Addressing the hurt

COEUR d'ALENE - Try as your family might - empathize as your best friend may - nobody but you can feel your chronic pain.

"Chronic pain changes a person," said Dr. Scott Magnuson, a board-certified anesthesiologist and pain management specialist. "When hurting that much, it can distract you from life and frequently people withdraw - depression is extremely common in these circumstances.

"Pain has a warning function. But when pain becomes chronic, it's no longer a warning system."

Pain is frequently divided into two categories: acute and chronic. Acute pain comes on fast and can feel like you've been attacked by the business end of a broken bottle. The pain abates, usually, after its cause has been resolved. Kidney stones, for example, have been called the "poster child" for acute pain.

Chronic pain, on the other hand, involves an agony that persists long after the direct cause of it has ceased and desisted. Chronic pain can ping-pong around the nervous system for weeks, months and even years on end.

The American Academy of Pain Medication states that more than 100 million people in the U.S. suffer from chronic pain. Among the most common manifestations are back and neck pain, migraines, arthritis and cancer. The annual cost of healthcare and lost work productivity due to chronic pain has been estimated at $560 billion to $635 billion.

According to Dr. Joseph Abate, Chief Medical Officer of Dirne Community Health Center, pain management has historically been a field of ups and downs.

"Twenty years ago," he said, "it became apparent that cancer patients were being undertreated for their pain. So then it became important for MDs to concentrate more on assessing pain - it was the fifth vital sign. But the next thing that happened was that treatment of pain in cancer patients extrapolated to treatment of pain in non-cancer patients."

During this resurgence of medical interest in pain, the drug Oxycontin was released and immediately became a blockbuster. Oxycontin is a long-acting opioid initially believed to be non-addictive.

"But 10 years ago, addictions skyrocketed," Abate said, "and the unintentional overdose rate tripled.

Nearly 15,000 people die every year - that's 40 a day - from overdoses involving prescription painkillers (such as Oxycontin)."

Ron Weaver is both a long-term chronic pain patient and a lay counselor for others dealing with chronic pain.

"If three years ago you asked me what chronic pain was, I would have told you it was my mortal enemy and something I fought with every breathing moment," he said. "I would have said it was a losing battle.

"If you ask me today, when I'm no longer taking heavy opioids, I'll tell you that pain is a lifelong companion and that you have to make friends with it. You don't always like your friends, but sometimes you befriend them anyway."

According to statistics reported by Dirne, the overall risk of addiction for patients taking opioids is less than 4 percent. However, if you add in a history of drug and/or alcohol abuse or a psychiatric diagnosis such as depression or ADHD, that figure jumps to 50 percent. For the opioid user who has both a history of abuse and a psychiatric disorder, the risk of addiction becomes 90 percent.

According to a former sheriff's department jailer who requested her name not be used, "When I was prescribed heavy-duty drugs, I painfully knew I was on the same side of the street as the people who took drugs illegally. I could keep myself clean, speak better and dress better than other people and I didn't have a typical stereotype, but I knew in myself I was going dangerously down the road. I've seen a lot of lives ruined by it, but thank God I crawled out."

Though many of us immediately think of reaching for a pill every time we hurt, there are many other options for management of chronic pain.

"Opioids used to be the easiest for physicians to offer, but I think it's changing now," said Magnuson. "I guess you could call my own approach 'holistic.' For most patients, I tend to use a combination of treatment modalities."

The burning question, of course, is what actually works for pain?

These days, most physicians are prescribing alternative medications in addition to opioids. Steroids and anti-depressants have proven effective for pain, and drugs such as Lyrica and Neurontin have worked well to combat the pain of shingles, diabetes and some types of cancer.

"Surgery is always a possibility," Magnuson said. "A huge part of the interventions I do center around the spinal area."

During an epidural procedure, he said, medication - frequently steroids - is introduced into the epidural space surrounding the spinal cord, thereby going directly to the source of the pain.

In radio frequency ablation, pain is decreased through the application of a warmed electrical current applied to the affected area.

Spinal cord stimulation activates the non-pain nerves in the spinal cord and produces a light buzzing sensation in the area of the pain. This has the effect of masking pain signals to the brain.

"The pain pump - an implanted device - delivers medication to the spinal cord at the source of the pain," Magnuson said. That medication may be micro-doses of opioids, which produce far fewer tolerance problems than oral administration.

Increasingly, other non-interventional options are now being offered to patients. Magnuson recommends self-management techniques like biofeedback, relaxation and distractors.

"Pain is an emotional, sensory and cognitive experience," he said. "Most chronic pain patients can benefit from seeing counselors, but a lot of patients are resistant to this."

Other approaches include physical therapy, acupuncture, water therapy and chiropractic.

Weaver reached a point after almost a dozen years where he felt he could no longer go down the opioid path.

"In the beginning were the pain meds and the pain meds were God," he said. "I started small like most people do and then traveled up to the max dose. A lot of people get to the place where pain meds control you, but they don't necessarily control the pain. It wasn't until I came to the conclusion this couldn't go on, that I stopped all the meds and that's how I was introduced to Dr. Magnuson.

"There's no magic bullet here. It's just about adjusting attitudes and trying new things."