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

Jun 5 2008

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, Matthew 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.

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