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. The National
Pain Foundation’s “September is National Pain Awareness Month”
Web page is located at http://www.painconnection.org/MyTreatment/News_PainAwarenessMonth2005.asp.
- 30 -
News for
the week of Aug 22 –
Aug 27
