THE TREATMENT OF PAIN ( a 3-part series)

PART 1: Conventional treatments: Drugs

Pain is a global problem. Over 1.5 billion people worldwide have chronic pain in one form or another. Nearly one third of Americans suffer from chronic pain. In Europe one in every five people said they have moderate or severe chronic pain. The 3 most common sources of pain are low back pain, neck pain, and severe headaches or migraine pain.

Pain can be either acute or chronic. In acute pain, there is acute inflammation in the tissues and nerves at the site of injury. The inflammation leads to swelling that is actually part of our bodies healing process. Chronic pain continues after the trauma has healed, and can last for weeks or months or even years.

With chronic pain, nerves continue to send pain messages to the brain. This is possibly due to nerve damage at the injury site, but can also result from a malfunction in the way the brain maps sensory information, like a malfunctioning feedback loop from the injury site to the brain and back.

Pain effects our quality of life. About 65% of people with chronic pain have sleep problems. Lack of deep, restorative sleep worsens the pain and people end up in a negative cycle of pain and sleeplessness. In addition to the burden that comes with chronic pain, the emotional costs to patients and families is high as well.

Drugs are often prescribed for chronic pain patients as the first line of treatment. Yet only 23% of of chronic pain sufferers found opiates effective, and a recent review found that opioids were not effective for low back pain. The first randomized study to ever evaluate long-term effectiveness of opioids for pain relief found that those taking opioids were actually in more pain than those who were on non-opioid pain relief treatments! This is at least partly due to the ‘rebound’ effect opioids cause. Plus, opioids are addictive.

Opiate abuse and the depression that can result from opiate consumption have become common, especially in the US. And prescription opiate cause more deaths than heroin. An estimated 2 million individuals in the US are addicted to prescription opioids at an economic cost of $78 billion annually.

Non-steroidal anti-inflammatory drugs (NSAIDS), the most commonly used medications in the world, are another commonly prescribed drug treatment for pain. However, a recent study of over 440,000 patients concluded that using any NSAID, including over the counter drugs like Ibuprofen, for even a short period of time was associated with an increased risk of heart attack, even in healthy people. This is in addition to the GI problems, kidney disease and even death already associated with NSAIDS.

Acetaminophen, commonly known as Tylenol, is also a very popular pain drug. High quality evidence suggests that this medicine is ineffective in reducing pain and disability, or improving quality of life in patients with low back pain. Acetaminophen does offer a small, but clinically insignificant benefit for pain and disability in patients with hip or knee osteoarthritis, but keep in mind that amongst Acetaminophen’s side effects are also an increased risk of heart attack, as well GI bleeding, kidney damage and death!

In part 2 of this 3-part series we will discuss the use of surgery and other conventional treatments for chronic pain.