New cases of chronic pain occur more often in the United
States than those of other chronic conditions, like diabetes, depression and
high blood pressure, according to a study from the National Institutes of
Health.
اضافة اعلان
The findings offer a large-scale confirmation of what
previous research has shown: Chronic pain is staggeringly common in America.
Experts have known that around one-fifth of US adults have
chronic pain, but the new study offers a snapshot of just how many people are
newly suffering each year.
Researchers analyzed data from 10,415 adults who
participated in two editions of an annual survey led by the Centers for Disease
Control and Prevention, in which respondents reported how often they felt pain
in the past three months, and whether that pain interfered with their daily
lives.
“We’re talking about a major public health problem,” said
Dr. Gregory Terman, a pain medicine specialist at the University of Washington
School of Medicine and a co-author of the study.
A hard road to recovery
The study shows that as more people develop new cases of
chronic pain, existing patients struggle to recover. Only around 10 percent of
those with chronic pain in 2019 were pain-free in 2020, which underscores just
how hard it is to treat.
“It’s astronomical,” said Richard L. Nahin, the lead author
of the study and the lead public health researcher at the National Center for
Complementary and Integrative Health.
And it’s possible these numbers have grown during the
coronavirus pandemic, said Beth Darnall, a professor of anesthesiology,
perioperative and pain medicine at Stanford School of Medicine who was not
involved with the study. But a number of existing and emerging treatments can
alleviate pain.
“There really are solutions, and there is help,” Darnall
said. “Unfortunately, it’s just not easy to find.”
Why is chronic pain so difficult to treat?
It’s hard to pin down a singular definition of pain. The
study defined people with chronic pain as those who said they had pain most
days, or every day, over the previous three months.
Chronic pain itself can be a disease, said Dr. Prasad
Shirvalkar, an associate professor of anesthesia and neurological surgery at
the University of California, San Francisco, who studies pain management.
He added that it could take years for some patients to get
an accurate diagnosis for conditions that cause chronic pain, and that over
one-third of cases occur with no clear cause.
“It’s like a fire alarm going off, but there’s no fire,” he
said.
Even when doctors can diagnose conditions that cause chronic
pain, many aren’t equipped to treat it. “There really is an underappreciation
in the medical community about pain management,” said Dr. Michael Bottros,
clinical operations chief and medical director of pain services at the Keck
School of Medicine at the University of Southern California.
Moreover, because pain is “nebulous” and varies from person
to person, he added, it can be difficult to pinpoint the appropriate
treatments.
The study also examined how pain progresses into chronic
pain. Participants who experienced acute pain were more likely to develop
chronic pain in the next year, with about 1 in 6 people with non-chronic pain
reporting chronic pain a year later.
In other words, without early intervention, experts say,
pain can sometimes compound; what starts as an acute or occasional ache might
worsen into a long-term problem. But not everyone has equitable access to that
care, Darnall said.
How to get help for chronic pain
Experts recommend first going to a primary care doctor if
you are experiencing pain that interferes with your daily life. If you’re not
improving after six weeks, Bottros recommends seeking out a specialist.
If you are struggling to find a chronic pain specialist,
Shirvalkar recommends looking into pain centers at major universities, many of
which offer telehealth appointments.
Community hospitals may also be able to offer resources.
Darnall said that advocacy organizations for particular conditions, like the
Marfan Foundation, can also provide educational materials and help patients
find providers. Recent changes to Medicare have also expanded coverage for
treating chronic pain, Nahin said.
In response to the opioid epidemic, some doctors have tried
to move away from medication as the first response to treating chronic pain.
It’s critical to treat chronic pain through a multimodal approach, experts
said, using several therapies. A patient may go to physical therapy, for
example, but also see a mental health professional for cognitive behavioral
therapy.
“One flavor of treatment is never going to be adequate,”
Shirvalkar said.
Mental health treatment is a particularly promising, but
often underused, way to address chronic pain. “A psychologist can fundamentally
help reframe how people relate to their pain or even the cues that they listen
to in their bodies,” Shirvalkar said.
Newer treatments are also on the horizon like virtual
reality treatments and brain stimulation to see if they can alleviate pain.
“It’s not a one-size-fits-all,” Darnall said. “Patients are
not a monolith.”
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