Word: chronical
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Dates: during 2000-2009
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Even with the best alternative techniques, most patients with chronic pain will need some medication. Many general practitioners tend to use common analgesics as a one-size-fits-all remedy--a practice that contributed to the COX-2 fiasco--but pain experts try to carefully match the drug to the type of pain, the patient's risk profile and even his or her personality. "A patient's psychological preference for treating pain can be more important than the amount of medication," Palmer says. She cites the case of an elderly woman with arthritis in her back who preferred taking...
Although high-profile cases of addiction to OxyContin and other opioid pain-killers have scared off many doctors and patients, such drugs have an important role to play in chronic pain. They are particularly useful, says Palmer, for elderly patients, many of whom can't tolerate the side effects of anti-inflammatories. Younger people develop tolerances to opiates more quickly than the elderly, says Palmer, which means the young wind up needing ever higher doses. That is not a big problem in older patients. "I like to use low-dose opioids in the elderly because there aren't any liver...
Fishman, who is president of the American Academy of Pain Medicine, laments the way insurance plans favor quick pharmaceutical fixes over the kinds of physical and psychological therapies that chronic-pain patients need. The bias toward drug treatment is not only bad medicine but is also expensive. "When somebody comes in with 25 years of chronic pain," says Fishman, "I might sit with them for 90 minutes to get the beginning of the story, to really understand what's happening. The insurers would rather pay me $1,000 to do a 20-minute injection than pay me a fraction...
This barbaric notion was finally put to rest in the 1980s, as research proved that kids, with their still developing nervous systems, actually experience pain more intensely than adults do. But only recently have doctors begun to get serious about the problem of chronic pain in kids--even though millions of children suffer from juvenile arthritis, cancer, fibromyalgia and other extremely painful disorders. Moreover, as many as 20% of kids who undergo surgery each year develop chronic pain that lasts long after the body has healed. According to Dr. Lonnie Zeltzer, founder and director of the Pediatric Pain Program...
...UCLA program uses an innovative mind-body approach that has typically not been used before to treat chronic pediatric pain. Team members begin by taking a detailed pain history and asking kids--even as young as 4 or 5--where it hurts and exactly how bad it feels. Says Zeltzer: "You have to be a detective and put all the pieces together." The resulting treatment plan may include pain-killers, but these often have side effects--and because they're usually only tested in adults, they sometimes act unpredictably in kids. Whenever possible, Zeltzer chooses from a broad range...