New Treatments for Chronic Pain

The number-one reason patients come to see me or any doctor is pain—pain in all its forms: sharp, dull, tingly, burning, itching, aching. All any patient suffering pain asks of me is something obvious and simple: Make it stop.

But pain can be mysterious. Everyone experiences it—and yet you can't see pain, measure its intensity, or even reliably describe it. How people experience discomfort is as varied and subjective as how they experience beauty or happiness. The person who hurts is essentially alone with his anguish, which is part of what makes pain even more painful.

In many cases, we know the source of pain—a broken arm, for example, or a twisted ankle. Other times, pain warns of something more serious, such as cancer, appendicitis or heart disease. Then there's the pain that seemingly has no explanation, the kind that can linger for months or even years after an injury. Such chronic pain becomes a condition in itself.

Some 76 million of us live with chronic pain, according to the American Academy of Pain Medicine—more than the number with diabetes, heart disease and cancer combined. This unwanted, constant companion can afflict anyone. Says Dr. Penny Tenzer, vice chair of the department of family medicine at the University of Miami Miller School of Medicine: "It crosses the spectrum of cultural, ethnic and socioeconomic backgrounds."

The most common type of chronic pain is lower-back pain, according to a survey by the National Institutes of Health. Next are headaches and migraines, neck and facial pain. There's also the chronic pain of arthritis, fibromyalgia and cancer, as well as post-surgical pain, limb pain from diabetes, and pain following shingles.

Still, it can be difficult to convince others—doctors, co-workers, family members—that one's pain is "legitimate." Sufferers often complain that they're told, "It's all in your head." Physiologically, notes Dr. Tenzer, this is correct: "Pain is all in your head." As the center of the nervous system, the brain receives and sends pain signals to and from the rest of the body. We now know that these signals can get amplified or distorted, activating pathways not originally involved in the injury and causing pain to persist long after the injury occurred. Some sufferers also may have lower levels of endorphins, our body's natural painkillers, or a heightened sensitivity to pain.

The annual cost of chronic pain in the U.S. is $100 billion—in health-care expenses, lost income, and diminished productivity, says Dr. Todd Sitzman, the former president of the American Academy of Pain Medicine. Pain also affects an individual's self-esteem and self-image, notes Dr. Tenzer, leading to frustration, anger, sleep disturbances, anxiety, and depression. Many feel they have little control over their pain.

So what can be done to ease the pain? "There is no magic bullet, usually no single cure," says Dr. Michael McCeney, a pain specialist from Fort Collins, Colo. But there are options that, used in combination, can help relieve some pain some of the time. Talk with your doctor about what may work for you.

Stimulation

Electrical stimulation is a popular treatment for chronic pain, even though there isn't substantial scientific evidence to support it. Spinal-cord stimulation—mostly used to treat chronic back and leg pain—involves implanting a small wire in the back to carry currents to targeted areas in the spinal cord. When it's activated, patients feel tingling sensations instead of their usual pain. The patient uses a remote control to turn the current up or down. The effects can linger for hours. While pain specialist Dr. Michael McCeney calls it "the fastest-growing and most-promising treatment available for certain types of pain," the medical literature still is inconclusive about the treatment's benefits.

Another popular technique is transcutaneous electrical nerve stimulation, or TENS. While a recent review of hundreds of studies showed limited benefits, some patients still use it for lower-back, muscle, arthritis, and post-surgical pain. TENS consists of a device that produces electrical currents. When put on the skin via a patch, the currents stimulate nerves—mostly superficial ones—and can cause some reduction in pain. Here, too, the individual controls the frequency and intensity of the device.

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• Do Women Have a Higher Pain Threshold?
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