How best to treat chronic pain? The jury is still out

[Guest guest]

How best to treat chronic pain? The jury is still out

http://www.eurekalert.org/pub_releases/2008-06/iu-hbt060508.php

How best to alleviate chronic pain, a leading cause of disability and

employee absenteeism, continues to perplex both patients and their

doctors.

A review of recent studies on pain medicine appearing in the June

2008 issue of the Journal of General Internal Medicine reports that

while various approaches and combinations of therapies to treat pain

have advantages and disadvantages, researchers don't yet know how to

determine which is best for individual patients.

Among the approaches to pain management studied were those relying on

the prescription of opioids (drugs such as morphine, Percocet and

Vicodin), surgery, and alternative medicine (acupuncture, herbal

remedies).

" We conducted this review of pain management strategies because

doctors, especially primary care doctors who manage the bulk of

patients with chronic pain, are frustrated and want to know how to

better alleviate what is often debilitating pain. Many of these

physicians have not been well trained in pain management. And while

many are paying more attention to pain than ever before, especially

given JCAHO (Joint Commission on Accreditation of Healthcare

Organizations) and Veteran Affairs mandates that pain be regarded as

the --fifth vital sign,-- they don't know what treatment will work

for a given patient. They want guidance and we found very limited

information, " said the paper's senior author, J. Bair, M.D.

Dr. Bair is an assistant professor of medicine at the Indiana

University School of Medicine, a research scientist with the

Regenstrief Institute, Inc. and an investigator at the Roudebush VA

Center of Excellence for Implementing Evidence Based Practice.

Chronic or recurrent pain affects more than 75 million Americans.

" We have found that there are huge gaps in our knowledge base. For

example, none of the opioid research trials lasted longer than four

months, a small fraction of the time during which many chronic

sufferers typically experience pain and are prescribed this potent

class of medication, " said Dr. Bair. " Similarly there were

insufficient trials of herbal remedies versus other analgesics (i.e.

pain medicines), in spite of the fact that pain management is one of

the major reasons for the use of alternative medicine. "

Dr. Bair's own research focuses on understanding the interface

between affective disorders such as depression and anxiety and

chronic pain and developing strategies to improve pain management in

the primary care setting.