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Overview of the Treatment of Pain in America
Pain is a long-standing problem of epidemic proportions in America, with 83 million adults living with pain that affects their participation in daily activities, and 75 million people with chronic debilitating pain. Treatments most often prescribed by physicians include pain medicines—narcotic and non-narcotic, physical therapy, and surgery. Studies show that many people have endured years of agony and have undergone two or more failed surgeries seeking pain relief. Furthermore, 4.5 million patients die in pain each year, and 26% of nursing home residents experience pain daily.
Acute vs. Chronic Pain
Pain can be described according to its cause (malignant or non-cancer), physiologic description (neuropathic, visceral, or somatic), and/or temporality (acute or chronic). The distinction between acute and chronic pain is no longer considered primarily a function of how long the pain lasts. Instead, acute pain is described as pain that usually has an identifiable pathology and predictable prognosis. Examples of acute pain are a sprained ankle or ear infection. These types of pain usually resolve once treated and healed. Chronic pain, on the other hand, is generally of unclear pathology and unpredictable prognosis, and can be caused by countless diseases, syndromes, injuries, or surgeries. Chronic pain tends to last longer than six months—beyond the expected course of healing.
Impact of Chronic Pain
Chronic pain negatively impacts all aspects of an individual's life, including emotional, vocational, financial and social elements. The entire family may be dramatically affected, and many feel isolated because they can no longer work or must drop out of their normal activities, thus further isolating themselves from friends and family.
Shortcomings of Conventional Treatment of Chronic Pain
While more than 80% of all physician visits are for chronic pain, the majority of health care providers have little or no training specific to pain medicine and management. Pain costs the nation an estimated $100 billion annually in medical claims, disability payments and lost productivity. In an effort to improve on these shortcomings, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued guidelines in their 2000-2001 Standards Manual that recommend screening for the presence of pain, assessing its nature and intensity, keeping records of assessment so that follow-up can be performed, and establishing procedures to provide appropriate medication to patients in pain.
Various approaches have been tried to encourage patients and healthcare providers to talk about pain and to allow for adequate treatment. Despite these efforts to publicize proper pain management, under-treatment continues. Practitioners and even patients still view pain as something they must learn to live with.
Clinical Factors
Providers may fail to assess pain routinely or accurately. Clinicians are often fearful of patient addiction to narcotics and sometimes prescribe inadequate doses and/or inappropriate drugs. Some health care providers believe that a patient’s increasing requests for pain medication indicate a tolerance to these drugs instead of unrelieved pain. Clinicians are concerned about possible disciplinary action by regulatory authorities monitoring prescribing of controlled narcotics.
Patient Factors
A key factor in the underassessment of pain is that sometimes patients do not report their pain. Patients may believe that pain is a normal part of aging or that good patients do not complain. They also may be concerned about adverse effects and addiction. Lastly, patients often fear that if they acknowledge they are in pain, there will be financial or occupational consequences. These patient factors are in part attributable to inadequate patient education.
Benefits of Alternative Therapies in the Treatment of Chronic Pain
Despite the physical and financial toll, millions of people continue to suffer needlessly, unaware of effective pain-management options. The goals of an appropriate pain management program should be to decrease pain and suffering, improve physical and mental functioning, and to ensure improved quality of life. Patients have sought out non-conventional treatments when conventional medicine failed, and the recent attention on improving pain in America has placed an even greater emphasis on alternative and complementary modalities in the field of pain medicine. Today, the approach most pain management programs embrace is to respect pain, treat it intensively, address the patient's psyche, and to adopt an integrative multidisciplinary approach, incorporating the following: patient education, medications, physical therapies, relaxation techniques, psychosocial counseling, surgical procedures, injection techniques, various alternative medicine modalities.
For additional resources on relevant Alternative and Complementary Resources, see our Resource Guides on:
References:
American Pain Foundation. Fast facts about pain. Available at: http://www.painfoundation.org/page.asp?file=Library/FastFacts.htm
National Pain Foundation. The Need for the National Pain Foundation. Available at http://www.nationalpainfoundation.org/AboutUs/default.asp
Current Analgesic Options: Optimizing Pain Management. University of Wisconsin Medical School, the University of Connecticut School of Pharmacy, and PharmaWrite.
Berry PH, Dahl JL. Making pain assessment and management a healthcare priority through the new JCAHO pain standards. J Pharm Care Pain Symptom Control. 2000; 8: 5-20.
Dahl JL. Improving the practice of pain manageent. JAMA. 2000; 284: 2785.
Foley K. Dismantling the barriers: Providing palliative and pain care. JAMA. 2000; 283: 115.
Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being. A world health organization study in primary care. JAMA. 1998; 280: 147-151.
Ward SE, Goldberg N, Miller-MccCauley V, et al. Patient-related barriers to management of cancer pain. Pain. 1993; 52: 319-324.
