), emotions (tears, sobs), memories and a complex array of biochemical events aimed at protecting your body from further harm.

With chronic pain, however, the alarm continues to shriek uselessly long after the physical danger has passed. Somewhere along the line--maybe near the initial injury, maybe in the spinal cord or brain--the alarm system has broken down. What researchers have only recently come to understand is that prolonged exposure to this screaming siren actually does its own damage. "Pain causes a fundamental rewiring of the nervous system," says Dr. Sean Mackey, director of research at Stanford University's Pain Management Center. "Each time we feel pain, there are changes that occur that tend to amplify our experience of pain." That is why it is a mistake, despite our grin-and-bear-it tradition, to ignore or undertreat severe pain.

GETTING THE TREATMENT RIGHT