Recently the Star Tribune published an opinion piece titled “How not to treat chronic pain” by Ellen Stern. The article was quite interesting, but seems to miss the mark in understanding pain and its management. The author suffers from chronic low back pain. She tried treating it conservatively with the traditional route of management from medications, to therapy, to injections – none were very successful. She eventually underwent lumbar fusion and this also did not relieve her pain. Despite all the treatment she continues to be in significant pain.
The Complexity of Pain
Chronic pain is very complex. All of my patients understand the nature of pain and how difficult it is to find a good management option. Furthermore, since I have chronic low back pain with significant spondylolisthesis and severe stenosis, and have close family with pain problems, I have a very deep understanding of all these issues.
Rule number one in pain management is that there is no magical treatment. Chronic pain is “managed” and not cured. Complaining about the medical community may feel good but does not move you forward. Adjust your attitude, if necessary get professional help, and concentrate on all the things that you can do and not on the negative. If the physicians you are seeing are not helpful, it may be necessary to find someone who works with you better.
The issue with opioids and abuse is nationwide. It is now as much of a problem with accidental deaths as automobiles used to be and is ever increasing. As the country has become more aware of the problem, all prescribers of these medications have become more cautious. There are numerous ways to reduce abuse of opioids, and all patients who receive them are scrutinized. As a prescriber, we are constantly trying to determine if a patient is appropriate for opioids. Since our licenses and livelihoods are on the line when prescribing opioids, most of us are cautious when prescribing. We all can tell stories of success as well as ultimate disasters, so please understand close monitoring of the patient receiving opioids comes with a certain level of danger.
Medical marijuana in general is another complex issue. As with all treatments for chronic pain, it is just another management tool. Like any other compound, it works only for certain people and definitely not for everyone. Further as noted in multiple previous writings, the science behind medical marijuana has been minimally studied. There is very little rigorous research similar to any other drug that has been approved for medical use. Many physicians are reluctant to recommend a compound that has not been adequately analyzed and has solid research behind it. Many compounds in medicine have come on the market and we later find significant serious dangers caused by the compound.
Treating chronic pain is extremely complex. There is no silver bullet of a cure. There is much more that the medical community does not understand about pain than what we really know in detail. The majority of the tools we use today are often quite crude and old. Surgery is often quite brutal, and changes the body often in the wrong way. Morphine and its opioid derivatives are the same concoctions that we used to treat pain over 150 years ago. Research is slowly bringing medicine better understanding of pain. Physicians are struggling with the problems of pain and its treatments and a lack of new and better solutions with good scientific basis. Hopefully more funding and research will lead to better solutions in time since chronic pain does affect over 30% of the population worldwide.
Thomas Cohn, MD
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