Although pain is a part of life, there is much that doctors
and other health care providers can do to reduce the severity of acute or
chronic pain. Pain that is persistent, severe, continuous, or intermittent can
destroy the will to live and interfere with adequate treatment when it is not
controlled.
Chronic pain has its roots in social behavior and norms. People with painful
conditions tend to be generalized in the same terms as "street
addicts" when it comes to decisions that govern their ability to receive
appropriate treatment and pain-relieving medicine. While the "street
addict" who is psychologically sick and abuses drugs for recreation, the
patient in pain is psychologically healthy and requires medicine and other
measures as long as his or her symptoms remain.
Educating health care providers about pain diagnosis
A
real problem in the appropriate diagnosis of painful conditions lies in the
education of doctors and other health care workers. Pain has traditionally been
treated as a symptom, which is appropriate in terms of acute injury or medical
disease. Often, however, when injury has healed or the disease has
subsided, such individuals might be left with chronic pain; and because of the
disability it causes, this pain can be considered a disease in itself.
Pain management requires multidisciplinary approach
It
was Dr. John J. Bonica, an Italian, who recognized that many of the thousands of
wounded servicemen he managed during the end of World War II had pain long after
their original injuries had healed. Their chronic pain affected the
back, head and neck, abdomen, muscles, nerves, and limbs, and did not respond to
traditional treatment. He realized that a multidisciplinary approach was
required to satisfactorily control these symptoms. This approach required a
combination of special diagnostic methods, as well as psychological assessment
before treatment could begin.
Because the source of pain is often elusive, diagnostic techniques tend
to look at altered function and tend also to be divided into those relying on a
mechanical, chemical, or nerve related response.
Diagnostic tests
The traditional
tests used to diagnose painful conditions include X-rays, magnetic
resonance imaging (MRI), electromyography (EMG), and nerve conduction studies.
However, tests that are often performed in pain management centers are
directed toward eliminating or reducing pain as an endpoint.
For example, while EMG and nerve conduction studies might tell health care
providers what is wrong with a particular nerve or nerves, blocking these
structures with a local anesthetic can help the health care provider distinguish
between pain that might be arising within a nerve or nerves, or from the
structures that they serve. Such tests might involve the sequential blocking of a peripheral nerve, the
nerve root from which it arises, or a structure within the spinal canal, for
example.