An Urgent Need For An Integrated Approach To Chronic Pain Management

The last two decades have seen extensive research in the field of chronic pain management. This is a welcome development because today we have a greater understanding of the pathophysiology of pain resulting in better approaches to pain assessment, and advanced interventional strategies for managing patients suffering from chronic pain.

Help with chronic pain needs a multidisciplinary approach because pain is a complex phenomenon involving a blend of both the psychological and physiological aspects of a person.

Cognitive Behavioral Therapy

Extensive research has shown that physical changes in the muscles, joints and nerves generate nociceptive inputs to the brain that decode the type of pain a person experiences. For example, a sharp stabbing pain or burning pain is an interpretation by the brain that in the end influences a person's behavior. Based on the interpretation, the person will choose to either lead a normal active life or live a life of disability. It is common for us to note how differently each person responds to chronic pain. We have seen people who continue to work, walk, socialize and engage in all forms of normal activity without apparently paying heed to pain; and in contrast, we have noticed people who refrain from all activity and live the life of an invalid. This fact clearly points to the necessity that chronic pain management must focus on cognitive behavioral therapy. Doctors have now realized that Pain treatment options must not narrow down to just chronic pain medications but must also include counseling as part of an overall therapy plan.

Whichever way we look at it, chronic pain is a serious problem in modern medicine. Millions suffer from chronic pain and unfortunately, a good percentage of them choose opioids for relief. To add to the woes of sufferers there is massive denial of medication due to the regulatory laws. It is not uncommon to hear of chronic pain sufferers driven to depression and even suicide. All such issues have made Chronic pain management an unenviable challenge to doctors and health care providers.

Headaches and lower back pain may be common treatable disorders as long they are minor in nature, but when chronic pain sets in, long term relief will require Chronic pain management strategies.

The Role Of Drug Therapy

A stage comes in the life of a pain sufferer when common over the counter drugs like Tylenol, ibuprofen and aspirin do not seem to work. The sufferer then looks for a stronger painkiller. Fioricet and Tramadol are two such revolutionary drugs that have proved effective for chronic pain. Fioricet is a combination of barbiturate, acetaminophen and caffeine. This drug works mainly on the central nervous system and is used to treat migraines and muscle contraction headaches. The other drug Tradamol is a centrally acting opioid, which treats moderate to severe pain, besides relieving depression and anxiety.

Both the above drugs may offer relief but are not without their tradeoffs. These drugs are habit forming, addictive and might be potentially harmful. Doctors should prescribe these with care and patients on their part should limit consumption only to that much which is prescribed.

Drug therapy in a controlled manner may have its merits but in the long haul chronic pain management will have to focus on integrated cognitive behavioral treatment.