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Chronic Pain: New Research, New Treatments

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

Q: What about using supplements for chronic pain? What works?

A: Supplements are interesting, and several do seem to help. Fish oils, for example, have omega-3 fatty acids, which have potent anti-inflammatory effects as well as other health benefits. Others are glucosamine and chondroitin and evening primrose oil, which is a lipoic acid supplement that helps nerves function properly. It can be very helpful for patients with neuropathic [nerve] pain.

The problem is that people think of supplements as side-effect free. But they are potent medications that really do have impact -- both positive and negative. For example, people may not know that supplements such as fish oil or garlic or vitamin E are blood thinners, and if you take them together or with other blood thinners you can have problems.

Q: Anything new about treating migraine pain?

A: Migraine pain is a highly prevalent and widespread problem, but we really don't know yet what causes migraines. New information in neurochemistry and neuroimaging is helping to change that. In the last 15 years, we've seen a revolution in treatment with triptans and other drugs that can stop a migraine rather than just numb the pain.

Q: What's ahead for treating osteoarthritis pain?

A: Osteoarthritis is a kind of wear and tear, and we're recognizing that has much to do with use and disuse. If we keep people in fit condition, they rarely get this severe osteoarthritis. We're also learning more about the role inflammation plays in osteoarthritis. Recently, some anti-inflammatory drugs were taken off the market because they caused heart problems. Now, we are learning about this issue with all anti-inflammatories, and probably none of them is exempt. So in the future we'll find out what that problem is, and we'll be able to tailor drugs away from it.

Q: Fibromyalgia for many years was somewhat maligned as a diagnosis. Has this changed? And since this condition can be difficult to treat, where are we with treatment today?

A: I think we're pretty sure now it exists but we have to be honest. We're not sure what "it" is. And it may not be one thing. It may be multiple disorders that lead to a global deconditioning disorder. In terms of treatment, I don't think we're terribly far along. I think we can help people with fibromyalgia but we're nowhere near curing it.

Q: So many people have back pain. What's new in this area?

A: We're learning more about all the different small structures in the spine that can cause back pain. For example, there are now targeted treatments, usually injections, that put medication right into the area of the nerve causing the pain.

No question, back surgery can be very effective but it can also be devastating and harmful, so we have to resolve who is a good candidate and who isn't. New studies now coming out are helping us to better predict this. We're also asking new questions, such as, why do certain regions of the country have more back surgeries than others? I think within the next decade we'll have many more answers.

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