Medical Limits: Chronic Pain Syndrome
A survey in 2000 revealed that 42% of Americans are in physical pain every day and 89% report experiencing pain monthly. Chronic pain is a serious problem and likely to increase given our increased longevity.
When pain becomes chronic, there are a number of psychological and physical effects, including depression, slowing of metabolism, sleep disturbance, physical deconditioning and changes in appetite and sexual behavior. Although pain can start out as a symptom, it can become its own disease. Over time, chronic pain can take over and people can have trouble participating in normal activities. Chronic pain, when it interferes with daily activities such as going to work, relating to others, and enjoying oneself is often referred to as Chronic Pain Syndrome. This title captures the overwhelming nature of chronic pain and the ways it can intrude on and impact the lives of patients and loved ones.
The field of medicine has a long and complicated history regarding the sensitive treatment of patients who are in pain. As many people with chronic pain know, some medical clinicians have tended to blame or pathologize people in pain. Though this happens less often, many patients still complain that physicians resist prescribing certain medications for people with chronic pain and are not as sympathetic as they should be.
One reason some physicians may have trouble dealing with chronic pain has to do with the culture of medicine itself. Medicine is a fast-paced discipline and one in which cures are expected from both patients and the doctors treating them. When pain persists, many doctors, especially surgeons, are simply not prepared to help patients. A typical example of this is when patients see a surgeon for back surgery. The surgeon and patient hope and assume that surgery will take away pain. Sometimes it does. Often it does not.
Many patients have described scenarios of surgeons who simply throw up their hands at a third follow-up visit after surgery. These conversations are often reported as a patient saying they are still in pain and a surgeon saying something like, “I don’t know what to tell you. The surgery did what it was supposed to do. Go back to your primary care doctor and see what he or she can do.”
In other words, doctors and especially surgeons have the idea that they can fix people’s problems. Chronic pain presents a unique challenge to doctors, who spend years in training with the belief that they can cure disease. Chronic pain simply does not fit well in this model. Patients often bear the brunt of physician frustration.
When pain becomes chronic, patients are charged with a number of options regarding treatment. Medications are one option, but it is a common misconception that medications cure chronic pain; they do not. Most medications for pain dull uncomfortable sensations. So even when people choose to rely on medications, there are a number of behaviors patients can do to help minimize suffering. Current recommendations regarding the management of chronic pain include exercise, weight management, physical therapy, “pacing” (meaning not taking on too much when not in pain), getting adequate uninterrupted sleep, increasing socializing and pleasurable activities and engaging in meaningful work. If employment is not possible because of the level of disability, then volunteer work is suggested. Though these recommendations sound straightforward, for some people in pain, they can seem impossible to achieve.
People in chronic pain can feel miserable and complain that no one understands how they feel. To a large extent, they are right about this latter point. Those of us who do not experience pain every day do not know how it feels to wake up with pain, go to bed with pain, and to wake up in the middle of the night with a body that hurts. That being said, chronic pain can be managed. Management usually means that people live with some degree of pain.
Chronic pain serves as another reminder that Western medicine has limits in terms of how much it can help us.
Greenberg, T. (2011). Medical Limits: Chronic Pain Syndrome. Psych Central. Retrieved on December 9, 2016, from http://blogs.psychcentral.com/aging/2011/08/medical-limits-chronic-pain-syndrome/