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Why it is important to treat pain

The above question seems on the surface to be a rather pointless one with an answer that most people think they intuitively know. Well in fact they are very marginally right. Pain is an unpleasant experience, which is sometimes referred to as a sense of dysmorphia. The experiential component of pain is without question one to be avoided. However the question above relates more to the fundamental functions of the body that are detrimentally affected by the experience of pain.

There are generally two types of pain-acute and chronic- both of which share some features but have some distinctly different characteristics, which can be accounted for by their genesis and longevity. This essay will primarily talk about chronic pain but will initially touch on the subject of acute pain.

Acute pain or more commonly referred to, as protective pain is the sort of pain that one experiences when one places a finger over a naked flame only to automatically recoil the heated digit almost instantaneously. This type of conditioning is critical in young children as it teaches them valuable lessons regarding the dangers surrounding them. The general outcome id once burnt twice shy and it is rare for the child to repeat the same mistake.

The more fascinating and complex area of pain relates to the field of chronic pain, which is somewhat harder to define, and a more complex clinical entity that involves higher cerebral functions at some pint in its progression. To illustrate an example of how chronic pain develops, imagine a cyclist covering 40 miles a day for 10 years and then one day while getting off his bike he feels a sudden sharp pain in his back and then down his leg. He is unable to move and is transported to the local hospital where he is diagnosed as having sustained a herniated lumbar disc. The cyclist undergoes an operation to ‘fix’ the disc but unfortunately ends up in worse pain for the doctor has no answer. He is sent home with some mild painkiller, crutches and bill with instructions to take things easy for the next four weeks, which he dutifully does. The four weeks pass and he is still in pain. Nothing has changed, the wound has healed and the doctor can see nothing on the postoperative MRI, but he is still in excruciating pain.

The days, weeks and months pass by and still there is no improvement. This cyclist has developed a long-term chronic pain syndrome that will require specialized care to ameliorate the symptoms and maintain his level of functionality.

The science of chronic pain syndromes is vaguely understood and relates mostly to an internal re-setting of the nerve=-pain adaptors that now perceive pain in a much greater way than before the accident. The cyclist will experience the discomfort of pain more intensely than an individual that had not sustained an accident. This shifting of what is called the autonomic system leads to an increased sensitivity of the slightest of insults and necessitates a more complex treatment of modalities which include medication, spinal nerve blocks and in some recalcitrant cases implanted spinal cord stimulators.

The aggressive treatment and management of pain is critical as if not treated it can lead to a wide variety of other metabolic diseases such as diabetes, hypertension, renal insufficiency and depression. These other conditions are a consequence of the altered cortisol profiles that are frequently found with chronic pain syndromes. One of the other less talked about consequences of untreated chronic pain is obesity and this relates to the lack of sleep that chronic pain patient’s experience.

The mental effects of untreated chronic pain are severe and long lasting and include depression, anxiety, bi-polar disorder, anti-social behavior and sometimes suicide. It can therefore be seen that pain is both a serious symptom and long-term condition.

Within the US in the last decade there has unfortunately been a prolonged witchunt for doctors that have used synthetic opiates to reduce the pain their patient are experiencing. Each patient is individual and has a unique pain profile and it is this that allows the prescribing of a wide range of medication to different patients by the same practitioner, and until the day a device is developed which objectifies pain in the same way that temp is, then the relationship between the physician and the patient cannot be second guessed by an outside authority unless of course the individual is caught engaging in the criminal distribution of the opiate.

Social pendulums invariably swing from one end to the other and currently the swing is headed towards the more conservative end. No doubt it will spend there and then commence its journey back towards liberality.

The most important thing in this whole debate is to not forget the patient without who none of us would be necessary. We as physicians in this increasingly digital world must still talk and listen to what our patients say for it is in their history that 99% of most diagnoses are made, and it is also where you as the doctor/human will connect with the souls of your patient which is where the most profound of all healing takes place. Do not deny your patients the alleviation of pain because you are fearful of the DEA. Ensure your treatment plan is substantiated and your records are fastidiously kept. Document progress of function and pain but most of all treats your patients as humans and not medical charts.


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