Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Managing pain is a focus of medicine today. Here’s why.

Craig Chen, MD
Conditions
July 11, 2015
39 Shares
Share
Tweet
Share

The scope of the problem

Chronic pain is a health epidemic. Estimates suggest that up to a third of adults or a hundred million Americans live with chronic pain conditions that interfere with their work and life. From back pain to headaches to diabetic neuropathy, chronic pain is widespread and debilitating. These patients suffer tremendously, and societal consequences are significant; back pain is one of the most common causes of missing work and prescription drug abuse is a consequence of our struggle to manage these chronic conditions.

Pain syndromes span a wide spectrum of diseases

Patients who come to a pain clinic include veterans with phantom limb pain after a traumatic amputation, women with fibromyalgia who cannot leave the house, business executives whose migraines debilitate them and those with end stage cancer. Pain syndromes result from brain injuries like stroke, nerve damage like complex regional pain syndrome, musculoskeletal problems, and psychological trauma, yet they all have a common end result: functional debilitation affecting every sphere of life. By the time patients see a pain specialist, they are at their wit’s end, exhausted, frustrated, angry, sad and scared.

Most physicians fear the “pain patient”

For most doctors, chronic pain is a red flag. The problem with pain is that it is mostly subjective; if a patient feels pain or says she’s in pain, then we must treat her like she has pain. Many pain syndromes, however, don’t have obvious or impressive objective signs. There aren’t blood tests, and imaging is imperfect; there’s no way to measure how bad someone’s pain really is. General practitioners may feel uncomfortable prescribing high doses or extended regimens of opioids simply because a patient says she needs them. As a result, many patients with legitimate pain conditions are undertreated.

Pain management requires a multidisciplinary approach

Specialists in pain medicine come from a variety of backgrounds including anesthesiology, neurology, rehabilitation, and psychiatry. As a result, they recognize the most important aspect of successful pain management: a multimodal approach. Most patients focus on medications, but physical therapy, psychology and interventions such as nerve blocks are equally important. When we see patients in our pain clinic, we de-emphasize the focus on getting a pain pill prescription. We try to understand how their pain affects their life, set achievable goals and engage our multidisciplinary team. For many pain syndromes, opiates are not as effective as physical therapy, cognitive behavioral therapy or surgery. As pain management has become more and more complex, specialists provide a critical approach in tackling this health epidemic.

When talking about pain management, we have to think about prescription medication abuse

While chronic pain has become more prevalent over time, abuse of prescription pain medications has followed. Although appropriate use of opiates allows some patients with pain to maintain a job and raise a family, opiate abuse can impair addicts dramatically. Both groups can develop tolerance, requiring higher doses, and both can demonstrate withdrawal so that abruptly stopping their medications leads to symptoms. Thus, differentiating the two can actually be quite challenging.

This problem has grown so much that prescription opiates are rivaling traditional street drugs like heroin and cocaine in the number of emergency department visits and deaths from abuse. The costs of addiction to our health care system and to society are significant. To curb this trend, we need to design pain medications with less abuse potential, provide addiction specialists to those who need them and train more pain specialists so that multimodal approaches, rather than opiate monotherapy, are used.

Managing pain is a focus of today’s medicine

Although it seems like doctors should have figured out how to treat something as basic and simple as pain, it is not that straightforward. Only in the last few decades have we started considering pain a “fifth vital sign” and turned our attention to treating it aggressively. For outpatients, successful pain management means controlling someone’s symptoms such that she can return to a productive and fulfilling life. For inpatients, appropriate pain control will help someone heal faster and leave the hospital sooner, hopefully leading to decreased health care costs. Nevertheless, there is still tremendous room for improvement and research.

Craig Chen is an anesthesiology resident.  This article originally appeared in The American Resident Project.

Prev

Test your medicine knowledge: Reducing the personal risk of developing rheumatoid arthritis

July 11, 2015 Kevin 0
…
Next

How hospitals can kill. Here's what we can do about it.

July 11, 2015 Kevin 6
…

Tagged as: Pain Management

Post navigation

< Previous Post
Test your medicine knowledge: Reducing the personal risk of developing rheumatoid arthritis
Next Post >
How hospitals can kill. Here's what we can do about it.

More by Craig Chen, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Is health reform contributing to physician burnout?

    Craig Chen, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Rating health care: There are limits to every method

    Craig Chen, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Have a conversation with your family about the end of life

    Craig Chen, MD

More in Conditions

  • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

    Harvey Max Chochinov, MD, PhD
  • Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

    Hoag Memorial Hospital Presbyterian
  • The rising threat of lung cancer in Asian American female nonsmokers

    Alice S. Y. Lee, MD
  • Urgent innovation needed to address growing mental health crisis among children and families

    Monika Roots, MD
  • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

    Cheryl Lazarus
  • The unjust reality of racial disparities in pediatric kidney transplants

    Lien Morcate
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 14 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • More Anxious Kids Medicated; Apple's Mental Health Moves; OTC Video Game for ADHD
  • ADHD Meds Linked to Lower Suicide Risk in Borderline Personality Disorder
  • Promising Gene Therapy for Overactive Bladder
  • The Case for Mandatory LGBTQ+ Health Education in Medical School
  • Shotgun Sequencing of Small Intestine Reveals Species Tied to GI Symptom Severity

Meeting Coverage

  • Promising Gene Therapy for Overactive Bladder
  • Shotgun Sequencing of Small Intestine Reveals Species Tied to GI Symptom Severity
  • FGFR Inhibitor Stakes Claim to Post-Anti-PD-1 Role in Advanced Bladder Cancer
  • Multimorbidity Patterns and Healthcare Utilization in Vets With Schizophrenia
  • Checkpoint Blockade Stumbles in Advanced EGFR-Mutant NSCLC
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician
    • A revolution in patient empowerment: Working together to save our medical system [PODCAST]

      The Podcast by KevinMD | Podcast
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Unlock financial freedom: The physician’s guide to lucrative multifamily syndications and wealth accumulation

      Pranay Parikh, MD | Finance

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Managing pain is a focus of medicine today. Here’s why.
14 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...