Treatment of chronic or acute pain varies with the individual, because what works for one person can exacerbate pain in another.
But experts agree that a comprehensive pain-management program should address both physical and psychological well being and seek to reduce the stress and tension that make any affliction worse.
Experts say sufferers should speak out to doctors and healthcare providers about their pain, describe specifically what hurts, what makes it better, what time of day it hurts most and how the pain affects their daily lives. Many patients say that a pain-management program of medicines and therapies can be greatly enhanced by prayer or meditation, volunteer work and other spiritual and altruistic endeavors. For starters, a patient should have a doctor who is willing to treat pain effectively. If not, the patient should consider asking his or her doctor to consult with a pain specialist, seek a direct referral to such an expert or switch doctors, says Lennie Duensing, a spokeswoman for the American Pain Foundation in Baltimore.
Medications
The oldest and most conventional treatment for pain is the prescription of opioid analgesics, such as morphine, Demerol and codeine. These work by activating receptors on brain neurons. They can be given in high doses, and contrary to popular opinion, are usually not addictive if carefully administered, experts say, and neither do they impair normal functioning. While conventional wisdom says that morphine makes people feel drugged, those who receive morphine and other pain medications as part of a doctor-controlled pain regimen are usually able to drive and otherwise function normally.
"Addiction is a function of how the drug is delivered," says Dr. James Campbell, a professor of neurology and director of the Blaustein Pain Treatment Center at Johns Hopkins Hospital in Baltimore.
Campbell, who is also chairman of the board of directors of the American Pain Foundation, draws an analogy between the use of opiates to ease pain and the use of the nicotine patch, which delivers a steady dose of nicotine to smokers trying to quit.
"No one gets addicted to the nicotine patch, and the reason is that when someone smokes, the nicotine reaches the brain within six to seven minutes. There's something about that rapid delivery that's very important for the addiction syndrome," Campbell explains.
"The way we give the opiates with the long release dose, we're giving it really slowly, like the nicotine patch. And 99 percent of the time, people don't feel any high. They don't get any pleasure out of it, except for the hoped-for pain relief."
Side effects of opiates include nausea and constipation, but doctors can prescribe other medications to relieve the side effects. Unlike many other drugs, even long-term opiate use does not cause organ damage, Campbell says.
Another class of drugs widely used to treat pain is a group of painkillers known as non-steroidal anti-inflammatory drugs, commonly abbreviated NSAIDs. These include aspirin and ibuprofen and work by cutting off production of prostaglandin, a key pain chemical released during tissue injury that activates pain receptors.
But there are side effects here too. Prostaglandins are found throughout the body and some, such as those in the digestive tract, are beneficial. When eliminated by NSAIDs, they can cause irritation of the stomach lining and even ulcers. In some cases, NSAIDs can also cause kidney failure.
That's why doctors are so hopeful about a new group of drugs called cyclooxygenase, or COX-2 inhibitors, which suppress the pain prostaglandins while ignoring those found in the stomach.
Campbell says doctors are also optimistic about using anti-epilepsy drugs to treat pain, since there is preliminary research indicating that drugs which control seizures can control pain as well. As doctors begin to understand those who suffer from chronic pain every day, year after year, they are increasingly prescribing anti-depressants as part of the pain-management treatment.
Medications to induce sleep may also help, experts say, since many pain sufferers find it hard to relax long enough to fall asleep soundly.
Alternative Therapies and Exercise
But medications are just the tip of the iceberg when it comes to pain management. Many other forms of therapy exist, such as nerve blocks, steroid injections and electrical stimulators. Exercise can help alleviate the pain of some sufferers, depending on the type of pain. Stretching and lifting weights to strengthen muscles can help others.
Alternative therapies such as gentle massage, biofeedback, relaxation therapy, yoga, acupuncture and meditation are embraced by others. These therapies have grown in such popularity that many doctors, such as Campbell, no longer want to distinguish between alternative and conventional therapies, but rather what works and what doesn't.
"When you're in such agony, you'll try anything," says Susan Norton of Charlottesville, Virginia, who found biofeedback especially helpful in teaching her how to relax after she suffered massive scarring and nerve damage in her lower abdomen after a ruptured ovarian cyst went undiagnosed. Now, she practices biofeedback techniques daily. "It's a part of my life," she says.
For many people, the spiritual aspects of prayer offer great solace and healing powers. Norton says she prays every day for long stretches, which relaxes and focuses her and takes her mind off her pain.
Likewise, Norton recommends volunteer work, even if it's only one hour per week or per month, to provide a sense of self-worth and contribution to society. Many sufferers also join pain support groups, which help them find common ground, swap stories and provide mutual support.
"You have to make sense of this thing that's happened to you that you feel you don't deserve," says Norton, who helped found a pain support group in her town.
Lastly, Norton says, she has had to let go -- of her nursing career, her fast-paced lifestyle and her independence. These days, she won't make more than one appointment per day, she rests frequently, and she takes several small naps to conserve her energy. To manage her pain, Norton takes a combination of opiates, NSAIDs and an anti-depressant. "It's important for people to know that everyone is different," she says. "It's usually a mixture of things that help."
Denise Hamilton is a Southern California-based writer whose work appears in publications including Apria.com, the Los Angeles Times? Health section and New Times Los Angeles. Her first book, "The Jasmine Trade," is published by Scribner.
