More than 20% of the population, over 50 million people live and experience chronic pain. In fact, chronic pain generates over 24 million emergency room visits each year. Recently, this was discussed in an "Outside Magazine" article titled, "Have We Been Thinking About Pain All Wrong" so we had Dr. Paez and Dr. Saranita weigh in on the article.
Question: "Dr. Paez, a recent article in Outside Magazine titled "Have We Been Thinking About Pain All Wrong," discussed chronic pain being different because it has bio-psychosocial elements. Could you explain what this means?"
Dr. Julio Paez, M.D.: Chronic pain is complex, it is not simply a connection between nerves like acute pain. For example, if you break your arm. Rather, it involves physical and psychological processes. MRI and PET scan research shows that many parts of the brain are active during pain perception. This is where emotions and behavior are closely integrated, which means the processing of emotions, behavior and pain are closely linked. Studies have shown that individuals who experience depression, trauma or anxiety are at a higher risk for developing chronic pain.
We also know the "social" element of a patient has implications with pain. What I mean by that is for example, let's say a patient has chronic pain, but she also shares she lives in a home with domestic violence. We know these types of chronic social stressors impact the nervous system and thus impact the pain experience.
Question: Dr. Saranita, in the same Outside Magazine article, they mentioned that pain should not always be viewed as negative. What does this mean?
Dr. Saranita, D.O.: Pain alerts us that something is happening in the body, while this is a positive element of pain it also means there is something happening in the body that we need to address.
Question: Dr. Saranita, how should we change the way we treat chronic pain?
Dr. Saranita, D.O.: We believe it is best to address chronic pain with a whole patient approach in which we not only address chronic pain and the pain condition, but consider other factors of the overall health of the patient. Some examples include diet, we examine whether dietary factors could be contributing to inflammation because we know food impacts our health. We also look at sleep, we know a lack of sleep can contribute to the pain experience. In addition, movement and exercise. Often patients with chronic pain may avoid exercise or movement, but we know movement even light stretching is so critical for the body. And as discussed before, we look at the social elements that may contribute to the pain experience such as social isolation, abuse, addiction, lifestyle, etc.
It is also important to understand that when we treat pain, we integrate non medicinal treatments such as physical therapy, cognitive behavioral therapy, nutrition, massage therapy, acupuncture and natural therapies which are key in treating chronic pain. We do this not because we are minimizing the pain experience, but because we know these non-medicinal treatments significantly aid in restoring quality of life."
Question: "Dr, Paez what do you believe is important for patients to know about treating chronic pain?"
Dr. Julio Paez, M.D.: "We believe it is critical for patients to know that treatment of chronic pain requires more than one treatment method and examining the risks and benefits for each treatment. As Dr. Saranita shared, we want our patients to know that as we treat chronic pain, we also need to treat other factors that influence the pain experience.
There's not a one size fits all approach to the treatment of chronic pain. There's certainly no magic pill. Each patient, their pain experience and overall health status are unique and therefore treatment varies from patient to patient."
Lastly, both Dr. Saranita and Dr. Paez agreed, communication is critical to the treatment of chronic pain. Dr. Saranita shares, "We want our patients to communicate openly with us and their health care team about their pain experience, overall health and social situation. Similar, we encourage our patients to communicate with their family, caregivers or loved ones about what support they need as they manage living with chronic pain."