Weinstein SM, Laux LF, Thornby JI, et al. Physicians attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas cancer pain initiative. South Med J. 2000; 93: 479-487.
Won A, Lapane K, Gambassi G, Bernabei R, Mor V, Lipsitz LA. Correlates and management of nonmalignant pain in the nursing home. J Am Geriatr Soc. 1999; 47: 936-942.
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NOTE: The following resource listings are not intended to be comprehensive, nor to be used as a guide for treatment. They are provided for information only. The resources are selected and categorized to help you with your own research.
BOOKS
AUTHORITATIVE RESEARCH RESOURCES
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J. Dillard, M.D., D.C.
The Chronic Pain Solution: Your Personal Path to Pain Relief
Bantam, 2003
Dr. Dillard, director of Complementary Medicine Services at the University Pain Center in Manhattan offers this comprehensive guide to understanding chronic pain and available alternative and conventional medicine treatments. He includes a discussion on how to find a pain specialist, and information on children, pregnant, elderly, or terminally ill. |
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S. Fishman, M.D.
The War on Pain
Harper, 2001
The author is president of the American Academy of Pain Medicine who writes about an interdisciplinary chronic pain-management approach that integrates conventional and alternative techniques, including pharmacology, neuroscience, experimental procedures, and mind-body medicine. |
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Mayo Clinic on Health
Mayo Clinic on Chronic Pain
Kensington Publishing, 2002
Written by physicians at the Mayo Clinic, this book is a comprehensive resource on managing chronic pain and living an active and productive lifestyle. Topics include causes of chronic pain, exercises, pain medications, support, alternative therapies, new techniques, and goals. |
CASE STUDIES/OBSERVATIONAL DATA
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M. Caudill, M.D., Ph.D.
Managing Pain Before It Manages You
The Guilford Press, 1994
Dr. Caudill has developed a program from her experience as a pain specialist that focuses on teaching chronic pain sufferers how to cope with their pain. She discusses mind-body techniques, exercises, diet modifications and pain medications. |
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R. Cochran, M.D.
Understanding Chronic Pain: A Doctor Talks to His Patients
Hillsboro Press, 2004
This book offers a narrative of Dr. Cochran's over 40 years of experience in treating his patients suffering from chronic pain. These case studies may help readers gain a greater understanding of the mind-body role in pain. |
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N. J. Marcus, M.D.
Freedom from Chronic Pain
Fireside, 1995
Dr. Marcus has established and directed several pain clinics, writes about his narcotics-free pain treatment program, used at Lenox Hill Hospital. Included are patient histories, illustrating how body awareness, exercise, and coping and relaxation techniques can be used to control and reduce the devastating effects of chronic pain. |
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JOURNALS:
Alternative & Complementary Therapies
http://www.liebertpub.com/publication.aspx?pub_id=3
Provides the latest information on evaluating alternative therapies and integrating them into clinical practice. Publishes several articles on therapies for chronic pain.
Alternative Therapies in Health and Medicine
http://www.alternative-therapies.com
A bimonthly clinical research journal with particular emphasis on mind/body approaches to wellness; has occasional articles on pain.
American Journal of Pain Management
http://www.ajpmonline.com
The official peer-reviewed journal of the American Academy of Pain Management, serves as a vehicle for the transmission of knowledge related to the study and practice of pain management. Promotes an appreciation of the interdisciplinary, multi-modal approach to pain care.
Annals of Internal Medicine
http://www.annals.org
The Annals is the official journal of the American College of Physicians. Search the Annals for abstracts and full text articles on chronic pain and alternative therapies.
Clinical Journal of Pain
http://www.clinicalpain.com
The official publication of the Eastern Pain Association, this journal explores all aspects of pain and its effective multi-disciplinary treatment—both conventional and complementary. Articles cover a variety of topics, including clinical dilemmas in pain management; diagnostic procedures; new pharmacological, surgical and other therapeutic modalities; and the psychosocial and ethical issues of concern to all medical professionals involved in pain medicine and management. Often includes CAM articles.
Journal of Alternative and Complementary Medicine
http://www.liebertpub.com/publication.aspx?pub_id=26
This peer-reviewed journal includes clinical trials, observational and analytical reports on treatments outside the realm of allopathic medicine. It includes current concepts in clinical care, including that for chronic pain, for health care professionals and scientists seeking to evaluate and integrate these therapies into patient care protocols and research strategies.
Journal of the American Osteopathic Association
http://www.jaoa.org
This is the official scientific publication of the American Osteopathic Association, as well as the scholarly peer-reviewed publication of the osteopathic medical profession. Provides free access to full-text articles, many on chronic pain.
Journal of Pain
http://journals.elsevierhealth.com/periodicals/yjpai
This journal publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy.
Journal of Pain and Symptom Management
http://www.elsevier.com/wps/find/journaldescription.cws_home/505775/description?navopenmenu=1
This peer-reviewed journal provides the professional with the results of important new research and clinical information related to pain management and palliative care.
