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Doctor’s Orders

Dr. Gena Vennikandam
Chronic Pain Should Not Necessitate Chronic Drug Use

By Dr. Gena Vennikandam

Aches and pains are a part of life. They are the most common reasons why patients visit their doctors and perhaps the most frustrating, because many patients leave without a definitive cure to end the chronic suffering. This can be the impetus to a rampant drug addiction.

According to the Institute of Medicine, as many as 100 million Americans suffer with chronic pain. Almost twice as many Americans abuse prescription drugs as those who abuse cocaine, hallucinogens, heroin and inhalants combined, according to the Drug Enforcement Administration. A 2011 congressional testimony from the American Society of Interventional Pain Physicians states that the United States consumes about 80 percent of the world’s pain pills.

According to Davis Yang, MD, family medicine physician and program director of the MacNeal Family Medicine Residency Program says, “Chronic pain is dysfunctional by definition. Pain is a survival mechanism, it is supposed to help you; you sprain your ankle, it hurts so that you know to protect it and don’t risk making it worse. That’s its purpose.”

While the idea of chronic pain may seem like just another side effect of aging, and therefore the pills part of an eventual routine, that’s not necessarily the case. In certain situations, chronic pain can be traced back to a particular incident, whether it was a prior surgery, injury or infection. It could also be the sign of a serious, underlying condition, such as osteoarthritis, multiple sclerosis, fibromyalgia, shingles or neuropathy (nerve damage), to name a few.

Beyond the aforementioned pain initiators, there are day-to-day choices we make that can hurt us, such as sleeping in the wrong position or not getting enough sleep, lifting heavy objects with our backs or not getting enough exercise. There’s teeth grinding, excessive texting, wearing shoes without support (i.e., flip-flops), lugging a heavy laptop case around town and even sporting tight up-dos or hats, which can cause headaches.

These bad habits can be eliminated, and most likely, the pain will subside. But how does one eliminate chronic pain, which is pain that persists longer than six months?

“Sometimes, paradoxically, you have to stop focusing on the pain for the pain to get better,” says Yang.

And while it’s not a cure, if the mind over matter idea doesn’t work, the use of drugs can temporarily curb the pain.

Often patients will bounce from doctor to doctor, depending on which one or ones will provide them with the scripts they desire. Physicians most often prescribe pain medications on an as-needed basis in an effort to avoid patient dependence. But some of these drugs can lead to dependence and abuse.

According to the Centers for Disease Control and Prevention, in 2010, 20 percent of patients who presented with pain were prescribed opioids, such as morphine, codeine and oxycodone, and the numbers are increasing. Others are prescribed medications such as anticonvulsants and antidepressants, which were originally formulated to treat epilepsy and depression, respectively.

All of these drugs have been FDA approved as an option for pain relief and have proven to be effective in certain cases, but their use can still lead to dependence, which can lead to abuse.

Alternatives to curing some chronic pain cases involve physical therapy, acupuncture, massage, yoga and meditation. Low-impact exercise, like swimming or walking, nerve stimulation, cognitive therapy and biofeedback—a form of therapy, which trains one to control one’s body’s involuntary responses to stress—are also helpful.

Although we can mask that pain with a magic pill, masking should never be used as a permanent solution. When trying to put an end to a patient’s chronic pain, the doctor—and the patient—must understand that every person and situation will have a different set of solutions that work.

Ultimately, medicine as a practice should have the goal of finding the correct combination of treatments to fix the problem over time instead of creating a dependence on the mask.

Originally published in the Summer/Fall 2014 print edition

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