Chronic Pain: New Research, New Treatments
WebMD talks to Scott M. Fishman, MD, president of the American Pain Foundation
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.
Q: What new chronic pain drugs are in the pipeline?
A: I'm very pleased we are coming up with ways to deliver drugs that are
less of a burden on patients. There are now several long-acting (also called
sustained-release) products that patients don't have to take every three or
four hours and be constantly thinking about when to take the next pill.