Recently, the deaths of a several famous people have been linked to the misuse of pain medication. So if you read the gossip mags – or, in the case of Michael Jackson’s recent demise, aren’t illiterate, tone-deaf and living under the proverbial rock – you probably know more than you think about the lengths someone might go to in their search for pain relief.

According to many reports, celebrities like Anna Nicole Smith and Michael Jackson were hooked on medication, in part for chronic pain.   You would think that these wealthy and high profile people would have the best medical care but, just like a number of everyday sufferers of long term pain and distress, they struggled and failed to manage their problems effectively. And when you think about what chronic pain actually entails, it’s not all that surprising. 

Can you remember the last time you had the flu and were aching all over? Maybe you were not confined to bed, but still sore and taking pain relief.  Imagine feeling like that every day for months on end.

Long term or chronic pain gets people down. Most people cope with pain pretty well for three weeks. After that, it tends to be all downhill: and we’re not talking a gentle slope, but an icy, triple black diamond precipice. To make matters worse, spectators often seem to blame the sufferer for their out-of-control tumble. After all, there’s no arm in plaster, no visible source of the pain. So what exactly, spectators often wonder, is the problem? 

There are two key ways in which the treatment of chronic pain tends to go wrong:

1. Patients with long term or chronic pain often say they feel doctors don’t believe their condition is genuine. Sure, they may be believed for a few weeks, but when the problem drags on for months or even years and nothing the doctor does seems to make a difference, sympathy wanes and patience diminishes. Patients with chronic pain often perceive their doctors trying to tell them their pain is “in their mind.” 
2. At the other end of the spectrum, patients with chronic pain may be sent on a cycle of being referred for tests which don’t show an abnormality. The search for the cause of the pain continues, fruitless, but with good intentions.   Tests that don’t show the problem are often more distressing than no tests at all. 

How does this affect patients and doctors?

Patients report feeling disheartened and diminished by the process, having the sense that the doctors is frustrated with them and does not want to continue to see them.

Doctors report that patients with chronic pain are difficult to deal with, and doctors feel helpless about being able to make a difference.  In the early days, prescribing heavy dose medications such as opiates may seem sensible, but over time doctors can become trapped in the cycle of looking for a cause for the pain, and doing what they can to “help”. A primary care practitioner might end up prescribing a heavy dose of medication such as OxyContin, while a surgeon’s might suggest an operation, which may have little long-term impact.

As we have seen with some of the high profile cases, physical pain can be mixed up with emotional distress. The distressed patient is more likely to get a greater number of investigations, and is more likely to be prescribed stronger drugs. Of course this approach is done to help the distress, but easily results in medication addiction.

So what can we actually do to help patients with chronic pain?

The first and most important thing is to acknowledge that the individual is in pain and to let them know that they are believed and understood. One does not need tests to do this, but the patient needs to trust their practitioner. The patient needs to believe the problem has been appropriately evaluated and understood.

Appropriate treatment options include the use of analgesics, and cognitive behaviour therapy. Cognitive behaviour treatment helps people cope by altering their way of thinking about the problem. Helping them stay engaged by getting them involved in problem solving and finding positive ways of dealing with their situation. 

There was an interesting (but painful!) study of cats done many years ago. Scientists sent an electric shock through the cat’s tail, and measured the brainwave pattern when the cat felt pain. When the process was repeated with a movie of a mouse running across the screen, the brainwave patterns did not register the pain from the electric shock.

The point of the study is that when people are distracted they are less likely to suffer with the pain. It is hard, but ensuring that they remain integrated with everyday activities and hopefully integrated with work can help reduce the burden of pain. That is not always easy but it is an important aspect of helping them in the longer term. It also helps prevent many of the long term issues such as addiction to medication, isolation and depression. 

Patients in these circumstances need good advice about their condition. They need to understand what they can do to help themselves. They need appropriate treatment to lessen the pain. They need to understand the natural history and timeframes for the problem to improve or not improve. They need to be encouraged to remain active and most importantly they need to be supported with what is often depressing and debilitating problem.