The "right" target in the management of pain

The "right" target in the management of pain - It is logical that the main goal of pain management should be to reduce the pain. 

However, a recent editorial in the New England Journal of Medicine made a strong case for looking beyond the pain intensity assessed what is the pain management "success".

The "balance" the management of chronic pain 

Here's the problem: For people with chronic pain, pain affects nearly every aspect of their lives. At the same time, treatment to relieve chronic pain also have the potential to influence many aspects of a person's life. 

Our best medications for pain relief have many unpleasant side effects. Even non-pharmacological interventions (such as physical therapy) and complementary therapies (such as acupuncture) usually not only have a unique effect.

This means that if we give priority to reducing the pain any other result, we end up doing as much damage as we do it well. In particular, the authors suggest that the editorial focus solely on reducing the intensity of pain, and the creation of a moral mandate to relieve pain, have contributed to the crisis of opiates in that country. In recent decades we have seen a steady increase in prescriptions for opioids, misuse and abuse of opiates and related overdose deaths. 

Patient surveys also show that people with chronic pain care more about the experience less pain. They care more enjoy life, have a strong sense of emotional well-being, increased physical activity, improve sleep and reduce fatigue, and to participate in social and recreational activities. These objectives must be weighed against the disadvantages of pain.

For example, opioids such as oxycodone (OxyContin) may reduce the intensity of pain and make it easier to fall asleep. But they make people tired, cause constipation and memory problems, and bear the risk of abuse and overdose. 

How the pros and cons cell is very personal and varies from patient to patient. For some people, the risk of abuse is small side effects are minor, and the drug reduced a lot of pain. For others, these drugs reduce the pain just a bit, so that fatigue and cognitive side effects are so bad that it is difficult to carry out routine activities such as driving or going to work.

The future of pain 

The authors also suggest that editorial treatment to control pain is not only that but also individualized multimodal (ie, a combination of different therapies) can produce the most benefits with the least damage. A solid base of scientific research supports this position.

For example, a person with chronic back pain, a recent history of alcohol abuse and depression and insomnia may do better with a combination of non-opioid analgesics for pain, cognitive behavioral therapy and antidepressant, while the other person, also with chronic low back pain can get the best results with a combination of low-dose opioids daily and weekly acupuncture.

Dr. Robert Jamison hospital at Harvard-affiliated Brigham and Women of shown that behavioral treatment to improve adhesion of opioids in patients suffering from chronic pain actually reduced rates of drug abuse among patients most likely to abusing these drugs. 

The "success" of pain is very individual. So you can not assume that what you read or hear online with other people (eg, "Drug X is large, you should try" or "drug Y is terrible, why would prescribe this") represent how a drug will work for you.

The field of pain management needs a lot more research to determine which patients are most likely to benefit from a given treatment. Perhaps, for example, patients Younger migraine sufferers can gain more drug A, while elderly patients with tension-type headaches can do better with drug B.

This kind of categorization, known as the "phenotype", provide a basis for management Custom pain, ideally, it would improve the clinical management of people with pain and minimize damage related to treatment.

Above all, I believe the combination therapies that not only reduce pain, but contribute to long quality life goals with a renewed focus on individualized treatment approach represents significant progress in the field of management pain and are important steps towards the full effectiveness of our duties to suffering patients. 
By: Robert R. Edwards, Ph.D.