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Managing Pain

Pain Management

Chronic Pain Requires a Whole-Person Approach to Diagnosis and Treatment

Pain.

It’s one of the least pleasant words in the English language, something we try to avoid at all costs. One of the realities of living, however, is that we will face pain occasionally throughout our lives.

Most of the time, pain is short-lived: the result of a headache, overexertion, dental or surgical procedure, or other specific occurrence. Typically, pain medication and other simple remedies—along with a bit of time—relieve this type of pain, known as acute pain.

There is another category of pain, though, that millions of Americans struggle to cope with every day of their lives: chronic pain. For many, the back and/or neck is the source of pain. Others deal with chronic pain from cancer, arthritis or other conditions.

The International Association for the Study of Pain (iasp-pain.org) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

“Pain is an alarm mechanism,” said Simi Valley Hospital pain management specialist Lana Louie Wania-Galicia, MD. “Sometimes, pain is a good thing; it tells us to stop doing something harmful, such as touching a hot stove. Pain is a very subjective experience that is perceived by various people in various ways.”

It is that intangible quality of pain that makes it a challenge for physicians. While a doctor might be able to see the source of pain—a damaged vertebra, for instance—it is impossible to see the pain itself since it is interpreted in the brain. Pain is perceptible only by the person feeling it.

Among the most perplexing types of pain—for both patients and physicians—are those that have no identifiable source. One type of this sort of pain is complex regional pain syndrome, which may be caused by trauma to the body or may occur spontaneously, creating burning pain in the arms and/or legs.

“This pain can be amplified by stress from extremely emotional experiences, financial difficulties, sleep deprivation and so forth,” Dr. Galicia said. “Areas of the brain that don’t usually perceive and propagate pain are now doing so.”

Sometimes, the biggest challenge for people who are experiencing pain is knowing when it is time to seek medical attention.

“There are a number of things that might indicate it’s time to ask for help—or return for additional intervention,” Dr. Galicia said. “If you’ve tried medication but are still impaired, if your pain is the first thing you think of when you wake up in the morning, if you can’t do the things you love doing, if you’re experiencing severe emotional results of your pain, if your family members are starting to worry about you—any of these can be an indication that you need to seek the help of a physician.”

The most critical component of effective diagnosis and treatment of chronic pain, Dr. Galicia said, is the patient himself or herself.

“The patient plays a great role in getting better,” she said. “Achieving effective pain management is a collaborative effort among health care providers, patients and their family members, but the patient is always at the center of that process.”

When physicians look for the source of chronic pain, they must also take into account the entire person, Dr. Galicia said, including physiological, emotional, psychological, cultural and social factors that may contribute to the perception of pain.

“We address the pain in a multidisciplinary fashion,” she said. “We look for the results of the pain, the effect on the patient’s overall well-being. We look for psychological issues, things that amplify the pain, such as employment problems or issues at home.”

There are many options to treat chronic pain: lifestyle and diet modification, exercise, physical therapy, oral medications, injections, surgery and so forth. A pain management specialist helps patients make the right choice for treatment.