Word: paines
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Dates: during 1980-1989
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People with chronic pain often wind up on a medical merry-go-round: psychiatrists tell them that their problem appears to be physical; internists and surgeons tell them they ought to have their head examined. Western doctors, trained to cure acute illness, are often frustrated by patients with vague pain that refuses to go away. So are the families, who quickly tire of hearing complaints. Dejected, guilt-ridden and increasingly isolated, many pain patients eventually seek care outside standard medicine: herbal treatments, chiropractic, faith healing and, too often, quackery. Says Fields of U.C.S.F.: "They fall through the cracks...
Many of these people are now finding their way to multidisciplinary pain clinics, of which there are about 150 around the world. The idea...
...combining the skills of doctors in many disciplines to deal with pain was pioneered by Bonica at the University of Washington Medical Center's Clinical Pain Service in Seattle (see box). Treatment at a pain clinic begins with a thorough workup, including physical, psychological, neurologic, orthopedic, radiologic and laboratory examinations. If a physical problem is detected-a tumor pressing on a nerve, a slipped disc-surgery or some other appropriate treatment will be recommended...
However, in general, pain clinic patients have less concrete causes for their suffering. For them, the first step often is to be weaned from whatever narcotics they have been taking for relief, substituting methadone if necessary and offering psychological counseling. Doctors tend to frown upon the use of narcotics and muscle relaxants like Valium because they may add to a pain sufferer's debilitation...
...first line of treatment is the "simple analgesics": usually aspirin and acetaminophen. Even cancer patients can sometimes find relief in a bottle of aspirin. A number of other nonnarcotic drugs have proved useful in treating specific kinds of pain. Migraine Sufferer Elaine Anderson, 31, of San Francisco had tried everything from strong doses of codeine to psychic counseling to relieve pain "that felt like someone was tightening my head in a vise." She finally found relief with calcium channel blockers, originally developed for heart patients. Antidepressive drugs like the tricyclics are frequently recommended for shingles and chronic lower-back pain...