Pain is treatable, not always curable

Pain is treatable, not always curable
http://deseretnews.com/dn/view/0,1249,640193153,00.html
By Lois M. Collins
Deseret Morning News

Low back pain is high on the list of reasons people go to the doctor. If you figure the price of disability, time off and other related expenses, it costs about $100 billion in the United States every year.
Add in the cost associated with all the other types of pains — headaches, misery that accompanies some cancers, the post-surgery pain that won't leave — and it's daunting, says Dr. Christopher Caldwell, who completed an Anesthesia Pain Medicine Fellowship and is board-certified in neuromusculoskeletal medicine and osteopathic manipulative medicine.
Scott G. Winterton, Deseret Morning NewsClaudia Campbell, clinical director of the Intermountain Pain Center, will field Health Hotline calls with Dr. Christopher Caldwell today. Although it's not always curable, pain is treatable, if patient and health-care provider can work together.
Pain is the subject of today's Deseret Morning News/Intermountain Healthcare Hotline from 10 a.m. to noon. Caldwell and Claudia Campbell, clinical director of the Intermountain Pain Center at Cottonwood Hospital, where both work, will answer phoned-in questions. All calls are confidential.
One of the challenges with treating low back pain is that so many different things may cause it. It can result from arthritis or muscle pain, for instance.
Pain often comes in layers. "There's almost never a single cause with a simple solution," Caldwell says, so it "requires a willingness to look for and find all the different contributing factors, and then we must try to address each of them appropriately."
Some doctors simply don't have the time or the expertise to peel away the layers.
"We need to do better," Caldwell says. "Physicians are folks who've given their lives to be in a position where they can help. Pain is a very humbling thing to treat. Often we can't make it go away completely. We can manage it with exercise and by increasing our understanding of the options . . . but it's often a very frustrating thing for physicians who really want to offer lasting relief and help. Pain eludes even the specialists in finding that cure in many cases."
Often, though, it responds very well to treatment, he and Campbell agree.
The center doesn't offer surgery but will make a referral. As a profession, Caldwell says, they "don't understand very well who will and who won't benefit from surgery. We take our best shot at it, and we're getting better, but there's still a mystery to that."
Several classes of medications help treat pain, and which one is used depends on where the pain is, what's causing it and what's keeping it alive. While most people think first of strong opioid medications, they offer only limited benefits for chronic pain. It's much better for acute, short-term pain such as a broken arm or after surgery.
Medications that work on nerves make them less likely to send a pain message to the brain, often used to treat neuropathic pain. Pain itself can change how the body signals, which is why pain sometimes persists when the root cause is gone.
Anti-inflammatory medications are often helpful. So are exercise and osteopathic manipulative treatment. There are a dozen different procedures that can be done under X-ray guidance to apply medication or technology in the body, including placing steroids deep in the lower back by the spinal cord. Radiofrequency neuroablation, spinal cord stimulators and nerve blocks are part of the arsenal.
Backs don't get better without physical rehabilitation, "with enough (pain) relief to accomplish it. There's no way through it other than through it," Caldwell says, so patients must be willing to do their part.
Cancer pain unleashes a "very different philosophy right out of the gate," he adds. For those with limited life expectancy, the goal is better quality of life and pain control, not rehabilitation. With less concern about the long-term implications of what treatment is chosen (addiction, for instance, is a moot point), there are more options in terms of pain relief.
Campbell points out that being addicted does not mean pain is not real. But it adds another challenge to treatment.
Intractable pain that lingers after surgery is comparatively uncommon and may be unrelated to a surgical problem. Sometimes, the body and mind have a difficult time after surgery and specialists work to create a window where they can get ahead of the pain. "For most people, that pretty well works." Such treatment is usually of short duration, he says.