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    Combination Therapy Needed to Fight Chronic Pain

    Researchers Say Effective Pain Relief Must Combine Drugs, Physical Therapy, and Lifestyle Change
    By
    WebMD Health News
    Reviewed by Laura J. Martin, MD

    June 23, 2011 -- The last decade brought advances in our understanding of chronic pain, but this has not translated into better treatments yet, an analysis shows.

    The analysis was published in The Lancet.

    It found that treatments for chronic, non-cancer pain such as low back pain, arthritis, headache, and fibromyalgia don't do enough to alleviate pain or restore functioning in the majority of people.

    And don't expect any one pill to do the trick, says the report's author, Dennis C. Turk, PhD, an anesthesiologist and pain specialist at the University of Washington in Seattle. "There is this expectation that you will wave a wand and there will be a new pill or new surgery to alleviate your pain, and that is not likely to happen."

    "Chronic pain is a complex problem, and the only way to treat it is with a combination of treatments because no one treatment is sufficient," he says. Combination therapy may mean multiple medications or medications plus lifestyle changes, psychological treatments, and/or rehabilitation and physical therapy.

    Likening chronic pain to diabetes, Turk says "there are a lot of things to do in addition to medication, as in diabetes, where you also watch your weight and test your urine and blood."

    It will involve a more holistic approach, he says. "We have a tendency to try to diagnose people in silos and treat everyone with knee osteoarthritis (OA) the same way," he says. But "we need to treat people as a whole and not just knees." Social, emotional, and environmental factors all play a role in how we experience pain and painful conditions.

    One Treatment Not Always Enough

    Roger Fillingim, PhD, associate professor in the College of Dentistry at the University of Florida in Gainesville, says that there have been advances in understanding the biology of pain and in awareness of pain as a pressing public health issue in recent years.

    But "this hasn't translated into terribly effective treatments of chronic pain, and we will need more multidisciplinary treatments in order to provide more optimal clinical outcome for patients in pain," he says.

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