Pain management difficult, subjective for patients, physicians

ItÂ’s difficult to treat something that is hard to measure.

However, an estimated 76 million Americans who suffer from pain, according to the National Centers for Health Statistics, must deal with their sometimes debilitating problems while trying to seek medical treatment that is based on subjective reports.

The American Academy of Pain Medicine estimates chronic pain costs the United States anywhere between $60 billion and $100 billion every year in health care expenses, lost income and lost productivity. Many Americans live with pain every day, and they may live with the pain for decades.

As the baby boomers encounter the aches and pains of growing older, physicians estimate there are millions of Americans who are not adequately controlling their pain. Much of that may have to do with common pain treatments, and specialty physicians are looking for ways to educate more doctors and patients about what can be done to cut down on pain and restore functionality.

When it comes to treating pain, patients most often turn to primary care physicians and surgeons. Primary care doctors can often manage pain with medication, but drugs available today have their limits. Surgeons may be called upon to physically strengthen the body, as with procedures to fuse parts of the spine, but once a body is stable again the pain can still linger.

Pain management specialists, often anesthesiologists who complete fellowships in pain management and get subspecialty certification, are trying to step in between primary care physicians and surgeons to manage pain with a wide array of treatments.

The Fort Worth area recently gained two new pain management programs, one at Harris Methodist Southwest Hospital and one at Harris Methodist Northwest Hospital. The physicians are all specially trained to pinpoint sources of pain and treat it despite the problems that come with the nature of pain.

“I really don’t have any tools other than what someone tells me,” said Dr. Brian Flanagan, a partner in Pinnacle Pain Management and a co-leader of the pain management services at Harris Methodist Northwest Hospital.

Patients are usually asked to report how much pain they are experiencing on a scale of 1 to 10, with 1 being no pain and 10 being the worst pain imaginable. There are few ways to measure pain except by what a patient says; scans

can show obvious defects, like a ruptured disc in the spine, and nerve blocks can help pinpoint where pain is coming from, but pain is a persistent, strange

phenomenon.

Leaving pain untreated is not an option, though, said Dr. William Moore of Capstone Pain Management PLLC. Moore, who is heading the pain management program at Harris Methodist Southwest Hospital, said chronic pain can wear down a patient whoÂ’s faced with the prospect of living with the pain for the rest of his life.

“If they’re in their 30s, they’re looking at 50 or 60 years of pain,” he said.

Drugs, including muscle relaxers, narcotics, and even antiseizure and antidepression medications, which can affect pain signals in the brain, are still commonly used to treat pain. Pain specialists are trying to encourage use of other treatment options as well, such as nerve blocks, injections, electrical stimulation and rehabilitation, said Dr. Marc Hahn, senior vice president for health affairs and dean of the Texas College of Osteopathic Medicine at the UNT Health Science Center. Hahn was formerly the director of the pain medicine fellowship program at Pennsylvania State University College of Medicine, and thereÂ’s an

annual award named after him to

recognize outstanding pain medicine

fellows at that medical schoolÂ’s department of anesthesia.

“A pain specialist today will use multiple approaches to treat one pain problem,” Hahn said.

There has been a general movement in medicine toward creating more individualized treatments, and pain management is no exception. Certain types of drugs work better for certain types of pain and on certain types of people — for example, a drug may work better in women than in men — and there are about 28 new pain medications being compared to current gold-standard treatments in clinical research, said Dr. Andrew Konen, who leads the pain services at Harris Methodist Northwest Hospital with Flanagan and is also a partner in Pinnacle Pain Management.

New drugs will hopefully cut down on some of the problems with current medications, such as those that wonÂ’t offer more relief after a certain dosage has been reached and those that the body becomes tolerant to, forcing the physician to keep increasing the dosages.

Despite stereotypes of narcotic users being addicts who seek out powerful drugs, Konen said the incidence of addiction is low. Also, there is a difference between addiction, which is a mental problem, and physical dependency, he said. Physical dependency just means that a person shouldnÂ’t abruptly stop taking the medication, he said, and itÂ’s a trademark of almost all drugs that have to be taken every day.

“We don’t say someone’s addicted to insulin because they have to take it every day,” he said.

Moore said many pain specialists regularly run urine drug tests on their patients to ensure the patient is taking the medication at the correct dosage and isnÂ’t taking other drugs, illegal drugs or no drugs at all, as when a patient sells the prescribed medication instead of taking it.

Some people may have a very high pain tolerance, but many people do not. Pain can infringe on every day activities, such as getting dressed by oneÂ’s self, and it can also have psychological effects. But pain specialists are certain that while they may not be able to make pain completely go away, they can get it controlled.

“I would love to take the pain away completely, but my major goal was improving their ability to function, physically, emotionally, spiritually,” Hahn said.