Chronic pain doesn't just remding you of your pain all the time. Some say they need solutions for the emotional, behavioral, and mental toll, too.
For Curtis Lundgren, 62, chronic pain is like riding a different roller coaster every day. He gets up – if he sleeps at all – straps himself in, and tries to prepare himself for a gut-wrenching ride with unpredictable twists and turns.
The chronic pain in his body is everywhere from fibromyalgia, brought on by years of suffering that turned him into one, big raw nerve ending.
Stoic and, he says, ashamed, Lundren, from the western suburbs of Chicago, does his best to have a normal day. But the pain has robbed him of his ability to take cherished walks in the woods, which helped him both physically and mentally. The drugs he takes to make the pain barely tolerable have side effects.
The more he has to stay at home, the more he thinks about the constant pain. Lundgren lost well over 100 pounds to take pressure off his knees, have them replaced, and improve his overall health, but he still developed metabolic arthritis (gout), which caused extreme pain by breaking down the cartilage in his joints.
Like many patients with chronic pain, he has been to every specialist under the sun, went to a pain clinic, has taken painkillers strong enough to knock out a horse, and has had to take palliative measures with his body that cannot be politely described.
“It just takes you so long to sift thought the different doctors that might be of help,” he says. “I learned later that fibromyalgia often develops from dealing with pain for a long time. The theory is that after a person deals with pain over time, he becomes much more sensitized to it.”
He adds that one of the byproducts of chronic pain is being “tensed up” all the time, a problem likely related to his muscle pain.
One in five Americans goes through something similar every day, according to a large survey that revealed the elderly and women suffer the most. Like Lundgren, more than two-thirds of those with chronic pain said it was, at times, “unbearable and excruciating.”
Debilitating pain that lasts for three months or more is now common in the daily lives of about 39 million Americans, the survey found.
“I wasn’t particularly surprised by our findings,” said study author Jae Kennedy, PhD, a professor of health policy and administration at Washington State University. “But I found it sobering that so many American adults are grappling with persistent pain.”
If you are in constant pain, you also tend to be depressed and tired all the time, Kennedy said. Depression and anxiety is often more pervasive in patients with chronic pain. Lundgren said he fights the depression with deep faith, but is, indeed, relentlessly tired and naps like a cat throughout the day.
The upshot of the study, Kennedy said, is to track changes in rates of persistent pain in the U.S. and compare them to other countries with different healthcare systems. That might provide clues to approaches that work better in treating and lessening long-term pain.
Kennedy suggested that if you have chronic, debilitating pain, interventions can include physical and occupational therapy, exercise, changes to your diet, weight loss, massage and psychotherapy, and complimentary alternative medicine (CAM), such as acupuncture, yoga, and chiropractic treatment.
It’s also prudent to seek out one of about 3,000 to 4,000 pain specialists spread across the U.S. They are more likely to be of help because they tend to take an integrative, multidisciplinary approach that attacks the pain syndrome from different angles simultaneously.
Drugs can be, and have been, helpful, but many studies have examined the addiction risks in long-term use. For pain treatment, they tend to be variants of opioids. Kennedy said they are already being overused, and they're often deadly.
Americans use about 80 percent of the world’s opioids and almost all of the supply of hydrocodone, a drug that’s even stronger. For treatment of postoperative pain or an injury such as an ankle sprain, they work well, but long-term use often leads to dependency or addiction, Kennedy says.
One pain expert, Bob Twillman of the American Academy of Pain Management, said drugs for pain are very useful when they work, but on average they relieve only one third or less of chronic pain and may be ineffective for certain kinds of pain.
Twillman believes a more promising approach to managing chronic pain in millions of people is to turn the policy focus from drug development to the various aspects of the pain syndrome, such as solutions for the emotional, behavioral, and mental toll. In fact, mental healthcare may be a necessary component of treating chronic pain.
Lundgren couldn’t agree more. “I used to be a morning person. I don’t know what’s happened, but I can’t get to sleep until 1 a.m. or 2 a.m.,” he says. “I feel the effects of that all day, so I can’t do anything. I never know when I’ll feel well enough to do anything. I used to volunteer a lot. It made me feel good and got me out of the house. Now, the pain gets me down, and the depression makes the pain worse.”
March 27, 2020
Christopher Nystuen, MD, MBA