How to deal with chronic pain

The consequence of chronic pain
The root cause of chronic pain often remains a mystery. Another survey carried out last year, by Harris/Decima for Pfizer Canada, found that among those who have been regularly suffering from two or more symptoms of chronic pain for more than six months, almost half (47 per cent) have not been diagnosed.

Chronic pain is also costly, with nine per cent of women and 10 per cent of men with chronic pain reporting that their pain interferes with their ability to work. The price tag is an estimated $12,558 in lost income per person with pain per year, according to SES.

Worse, it can have devastating consequences on self-esteem. When Nicole St-Laurent-Ward, 53, of Moncton, N.B., developed fibromyalgia in 1995, the excruciating pain in her hips began to limit her mobility and led to chronic fatigue. She was forced to quit her job at Radio-Canada and became depressed and anxious. "I felt scattered, disconnected," she says.

Seeking help
Like Kelly, Nicole sought help from traditional pain drugs. But while over-the-counter pain relievers, such as hot packs and analgesic rubs, are readily available in drugstores, they're not likely to do the trick for chronic, unremitting pain. It's often a challenge for chronic pain sufferers to get effective prescription pain medication, partly because doctors are leery of taking on the task. "Are patients undertreated? I think so," says Dr. Zohar Waisman, a psychiatrist with the Wasser Pain Management Centre in Toronto. "Unlike an infection, where we give a person antibiotics," he says, "chronic pain is much more complicated to deal with."

That's not to say there isn't a wide variety of effective prescription pain relievers. First, there are the opioids, such as codeine, morphine, oxycodone and methadone, which can be critical in chronic pain management, says Mary Lynch, president-elect of the Canadian Pain Society and director of pain management at Queen Elizabeth II Health Sciences Centre in Halifax. These drugs, which are most often taken orally but can be infused (administered through intravenous, intraspinal, epidural or subcutaneous routes) or applied through the skin with a patch, can be important in managing pain. However, doctors need to screen for risk of addiction and watch for signs of overdose (recently reported with the use of fentanyl patches) and long-term dependence. "About 10 per cent of the population has the disease of addiction," says Allan Gordon, a neurologist and director at the Wasser Centre.

As well as the opioids, there are analgesic combinations – an antidepressant taken with an anticonvulsant – that act as aneuro-modulators, explains Lynch, meaning they alter the way the brain processes pain. Included in these combinations can be Gabapentin and Carbamazepine, anticonvulsant drugs formerly used solely to treat epileptic seizures.

Also emerging are the cannabinoids, drugs derived from cannabis, such as medical marijuana. "It's a field that is developing," says Lynch.

Accurate diagnosis
Before a doctor prescribes any of these drugs, though, he should make an accurate diagnosis. And that can be difficult because of the many different types of pain; for example, there are various forms of arthritis pain, neuropathic pain (stemming from an injury to the nervous system), multiple sclerosis pain, migraine pain and fibromyalgia, to name a few.

Accurately pinpointing the source of pain takes some detective work, but it's important because it can affect treatment, notes Marlene Noble, a physiotherapist at St. Paul's Hospital in Vancouver. "There's a whole different way of treating pain if it's peripheral pain due to a new injury than if it's long-term chronic pain," she says.

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