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Chronic Pain: New Research, New Treatments

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

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.

Q: What new chronic pain treatments are you particularly excited about?

A: One has to do with teaching patients how to overcome their pain. We know that the human mind can create pain but that it also has enormous power to take it away; we can teach people skills that were known to Buddhists hundreds or thousands of years ago.

It's the same focusing technique athletes use to help them improve their performance. Take Lance Armstrong on that last hill of the Tour de France. Even though his legs are burning, he can divert his attention from the pain to the goal of performance. And you can do this with many different techniques. In this case, he's used a cognitive technique to change the internal message, "I'm hurting, I better stop" to "I better keep going but perform differently." A pain psychologist teaches these techniques.

What I tell my patients is that pain psychologists are really coaches. They're not there to diagnose an illness but to help you learn techniques to use your brain better -- just like you would go to a physical therapist to learn techniques to use your body better. It's the same thing.

Q: You're describing a mind/body way of dealing with chronic pain.

A: Yes. You can't have pain without a mind, so it's all connected. My patients are always afraid I'm going to think their pain is all in their head, that they have a mental illness rather than a physical illness, and ignore the real problem. I try to counsel them that it's quite the opposite, that any pain requires a mind and you can't have pain without a head; so recognizing that opens up all sorts of opportunities to help cope and reduce suffering.

I think of mind/body approaches as techniques that tap into the body's own pharmacy. Things like mindfulness and biofeedback and cognitive behavioral retraining, or guided imagery, even self-hypnosis. Things like acupuncture and massage. We don't know how these things work but we're certain they're helpful.

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