"Pain is vastly undertreated today for several reasons," says Jim Guest, executive director of the American Pain Foundation in Baltimore, Maryland. Until recently, health care professionals received little training in pain treatment. Patients hold low expectations for relief and don't want to be seen as whiners. Many doctors and patients are wary of strong painkillers, such as opiates (derived from opium) like morphine. Patients fear addiction, often needlessly. And doctors are concerned about increased scrutiny from drug regulatory agencies when prescribing stronger medications.
Despite the hesitation to talk about pain, it is epidemic: 50 million Americans have chronic pain (lasting six months or longer), and 25 million experience short-term pain from injuries or surgeries annually. Women tend to experience daily pain, miss work due to pain, and develop conditions that cause chronic pain.
Both the Joint Commission on Accreditation of Healthcare Organizations and the Department of Veterans Affairs call for pain to be treated as the "fifth vital sign" and assessed as vigilantly as blood pressure, pulse, temperature, and breathing rate.
"Doctors can't measure pain," says John Klippel, M.D., medical director of the Arthritis Foundation in Atlanta, Georgia. "Their ability to understand pain is determined by their patients' ability to describe it."
This calls for straight talk. Tell your doctor:
Choose words carefully to describe pain: stabbing, aching, dull, piercing, tingling, gnawing, deep, pounding, shocklike.
Share your ideas about the cause of the pain. Explain -- directly and succinctly -- the methods of relief you've tried and the results.
It's important that you explain how the pain affects your life. "An accurate explanation puts the pain into perspective for the doctor in terms of what kinds of things might be achievable through therapy, and what difference it would make in a patient's life," says Klippel.
The future is bright in terms of treating pain, says Scott Fishman, M.D., chief of the division of pain medicine at the University of California at Davis and author of The War on Pain (Quill, 2001).
"We have a better understanding of the impact pain has on someone's life," he says. "We're now decoding pain through neuroscience and understanding how the language of pain is relayed to the brain. We're seeing new breakthroughs daily: new pain receptors we didn't know existed and new effects of drugs."
Some people with neuropathic pain, which is caused by nerve injury, can benefit from the anticonvulsant drug Neurontin (gabapentin), even if they don't have convulsions. Antidepressants can block pain in patients who are not depressed. "The same molecules involved in regulating mood may be involved in regulating pain," says James Campbell, M.D., professor of neurosurgery at Johns Hopkins University and chairman of the board, American Pain Foundation.
Scientists have developed drugs that may be better pain medication for some patients than the common choices of aspirin, ibuprofen, and naproxen sodium (nonsteroidal anti-inflammatory drugs), which can cause a range of problems from upset stomach to serious gastrointestinal bleeding. The newer drugs include Vioxx (rofecoxib) for arthritis pain and menstrual pain and Celebrex (celecoxib) for arthritis. They inhibit COX-2 enzymes, which trigger pain and inflammation, without blocking COX-1 enzymes, which protect the stomach lining.
There are faster ways to stop pain too. For instance, Actiq (a form of the opiate fentanyl) is available as a flavored lozenge that dissolves in the mouth. This medication offers relief for cancer patients whose severe pain has broken through their regular narcotic treatment.
Ask your pharmacist what you can expect from your medicine, what side effects to watch for, and what to do if you miss a dose, says Susan Winckler, a pharmacist and group director of policy and advocacy for the American Pharmaceutical Association. Give precise information about the other medications you're taking, including any over-the-counter (OTC) drugs, vitamins, and herbal supplements.
Be aware that OTC medicines can contain some of the same ingredients as prescription medications. If they both have acetaminophen, for instance, you could end up getting too much and cause liver damage. Vitamins may contain herbal ingredients -- ginkgo, for one -- that interact with pain medicine.
The shame, says Winckler, is when people don't take medications correctly or fail to try them at all. "Learn about your medicine," she urges. "Some people, when they're prescribed a medication with codeine, think, 'I'm going to be really out of it. I don't want to use narcotics.' But if other things aren't working, it could be the best medication for you, and you may not 'feel out of it.'"
When you, your pharmacist, and your doctor work together, your medications have a better chance of accomplishing what they were designed to do.
Banishing pain, especially chronic pain, involves more than popping the latest pill. Russell Portenoy, M.D., chairman of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City, stresses that many pain specialists favor a multidisciplinary approach. The minimum approach includes drug therapy, a pain rehabilitation or physical therapy program, and psychological help. Incorporating other treatments, such as massage, biofeedback, or acupuncture, is not unusual.
Why seek psychological help? Not because the pain is all in your head. "Anybody with chronic pain is going to suffer changes that affect all aspects of life, including their psychological health, family life, sexual life, and social life," says Dr. Portenoy. "Psychological interventions may help coping skills and reduce the pain through the power of the mind."
Pain specialists now have access to drugless invasive techniques that jam brain signals. Portenoy says that there has been success with deep brain stimulation, which sends a low electric current through an electrode placed in the brain. Spinal cord stimulation, in which a thin wire goes into the spinal cord, also has been effective.
Even with new treatments, good communication remains all-important. A lot depends on the patient taking action. Be vigilant, whatever your level of pain, and get answers before pain worsens.
"In nursing school back in the 1980s, we were taught that a little pain never hurt anyone," says Pamela Bennett, R.N., who is a pain management nurse consultant in Derry, New Hampshire. "We're finding out scientifically that pain can be harmful. If we treat it early and aggressively, we can prevent many chronic pain conditions from developing."