Blog | Tuesday, September 10, 2013

Elements of chronic pain are often overlooked


I think everyone who sees patients, and treats a lot of them with a particular condition, comes to see that condition as a microcosm of all of medicine. And that’s the way with me and pain. For some reason—perhaps it’s because I tend to see these patients more frequently than others—I think I have more of them.

Pain, and I mean here chronic pain, has certain characteristics which are shared with many other chronic diseases. Such elements of illness are often overlooked, and focusing on the forms they take in pain might be useful in conceptualizing them.

• Often, medicines for chronic pain [as for other conditions] don’t work that well.

• For many people with chronic pain there is no one “medical” cause that explains their symptoms.

• Other stressors, whether psychological, psychiatric, or social, play an important role in the severity and treatment of pain, and frequently these are un- or undertreated.

• Pain is a symptom experienced by nearly everyone at some time or another. Thus many people think they know what chronic pain is like. But if I’ve heard one thing from every one of these patients, the occasional bout of acute pain does not reflect the experience of chronic pain.

Do you have or have you had chronic pain? Do you agree with these assessments? And what should we do to improve matters?

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.