Word: chronical
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...therapies (nerve blocks like epidurals); physical therapy and exercise; and behavioral techniques that include relaxation training, biofeedback and psychotherapy. "If you ask most physicians how they would treat a patient, they would say, 'I use this drug' or 'I use that drug.' But there are many ways of treating chronic conditions that don't involve drugs," says Dr. Allan Gordon, director of the Wasser Center. "You have to look at the whole individual. A multidisciplinary approach is the only answer." A patient who learns to reduce pain with breathing exercises or biofeedback, Gordon notes, can often manage his misery with...
...doing is telling them they have a mental illness and you don't really believe they have a physical problem," says Dr. Scott Fishman, an anesthesiologist, internist and psychiatrist who is chief of pain medicine at U.C. Davis. But the mind is always actively involved in pain, especially in chronic cases. "We know that when you image the brain, the areas that light up when you experience pain include parts of the brain involved in emotions," says Fishman. That is why learning to relieve fear, anxiety and depression related to pain actually helps bring relief, probably by activating the body...
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...