Over the years I have listened to many of my chronic pain patients talk about how angry they were at their pain management doctors. That’s why I wasn’t surprised to read about the latest report presented at the American Academy of Pain Medicine (AAPM) meeting in Florida this week.  The presentation was by psychiatrist David Fishbain, M.D., of the University of Miami and Rollin Gallagher, M.D., a clinical professor of psychiatry and anesthesiology at the University of Pennsylvania.  Below are some brief passages from their presentation.  To read it in full go to:

http://www.medpagetoday.com/tbindex2.cfm?tbid=8394

“Acute pain patients and chronic pain patients were at greater risk than patients without pain for affirming the hostile wish statements,” Dr. Fishbain reported at the American Academy of Pain Medicine meeting. The study found that the chronic pain patient most likely to harbor the hostile wish is involved in litigation — and most frequently that is a worker’s compensation legal tussle. These patients are forced to see physicians against their will — often because of dictates of the litigation, and patients don’t trust the doctors.
 
Dr. Gallagher, who was not part of the studies, said that pain patients tend to be frustrated and have loss of hope, problems that doctors need to address and be aware of when they are treating these individuals. He also said the study points out the need for further education of doctors on the complexity of chronic pain and “emphasizes the need for the timely referral of patients to pain specialists.”

Many of the angry patients that I worked with had been seeing their General Practitioner (GP) for their pain management and when their pain worsened or the dose of the necessary medications increased, both physicians and patients became frustrated.  I agree with Dr. Gallagher that there is a very great need for more timely referrals of chronic pain patients to providers who have training and expertise in dealing with this population.

If people don’t get effective pain management within six months to a year they can develop other major coexisting disorders that cause major quality of life problems. Many chronic pain conditions require a multidisciplinary approach instead of just covering up the pain with opiates. Some conditions may require opiate interventions, but there are many other medications, as well as nonpharmacological approaches that should and can be implemented at the same time.

For more information about chronic pain management with coexisting psychological disorders including addiction, please go to my publications page http://www.addiction-free.com/publications.html and check out my latest book Managing Pain and Coexisting Disorders. For an overview of my book you can go to my Article Achieve page http://www.addiction-free.com/articles/articles/archive and read Serving People with Chronic Pain & Coexisting Disorders.

Over the years I have been very outspoken about the need for people in recovery, who have an addictive disorder, to stop smoking.  About five years ago I was working with a doctor at a pain clinic who had done extensive research on the effects smoking has on pain management.  This morning I ran across a recent study that demonstrated that people who were living with neuropathic pain and continued to smoke were actually amplifying their level of pain. This was published in 2005 by the Journal of Spinal Cord Medicine Volume 28(4): 330-332.  I’m going to insert a portion of that report below.

The first subject rated his pain as 4/10 when not smoking and 7/10 when smoking. The pain subsided 30 minutes after smoking was discontinued. He noted an immediate increase in neuropathic pain when smoking. The second subject quit smoking for 1 month and immediately noted that the pain disappeared, rating it 0/10. After he resumed smoking, his radicular pain was 8.5/10 in the morning and 5/10 in afternoon.

This particular study focused on people with spinal cord injuries (SCI) and neuropathic pain, but the findings could translate to any type of neuropathic pain, whatever the trigger or pain generator was.  I have seen many patients quit smoking over the years and almost all that stopped reported an improvement in their pain levels.  Many of them did not have SCI or neuropathic pain, but even so they reported improvement in their pain management.

For an article on my views about smoking please visit the articles page of my website by clicking:

http://www.addiction-free.com/articles/

Then read my article Smoking and Recovery Just Don’t Mix.

I recently ran across an article reporting on a presentation by Michael J Cousins AM, MD, DSc, professor and director of the Pain Management Research Institute at the University of Sydney, Royal North Shore Hospital, in Australia.  Please see below some of the highlights from his presentation to the 24th Annual Meeting of the American Academy of Pain Medicine at the Gaylord Palms in Orlando, Florida on February 14, 2008.

“Chronic pain is different from acute pain,” explained Dr. Cousins. “If pain persists despite reasonable treatment from a primary care physician and other specialists, the advice of a pain medicine specialist should be sought. The earlier such help is obtained the greater the chance of returning to a reasonable range of life activities.” Dr. Cousins has been the driving force in Australia, as well as internationally, in drawing attention to evidence that shows that severe persistent pain becomes a “disease entity” and has also championed the concept of pain relief as a basic human right.

To read the entire article please go to:

http://www.eurekalert.org/pub_releases/2008-02/aaop-cps021508.php

It has been my experience that when a chronic pain condition is not accurately diagnosed and effectively treated within the first six months, major life-damaging problems occur.  What starts out to be complaints about severe pain impacting functioning and quality of life, often amplifies into coexisting psychological disorders including addiction. 

Some of the common problems people experience are sleep disturbances, depression disorders, anxiety and stress disorders, substance use disorders including abuse, addiction or pseudoaddiction, cognitive impairment (problems with thinking) and even eating disorders.  Many of these conditions go undetected by healthcare providers until they are so severe it takes a major intervention to just contain the situation.

I agree with Dr. Cousins that living with debilitating chronic does become a disease or syndrome in and of itself.  Not only does it affect the person’s physical health and psychological functioning, it also impacts the person’s relationships with family, friends and coworkers.  For many people it also damages their spiritual condition.  We need to move beyond symptom management—e.g. numbing the person out with powerful pain medications—and start treating the whole person.