In Canada more people miss work due to chronic pain then almost any other reason. It’s probably safe to assume that this phenomenon is not isolated but spread through out North America. Back problems, migraine headaches and other pain related distresses can be so debilitating as to cause permanent job loss.
Remarkably, given it’s impact on our economies, it remains one of the more unrecognised and untreated ailments in our society. More often then not most doctors are unable, or in some cases unwilling, to alleviate their client’s suffering. Although there is a public impression that doctors seem willing to hand out pain relief agents at the drop of the hat, in reality there is still resistance to providing adequate levels of analgesic to effectively give relief of suffering.
There are still sufficient taboos associated with narcotics(Morphine and Demerol)that some doctors who have attempted to prescribe large enough doses have had their practices suspended or been censored to the extent that they have closed their doors. The latter case occurred in my home city of Kingston Ontario where a local doctor was forced to relocate because of his willingness to supply his chronic pain patients with Morphine.
In spite of the fact that his patients were able to re-establish their lives, some even to the extent of being able to return to work, this doctor was still considered a pariah for his actions. He has since relocated his practice to the United States. I don’t know what the attitudes are like there, but one can only hope for a more enlightened perspective then the one shown here. In a series of interviews given by his former patients they all expressed concern about what they were going to do in the future.
Pain is considered a subjective illness. This means that doctors have no ready way in which to gauge a subjects suffering except through a patient’s self report. Many chronic pain conditions have no discernable physical cause. It is very difficult to obtain x-ray evidence of any type that could offer proof. The high incidence of nerve damage renders even Magnetic Imaging and Nuclear Scans ineffectual for attempting to pin point a cause.
In order for a physician to give an accurate assessment a patient’s condition she is limited by her knowledge of and trust in her client. Without an awareness of the patient’s history what doctor is going to feel comfortable prescribing large amounts of narcotics? Only after eliminating other potential interventions do most doctors begin the process of developing a pain control regime with their patients.
In the mean time the patient is suffering and the longer it takes for the doctor to reach a decision the harder it will be to combat the pain. Pain is like interest owed to a loan shark. It compounds on a daily level. The longer you take in “paying off the debt” the more you end up owing. As pain weakens your defences by depriving your body of rest, your resistance to it’s effects decreases. The pain increases until a point of no return is reached.
The brain recognises pain using the same synapses and nerves that it utilizes for memory. This is part of our learning mechanism. It’s what teaches us not to do things like puting our hand on the hot burner of the stove more then once. We store up reminders of the effects of pain in our memory. The problem, when the pain is persistent, is that a point is reached when overload occurs and the nerve endings can not shut off the message no matter what drugs are used. We “remember” the pain even if there are moments when it has abated. The pain an amputee feels, referred to as phantom limb pain, is an example of that scenario.
There is no consistent rule of thumb governing when this point is reached. There are too many variables at play. The intensity, the amount of area the pain covers, where the pain is located and each individual’s system all play a role in when overload is reached. This makes the case for early intervention even more urgent. After this point is reached it requires radical treatment, such as intravenous application of analgesics or pain blocks, to alleviate the suffering. ( A pain block is an attempt to anaesthetize the affected nerve by injecting it with an anaesthetic, thus blocking the signal being sent to the receptor. While it can be effective, it is only temporary with its effects wearing off in as little as a week’s time. Depending on which nerves are involved there is also a risk of paralysis if the injection goes awry.)
Only recently has research been undertaken to try and find more permanent solutions for these debilitating conditions. One method that has been formulated are Trigger Point Injections. This involves the injection of a mixture of steroid and anaesthetic into the specific pressure points in the body where the pain is located in an attempt to disburse contracted tissue that could be causing the disturbance.
There has been some success treating cases of migraines, back pain, and other muscular associated situations with this procedure. If they are able to isolate the centres that are the focal points of the pain then a series of treatments are started. In theory as the treatment progresses the nerves are released from the pressure that is causing the continual transmission of the pain signal to the memory centre of the brain. This in turn should allow the brain to forget the pain.
At this time these procedures are not readily available in North America for two main reasons. In the United States when the procedure was reviewed for purposes of Insurance coverage by the government, those doing the reviewing did not recognise it’s validity. So a person wanting this treatment has to have sufficient financial resources to pay what ever cost the private clinics offering the service want to charge. It also means that the procedure is unregulated so you have no guarantee of any standard being maintained.
Although the procedure is covered by provincial health programs in Canada it can only be done by anaesthesiologists in a hospital situation. Since not all doctors in that field even perform this procedure, the wait time to get into a pain clinic can be as high as sixteen months.
Only recently has there been awareness of the seriousness of non lethal chronic pain as an illness. Even now too many people are living with untreated pain because of the stigma attached to admitting being in pain. Far too many doctors and other medical professionals have dismissed pain related suffering in the past for people to feel comfortable in approaching their physicians “just because something hurts”.
The perception that pain is not a real illness, that one should just buck up and get on with it, is hard to overcome. It is reflected in the attitudes of government’s refusal to fund significant research into the causes of and cures for a condition that in most cases is treatable. Our hang ups about the use of narcotics as painkillers(morphine is not addictive if used to fight pain)remains a stumbling block for the early intervention required to limit the consequences of a chronic pain condition. Until these issues are overcome too many people will needlessly suffer and our economies will continue to be impacted by the loss of work hours.
On a personal note: I have had a chronic pain condition since 1992, in 2001 it became persistent. The information in the article is based on personal experience and readings I have done to help me better understand the things that are happening to my body. I have been used as a guinea pig for numerous drug combinations in attempts to control the situation and have been undergoing Trigger Point Therapy since early winter 2003 with little or no success.
I’m incredibly fortunate that I’m under the care of two compassionate doctors whose primary goal is my comfort and well being. Both my G.P. and my pain specialist have allowed me the freedom to have complete control over the process of my treatment. Due to the rarity of my condition my pain doctor is continually researching and experimenting on his own time with methods and ways to provide relief. I can only hope that others in my situation are fortunate enough to receive the same care. Unfortunately I seriously doubt it.