Pain is real and a real problem in America. A 2003 survey indicated that 57 percent of those surveyed suffered from chronic (persistent) in the previous 12 months. Of those, 62 percent had been in pain for more than one year and 40 percent said they were in constant pain. This corresponded with findings of the American Chronic Pain Association (ACPA) which said that more than 50 million people in this country were in chronic pain. The ACPA also said that about half that number had experienced acute pain. Other leading pain organizations, including the American Academy of Pain Medicine, the American Headache Society and the American Pain Society have pressed for more public awareness and research for a public health issue they say affects up to 75 million Americans, according to The National Pain Foundation.

Chronic pain is characterized by lasting a month or more than the usual healing time for illnesses or injuries and can last for years. Acute pain, said the National Health and Medical Research Council, differs in having a distinct beginning and ending. Some examples of chronic pain are lower back problems, arthritis, cancer, repetitive stress injuries and headaches. There are no cures for chronic pain sufferers, only relief through treatments.

This year September was designated Pain Awareness Month by Gov. Bob Taft. The public — young and old — and physicians, too, need to learn more about pain and pain management and how they and their families might be affected.

Chronic pain is something that needs to be addressed not only to improve the quality of life but the length of life as well. The latter is especially true for the elderly. Of Americans with chronic pain, 56 percent experience trouble sleeping; 30 percent said it affects their ability to drive; 28 percent said it interferes with their sex lives; and 51 percent said it affects their overall mood.

For the elderly population, said Tracy Marx, D.O. (’92), OU-COM assistant professor of geriatric medicine/gerontology and a member of the Ohio Pain Initiative, chronic pain can have even more impact. Marx also was a member of Ohio’s Compassionate Care Task Force for the last two years. The task force was created by the Ohio General Assembly in December 2002.

“The older population tends to minimize their pain,” said Marx, who is board certified in family medicine with certificates of added qualification in hospice and palliative medicine and geriatrics. “They don’t complain. Too many think pain is a natural part of the aging process. Because of that, they’re not as active. They hurt when they walk too much, for instance.”

Because of decreased activity, she said, they become frailer. This represents a “Catch 22” resulting in even less activity, because they are more afraid to walk or engage in exercise due to the anxiety attached to their fragility. But then, at some point in this cycle of decline, when they do walk, they are more unstable because they’re not as flexible and, as such, are more prone to fall. Falls can result in other injuries needing more serious medical intervention. The injuries and the interventions themselves potentially pose critical risks to the elderly.

“Pain is subjective,” said Marx, which can be an obstacle to treating it well. “We can’t measure it as we can other things, such as for diabetics, checking blood sugars. You can’t get your pain levels checked. Pain is what the patient tells me it is.”

And pain is perceived differently by each and every one of us, she said. “And that’s the rub.” Some of those experiencing genuine pain are not believed.

If we could measure it, the treatment paradigm for pain would be easier and not as problematic, she said.

“If patients in pain are not believed and treated appropriately, there are certain inhibitory pathways in the brain that can create more pain, and a set of problems that develop with that, such as disability and depression. There are other chronic problems and unhealthy lifestyle modifications that can occur as a result of this as well. These complications cause a lot of people not to function very well.”

Unfortunately, said Marx, “There are misperceptions and fears on the part of patients and physicians regarding the risks of treating pain.”

Some patients fear addiction. Some physicians are concerned about drug abuse and diversion.

Most pain, however, said Marx, can be treated very effectively and successfully if treated appropriately. Unfortunately you don’t hear enough about the efficacy of pain management.

“Only six percent of the population has an addiction problem. You don’t hear about the 94 percent using drugs for pain management that doesn’t.” Oxycontin, she said, despite the media craze that raged around it, is no more absolutely dangerous than other opioids — opium derivatives — used for pain management. Other non-opioids, such as Tylenol, if abused, can be just as or more dangerous than an opioid. Some arthritis medications, for instance, are too high risk for the elderly to take.

“Pain pharmacology — using medications to treat pain — is very simple and easy to understand.” Despite this physicians often undertreat their patients in pain, despite a very real risk of being sued for the undertreatment of pain.

Some doctors are too timid in their employment of pain management because of misunderstandings or fear of regulatory scrutiny; fear that palliative pain management will hasten death or fear being accused of assisting suicide; a lack of understanding pain management for the elderly; and a lack of a basic education on pain management.

The last concern, said Marx, is being addressed at OU-COM in a mandatory two-week course block for its medical students dedicated strictly to pain management and palliative care. The medical school is one of a very few offering a well developed course in pain. OU-COM’s course has been in existence for two years. A 2001 study showed that only three percent of medical schools had a course in pain or end-of-life care.

“Pain management has to be covered systematically and as a separate course, starting at the beginning in order to be learned effectively.”

Patients, said Marx, need to know that they have rights — the right of access to appropriate care, the right to have their pain assessed properly and the right to proper pain management.

“Education is the key,” said Marx. Not only do physicians need to educated and trained in pain management, but “patients need to be educated. There are other ways to manage pain than medication — healthful lifestyle modifications, for instance. Pain also has emotional aspects that need to be addressed.”

The bottom line for people in pain, said Marx, is to “seek treatment, educate yourselves and be proactive. If you’re not getting answers, seek another opinion.”

Marx’s “lifelong dream” is to put together an interdisciplinary pain clinic at OU-COM. Also in the future she sees the creation of a network of pain management specialists in Southeastern Ohio.

During Pain Awareness Month, OU-COM will be sponsoring two public forums on pain management. The forums, “Power Over Pain: Drug and Non Drug Pain Management,” will take place Tuesday, Sept. 13, at 7 p.m. at the Athens Public Library and Tuesday, Sept. 20, at 6 p.m. at the Glouster Church of Christ in Trimble Township. The forums are free.

Additionally, two “Health Matters” radio shows (WATH 970 AM) will feature Marx addressing pain and pain management issues. The shows will air Thursday, Sept. 8, and Thursday, Sept. 15. “Health Matters” begins at 10:05 a.m.

For more information on the forums and radio shows, please call (740) 593-2518..