Published in The Post-Star (B1)
11/13/05
Sometimes, pain is more than a symptom of illness. It is the illness.
Physicians recognized this 40 years ago, when pain management emerged as a sub-specialty of medicine, but public awareness remains low.
"There are few illnesses with an adverse public health implication as great as chronic pain," said Dr. Russell Portenoy. "Yet we haven't widely accepted the reality that pain is an illness in its own right, and that should be the foundation for every conversation about it."
Portenoy is the chairman of the department of pain management and palliative care at Beth Israel Medical Center in Manhattan. He recently conducted a survey that found at least 30 percent of Americans had experienced, within the past year, pain that lasted for three months or more -- in other words, chronic pain.
Chronic pain can be triggered by a disease that causes tissue damage, such as arthritis, or by a terminal illness like cancer.
In some cases, however, people experience pain even though their body appears to be physically healthy. Nervous system dysfunction seems to be at the root of such cases, but that's about all doctors know at this point.
"We call those cases idiopathic," Portenoy said, "which basically means we have no idea."
Little funding is available for researching pain as a disease, although the pharmaceutical industry has invested heavily in developing medications that temporarily reduce the sensation of pain.
Portenoy supports the long-term use of opioids like morphine and Oxycontin for chronic pain. At the same time, he hopes the medical community will someday understand the neurology of pain well enough that his patients may no longer need drugs.
"The amount of time devoted to pain management in medical school is minute," he said. "It's strange, since pain is the number one reason that patients see doctors."
There are only about 9,000 licensed pain specialists in the United States, and more than 30 million Americans suffering from chronic pain, Portenoy said.
"The implication is that there is no possible way for chronic pain to be managed only by pain specialists. Primary care doctors must step up and address the problem," he said. "We have a problem of access."
Neither Glens Falls nor Saratoga has a pain management division in its hospital. Patients in this region who suffer from chronic pain have few treatment options. They can seek referral to a specialist in Albany, or try alternative therapies like acupuncture and chiropractic care.
"The most common regions I treat in terms of chronic pain are the neck, back, and headaches," said William Tackett, a Queensbury chiropractor.
Tackett works with the muscles and joints to improve circulation, which can relieve inflamed nerves, but said he believes most chronic pain is caused by "a misfiring in the brain."
"It's the brain taking something that would otherwise be a non-painful stimulus, and interpreting it as pain," he said.
Tackett said chiropractic adjustments have made some chronic pain patients more comfortable, although he can't offer them a cure.
"I'm a hero to them if I can reduce their pain by 50 percent, because of how much pain they're in," he said. "I know darn well there's only so much I can do for them. There's only so much anyone can do for them, until we understand the brain better."
That's not a message that most patients want to hear.
"People tend to view disease as being a matter of a broken organ that they can take to a physician, like a mechanic, and get fixed," Portenoy said. "In fact, most diseases cannot be cured, only managed. Physicians really are chronic illness managers."
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To learn more, log on to:
Beth Israel Medical Center's Pain Management Dept: www.stoppain.org
American Pain Foundation: www.painfoundation.org
American Pain Society: www.ampainsoc.org
National Chronic Pain Outreach Association: www.chronicpain.org
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