Pain can take many forms. There is throbbing pain, stabbing pain, phantom pain, acute pain and chronic pain. Regardless of what we call it, we all know what it feels like. Pain can be both physical and emotional. It involves elements of learning and memory. It is a tangled, overlapping and complex condition. This is also why modern medicine continues to struggle when trying to accurately interrupt an individual’s pain and to safely alleviate it.
How we communicate pain to doctors speaks to the complexity of the problem. Patients are routinely asked to rate pain on a scale of 0 to 10. A score of 0 means no pain at all, and 10 indicates the worst pain imaginable. On this pain scale, ratings of 4 to 7 are considered moderate. Mild pain resides around 1 to 3. Anything over 7 is considered severe.
Clinicians are now realizing that this system is just too simplistic. Tolerance to pain varies among individuals. People’s perceptions of their pain can present a big challenge. If someone either under-scores or over-scores their response, a doctor can get the wrong impression of their condition, and this can affect a patient’s comfort and their treatment.
Health care providers are now trying to come up with a system that involves words, not numbers. Dr. William Maixner, of the anesthesiology department at Duke University School of Medicine and the current president of the American Pain Society, recently told NPR that he believes using words to describe pain will bring greater specificity to the measurement of pain.
Many believe that when care providers just look at a number, they are likely to over-treat or prescribe more medication. This is worrisome given the current epidemic of opioid abuse and addiction, and a shift toward de-prescribing with a more integrated approach to pain management.
A recent study shows that approximately one-third of Americans live with chronic pain and far too many of these sufferers continue to become dependent on the opioids prescribed to treat it. As I have reported in the past, drug-free pain management is now considered a top priority among researchers at the National Institutes of Health’s National Center for Complementary and Integrative Health. Many clinicians are now coming around to the belief that throwing powerful drugs at chronic pain problems only adds to the problem. It can eventually lead to needing increasingly higher doses to keep the pain at bay.
Since this new direction away from powerful and potentially addictive drugs as the “go-to” choice in pain management, in the 12-month period ending in March 2018, the Centers for Disease Control and Prevention reported a decline of 2.8 percent in the number of overdose deaths. As small as this progress is, it is at least moving in the right direction.
Research continues to show the potential power of the mind as a non-pharmacological means of relieving many kinds of chronic or recurrent pain. The placebo effect is a good example of this under-harnessed mind-body connection.
It is well established that placebo treatments can prompt real reductions in symptoms for patients, though scientists struggle to understand exactly how the placebo effect works. A new, small study published in Nature Communications found that when some people with chronic back pain took a placebo sugar pill, their pain was reduced as effectively as it would have been with pain medication. It further demonstrated that people who had certain traits reliably responded better to placebos than others. In the past, it was believed that responses were not predictable. A. Vania Apkarian, Ph. D., a co-author of the study and professor of physiology at Northwestern University’s Feinberg School of Medicine, tells Time magazine that he and the other researchers were able to predict who would respond and how much they would respond to the treatment. Certain individual’s brains seemed “primed to respond,” even if they knew they were taking a placebo.
Apkarian also noted that it is impossible to say when, or if, the results might be integrated into clinical practice. If doctors could consistently predict the placebo response, the impact would be huge, sparing patients from unnecessary drug use, says Apkarian.
Meanwhile, as doctors continue to feel the pressure to cut back on the number of opioid painkillers they prescribe, the pharmaceutical industry is said to be responding by looking to bring more non-opioid pain medications to market. According to Business Insider, an estimated 17 drugs are in late-stage clinical development and 40 drugs are currently in early-stage development.
At the same time, the public’s appetite for alternative choices continues to grow. According to a Mayo Clinic report, complementary medicine has never been more popular. Nearly 30 percent of adults report using complementary and alternative medicine, as patients continue to consider conventional medicine by itself inadequate.
In a recent study conducted by the University of Helsinki, research data was collected from more than 20 countries. According to the findings, 1 in 4 subjects in the study population had used complementary and alternative treatments for various health problems in the past year.
When it comes to patients looking for alternatives to opioids, it continues to be hard to get them paid for by insurance companies. Patients with chronic pain are often not left with many alternatives that are effective or accessible.
There needs to be wider discussion and increased legislation to help us close this access gap.
Write to Chuck Norris with your questions about health and fitness. Follow Chuck Norris through his official social media sites, on Twitter @chucknorris and Facebook’s “Official Chuck Norris Page.” He blogs at ChuckNorrisNews.blogspot.com.