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Feb. 22, 2002 -- Thanks to recent breakthroughs in treating and preventing chronic pain, experts say no one should have to live with excruciating pain that affects their daily lives. But millions do, and that's becoming a sore issue for both doctors and their patients.
"Pain is degrading, it robs you of your quality of life, and you have a right to have it treated," said Stacie Pinderhughes, MD, assistant professor of geriatrics and internal medicine at Mount Sinai School of Medicine. Pinderhughes spoke yesterday at a media briefing on pain management in New York City, sponsored by the American Medical Association through an unrestricted grant from Purdue Pharma.
Researchers say new advances in how pain works and how it can be prevented and treated could soon make living in constant pain a thing of the past. But fears and misconceptions about potentially addictive pain medications can make it harder for some patients to get the proper treatment.
For example, Pinderhughes says recent studies have shown that minority patients are significantly less likely to receive pain medications for a number of conditions. Many doctors may also fear criminal action against them if they prescribe opioid painkillers, such as morphine, which may be abused -- even though the likelihood of either prosecution or addiction is extremely rare.
However, experts say the good news is that there are many new developments in pain management that can not only reduce suffering with or without drugs, but stop pain before it happens.
Laughter is Good Medicine
Laughter may really be the best medicine for children with pain. A new study by researchers at UCLA's Jonsson Comprehensive Cancer Center at found a good laugh can help children cope with pain.
Researchers examined the responses to pain among 21 healthy children, ranging in age from 8 to 14, as they put an arm in a tub of ice-cold water while watching a humorous video and when they watched the video before or after the experiment.
"How much they laughed was also associated with the degree of pain they felt," said study author Margaret Stuber, MD. "If they laughed beforehand, they said the cold water didn't feel so bad. If they laughed during [the experiment], they were able to do it longer."
Stuber says those children who laughed while watching the video during the cold-water test also released less of a pain-related stress hormone known as cortisol. She says those findings suggest that laughter somehow affects how the body perceives pain and more studies are needed to find out how it works.
"In the future, watching humorous videos could be come a standard component of some medical procedures," says Stuber. "It's one of the few things that is effective, but isn't expensive."
Stopping Pain in Its Tracks
Another way doctors may be able to reduce the pain their patients endure after surgery could be to give them pain relievers before surgery, rather than after. Mark Lema, MD, PhD, chairman of the department of anesthesiology and pain medicine at Roswell Cancer Institute in Buffalo, N.Y., talked about new research that has shown giving patients pain medication several hours before surgery can not only reduce their pain after surgery, but also reduce the amount of anesthesia needed.
Lema says the body responds to a surgical incision like any other cut or trauma, and the nerve endings swell and become more sensitive to pain as a defense mechanism. By giving pain relievers before the cut is made, doctors may be able reduce that painful response.
"It's like a tree falling in an empty forest," Lema said. "If pain signals go to an unconscious brain, they're still capable of causing damage to the nerve endings."
In the past, doctors were hesitant to give popular pain relievers known as NSAIDs (which include aspirin and acetaminophen) before surgery because they could cause excessive bleeding. But newer, safer Cox-2 pain medications don't carry that risk.
A recent study found patients who were given Cox-2 drugs one hour before minimally invasive knee surgery had an additional six hours of pain relief after surgery and needed fewer pain medications in the days after surgery.
Targeted Exercise Beats Surgery
Some people with low-back pain may be able to avoid painful surgery altogether by following a targeted exercise plan that addresses their pain individually.
"One size does not fit all and there is not one exercise for everyone with back pain," said Joel Press, MD, medical director of the Center for Sports, Spine and Occupational Rehabilitation with the Rehabilitation Institute of Chicago.
"The back is a complicated structure with a lot of potential pain generators that we can twist and turn," he said. That means doctors and physical therapists should work with their patients to determine the exact cause of the pain before developing an exercise plan. Press says many health care providers and patients fall into the trap of thinking there are only a few general exercise that everyone should do.
Instead, Press recommends "directionally preferenced" exercises that direct patients in the opposite direction of their pain.
"That means if someone hurts when they bend forward all the time, then we'll initially move them in the opposite direction away from their pain," said Press. "Progression to strengthening of the hip, back, side, abdominal, and lower-limb muscles, the so-called core muscles, is then addressed."
"Core strengthening can form a 'muscular corset' to protect the back and prevent chronic pain," said Press.