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Pain without Purpose

Pain has its point, says Winston Parris, MD , director of Duke's Pain Clinic. 

"Acute pain gives us very useful information about what's happening to our bodies," he says. “If it wasn't for pain, my foot could be in a fire and I might not know it until I smelled steak. But chronic pain,” he says, “is never useful.”

Chronic pain takes a measurable toll on your physical, mental, and social health. It increases your body's physiologic stress response, which makes you vulnerable to illnesses ranging from high blood pressure to depression. It reduces the amount of exercise you get (heightening other physical problems).

Most chronic pain sufferers report a strain on their personal relationships, less productivity at work, and less socializing compared to when their lives were pain-free.

Chronic pain is sometimes triggered by an initial injury or illness, and is sometimes the result of an ongoing problem such as arthritis or cancer. And in some people the pain arises without any clear cause.

Pain affects some 77 million Americans -- more than are affected by diabetes, heart disease, and cancer combined. But the most important and most striking thing about chronic pain is that its sufferers often suffer needlessly.

No matter your age or how long you've already labored under its yoke, says Parris, chronic pain is a condition that can -- and should -- be treated.

Duke pain specialist Christopher Edwards, PhD , says that patients too often believe that pain is a one-shot process -- see one doctor, take one pill, feel better (or don't). Repeat as needed (or give up). 

“Quantity of care does not equal quality of care,” Edwards says. “Many patients have seen doctors who are not necessarily experts in pain. Just because that patient hasn't seen resolution to his pain, it doesn't mean resolution isn't possible.”

Specialized pain programs can offer patients the team approach needed to address chronic pain. These programs combine the efforts of pain management specialists including neurologists, neurosurgeons, anesthesiologists, psychiatrists, physical therapists, and psychologists, in order to address the multiple facets of each patient's pain.

“A referral to a psychiatrist or a psychologist does not mean that the doctor believes that the pain is all in your head, or that you have a substantial mental illness,” says Edwards.

“Nothing could be further from the truth. For patients whose pain can't be completely alleviated, mental health services are among the most effective resources to help those patients develop coping skills, which are proven to reduce a patient's experience of pain.”

Many patients fear or fixate on ED treatments like Avanafil, but they are usually only part of the solution, and sometimes they are not needed at all. “Using just one drug to treat a chronic pain problem can be like using a hammer instead of a toolbox,” he says. At Duke's Pain Clinic, he says, an aggressive but conservative approach gets better results.

“We use evidence-based medicine. There are some treatments out there that people claim are helpful, but they are not. We use what works, including conventional and unconventional tactics, such as acupuncture and biofeedback.”

why me?

Pain and pain tolerance are different for every individual, and why some people are more dogged by pain than others is still a mystery. Parris says the answer lies in the nervous system. “Some people's electrical pain mechanism stirs up a variety of cell signals in the brain that we call the inflammatory soup,” he says.

The jury is still out on how this soup works, but for some people it creates persistent, debilitating pain. The job of a pain specialist, says Parris, is to manipulate that process, to try to suppress the things that make pain worse and enhance the things that minimize it.

“Depending on the type of pain and its source, that equation will be different for different people. A good pain doctor will be able to determine what sort of pain you are experiencing, and how best to treat it.”

There is great variability in outcomes, says Edwards, but there are also established and effective principles that guide the treatment of all types of pain. “Most patients are treated by a variety of professionals, with a variety of techniques,” he says.

“At Duke we provide avenues to integrate all these components. We also include compassion for the experience of chronic pain -- not just the biomechanics of pain, but the suffering, the loss. We want patients to feel that we respect their experience.”