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    Chronic Pain: New Research, New Treatments

    WebMD talks to Scott M. Fishman, MD, president of the American Pain Foundation

    Q: About chronic pain: have researchers learned anything new about the origins of chronic pain that might lead to better diagnosis or treatment? continued...

    New information has emerged in the last 10 years from one of the most active areas of pain research, neuroimaging. Functional MRI (magnetic resonance imaging) scans that look at brain activity when it's in pain or when it's receiving a pain reliever now tell us that when someone is in chronic pain, the emotion centers of the brain are more activated than the brain's sensory centers, which are more involved in acute, not chronic, pain. That's why pain is likely an emotional experience.

    For all we've learned, however, we have not translated most of these advances to the frontline of medicine. Every time we take one of these discoveries and treat accordingly, we find unwanted side effects because pain is so pervasive. For instance, it's very hard to give someone pain relief without making them sleepy. It's very hard to turn off the nerves that transmit pain without producing the risk of seizure or heart rhythm problems.

    But we're making advances. We're learning more about the electrical channels involved in nerve function. And we have many more candidates to target, and we're very hopeful that's going to translate into drugs with far fewer side effects.

    Q: How can these chronic pain discoveries effectively help patients?

    A: We need to use the full range of treatments available, not just drugs and surgery but mind/body, alternative, and psychological therapies as well.

    Usually, a person in chronic pain is not suffering from just one perspective. One has to understand what pain does. We're designed so the alarm of pain grabs our attention and we prioritize that over other things. When your attention is absorbed and you can't attend to all the other things that are meaningful in your life, a downward cycle sets in.

    Say a person has a painful arm; before long, he may not be able to sleep, may not be able to exercise, and may become deconditioned -- which may lead to arthritis problems or obesity or sexual inactivity and a deterioration in his intimate relationship. He no longer can support his family. He becomes depressed and anxious and ultimately may become suicidal. Chronic pain undermines all aspects of quality of life.

    Therefore, we have to attack the problem from more than one perspective. Often the patient in pain needs to be treated both medically and psychologically, socially, and culturally. That's really what I would call a holistic approach, not an alternative approach -- one that addresses the whole person. I think where we're headed is a re-evaluation of how we are delivering fragmented pain care and possibly redefining the field so it can integrate, so that patients can get the best of all that's available from a single doctor.

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