Chronic Pain
AUTHOR: Judson J. Somerville, M.D., 
The Pain Management Clinic of Laredo

Chronic pain affects up to 80 million Americans a year. Low back pain is second after the common cold as the most common cause of illness.  For most of the world, management of cronic pain is relatively new. It's birth in America was pioneered by Dr. John Bonica in the 1940's during World War II.  He saw soldiers suffering continuing and disabling pain long after they healed from their injuries.  These patients had no other abnormality other than the pain and it was totally debilitating.  At the time there were only a few narcotics available to help control pain and a limited number of other pain control treatments.  His pioneering work focused attention on chronic pain.  Since then the field has rapidly progressed in the United States and we now have much better treatment options and medications for the treatment of chronic pain.

What is chronic pain?  It is pain which no longer serves a biologically useful function.  If, for the instance you place your hand on a hot burner your body will quickly tell you by the pain that it's hot and to remove your hand.  This is a protective mechanism.  However, if after you burn yourself the hand still hurts a month later or if you are in worse pain, you have chronic pain.  Other examples of chronic pain are migraine headaches, back injuries with pain that persists, pain after surgery or with the onset of cancer. One common symptom of chronic pain is sleep disorders.  Often, patients complain that they close their eyes for 8 hours at night, but still wake up tired and actually at times feel worse than when they went to bed.  Other symptoms of chronic pain are headaches, burning pain in different parts of the body that, in time, do not subside and joint or muscle stiffness.  Typically, any pain that persists longer that three months is considered chronic pain, but frequently symptoms will occur even earlier.  The most important thing to remember about chronic pain is to seek treatment early.  If not, the nervous system can become altered in such a way that makes chronic pain much more difficult to treat. Chronic pain patients are patients who've had some type of trauma to the body (i.e. surgery, accidental injury, illness) or sometimes no remembrance of any injury at all, but develop pain.

The best clinics use state of the art techniques to diagnosis the cause of the pain and then use medications and therapy to help control the pain. Sometimes patients are never completely relieved of the chronic pain, however, most of them achieve control over their pain to the extent that they return to their normal lives.

Frequently at pain clinics across the country it is not unusual for patients to have seen 9, 10, or 12 doctors of different specialties searching for help to relieve their pain before they finally are sent to or find a pain clinic.  As with any illness, it is very important for chronic pain sufferes to see an expert.

There are many new methods of studying the body to determine abnormalities.  One common diagnosis given chronic patients is fibromyalgia.  In fact, fibromyalgia is not a diagnosis, but is a description of symptoms.  At a pain management clinic great effort is given to finding a correct diagnosis.  The correct diagnosis is very important because it is closely correlated to the type of treatment prescribed to the patient.  Using MRI's, Diagnostic Ultrasound and Current Perception tests, pain management physicians are better able to diagnosis the true rause of the patient's pain.

The Current Perception test is diagnostic tool that quickly measures nerve function without using needles.  It shows which nerves are specifically affected by the pain, whereas as EMG cannot show this.  The ability to measure all the nerves and which ones are specifically affected by pain helps the physician obtain an accurate and early diagnosis of hte source of the patient's pain.  With early diagnosis pain management specialties are able to initiate treatment and to give better long-term pain control results.

Another diagnostic tool that is relatively new is the Muscular Ultrasound.  This is a very effective diagnostic tool that helps determine exactly where the pain is located.  This is a new modality and requires an expert technician to perform this study and an expert to read the study for the best results.  Sometimes, a doctor informs a patient who has complained of constant pain that there is nothing wrong with them when the MRI, x-ray and blood work come out negative.  Using the diagnostic Ultrasound on many of these patients a pain management physician can document bonafide pain or injury to the area of complaint.  This modality has helped patients get proper treatment and feel better.

The use of medications to treat pain is important.  Chronic pain frequently causes severe pain requiring potent pain medication. A pain management physician treats exclusively patients with chronic pain.  At a pain management clinics medication frequently used for other ailments such as seizures, depression and even **toxins ftm food poisoning** are used to treat chronic pain. There is a tremendous effort in the industry to flnd new and improved medications to treat patients with chronic pain. One new pain medication is called Snx-111. It is derived from a sea snail toxin.  Sea snails move slowly, but this snail from the South Pacific sprays out a toxin as soon as fish swim by and instantaneously kills the fish. Fortunately, the medication derived from this animal and used on humans is not the ingredient which kills fish. However, it does help control abnormal nerve function, which is frequently one of the main instigators of chronic pain.

There are many treatmems for chronic pain such as physical therapy, massages, chiropractic, electrical therapy, nerve injections and blocks, implantable pain devices. As with any disease, chronic pain has a range of treatments. Most probably the pain management specialist starts with the most general and least complicated or invasive treatment and progresses through the treatment options until he/she finds the best treatment to help the patient. For patients who've undergone physical therapy or chiropractic and massage, but still have severe pain, specialized injections allow better diagnosis and treatment of the pain. These injections are done in the hospital and the patient is given medication to relax. They are performed with x-ray guidance and specialized injections block the pain.

These injections help the pain management specialist obtain a specific diagnosis and determine exactly where the pain is coming from. Frequently. the patient experiences long lasting pain relief to that area.

For patients that suffer chronic pain as a result of cancer, one treatment option is an Morphine Infusion Pump, which gives up to 300 times as much medication as can be given by mouth with very little side effects. This is a huge advantage for the patient who suffers from severe pain. The pump allows them to get on with their daily lives with fewer side effect and without the worry of remembering to take numerous pain pills.

New techniques to diagnosis the cause of chronic pain, improved medications and therapies to treat it helps patients with chronic pain to live normal lives. Once chronic pain is reduced the patient can take control and do the exercise necessary to help keep the pain manageable.

Chronic Pain management is a very dynamic field with constant changes and improvements in the treatment for patients. This is a long neglected area and is still misunderstood by patients, their families and even many doctors. The key to treating chronic pain is to accurately diagnose the cause of the pain and manage it in conjunction with the patient's abilities, beliefs and limitations, in such a way that allows the patient to control his/her pain and a resume a normal life.