PAIN
http://www.iasp-pain.org/journal.html
The official publication of the International Association for the Study of Pain, publishing original research on the nature, mechanisms and treatment of pain.
Pain Medicine
http://www.blackwellpublishing.com/journal.asp?ref=1526-2375
The official journal of the American Academy of Pain Medicine is a multi-disciplinary journal dedicated to the advancement of pain management, education and research. Frequently publishes CAM articles.
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ARTICLES
Bandolier
http://www.jr2.ox.ac.uk/bandolier/painres/Mapain.html
Bandolier is a journal of evidence-based medicine. The above link lists articles from a systematic review of pain.
B. Berman, M.D.
Integrative Approaches to Pain Management: How to Get the Best of Both Worlds
British Medical Journal, June 14, 2003. Volume 326: 1320-1321
A summary of several alternative therapies often used as an adjunct to conventional pain management, including a description of the technique, what it is used for, and evidential support.
A. Cimbiz, V. Bayazit, H. Hallaceli & U. Cavlak
The Effect of Combined Therapy (Span and Physical Therapy) on Pain in Various Chronic Diseases
Complementary Therapies in Medicine, October 11, 2005. Volume 13: 244-250.
Investigates the possible effects of a combined spa and physical therapy program on pain and hemodynamic responses in various chronic diseases.
N. Eccles, Ph.D.
A Critical Review of Randomized Controlled Trials of Static Magnets for Pain Relief
Journal of Alternative and Complementary Medicine, June 2005, Volume 11 (3): 495-509.
A systematic literature review of whether there is evidence for or against the efficacy of static magnets to produce analgesia. Conclusion suggested evidence of analgesic effect.
T. Edwards, MD, MEd
Inflammation, Pain, and Chronic Disease: an Integrative Approach to Treatment and Prevention
Alternative Therapies, Nov/Dec 2005, Vol. 11, No. 6 pp.20-27
A Continuing Medical Education article that discusses inflammation as the underlying basis of a number of diseases. Evidence shows that lifestyle changes can significantly affect the inflammatory process and potentially help people live longer, healthier lives.
M. Kuchera, D.O.
Osteopathic Manipulative Medicine Considerations in Patients With Chronic Pain
The Journal of the American Osteopathic Association, September 2005, Volume 105 (4): 29-36
An overview of the physiology of pain, why people pursue complementary or alternative care, and an evidence-based description of how osteopathic manipulation can improve chronic pain.
E. Manheimer, M.S., A. White, M.D., B. Berman, M.D., K. Forys, M.A., and E. Ernst, M.D.
Meta-Analysis: Acupuncture for Low Back Pain
Annals of Internal Medicine, April 19, 2005, Volume 142 (8): 651-663.
A review of randomized, controlled trials evaluating acupuncture’s effectiveness for treating low back pain found acupuncture effectively relieves low back pain.
D. Marcus, M.D.
Treatment of Nonmalignant Chronic Pain
American Family Physician, March 1, 2000. Vol. 61, no. 5: 1331-1338
Nonmalignant, chronic pain is associated with physical, emotional and financial disability. Treatment of chronic pain involves a comprehensive approach using medication and functional rehabilitation.
S. Nadler, D.O.
Nonpharmacologic Management of Pain
The Journal of the American Osteopathic Association, November 2004, Volume 104 (11): 6-12.
A review of peer-reviewed medical literature on the nonpharmacologic management of chronic pain supports the use of manipulation and mobilization, exercise, psychological intervention.
K. Soeken, Ph.D.
Selected CAM Therapies for Arthritis-Related Pain: The Evidence from Systematic Reviews
Clinical Journal of Pain, January/February 2004. Vol. 20(1): 13-18
A systematic review and meta-analysis of the efficacy of selected CAM therapies for pain from arthritis and related conditions (acupuncture, homeopathy, herbal remedies, and selected nutritional supplements), shows there is evidential support for some therapies, but a need for additional high quality research for other therapies, especially for herbals and homeopathy.
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PROFESSIONAL ORGANIZATIONS
American Academy of Pain Management (AAPM)
http://www.aapainmanage.org
13947 Mono Way #A
Sonora, CA 95370
Tel: (209) 533-9744
Fax: (209) 533-9750
Email: aapm@aapainmanage.org
A non-profit, inclusive, interdisciplinary organization serving clinicians who treat people with pain through education, setting standards of care, and advocacy. Also provides credentialing, accreditation of facilities, networking opportunities, continuing education, quality publications and an annual clinical meeting. Patients can search the website for practitioners, clinics, and access conventional and complementary treatment web links.
The American Academy of Pain Medicine (AAPM)
http://www.painmed.org
4700 W. Lake
Glenview, IL 60025
Tel: (847) 375-4731
Fax: (877) 734-8750
Email: aapm@amctec.com
The AAPM is the medical specialty society representing physicians practicing in pain medicine, and is involved in education, training, advocacy, and research. The AAPM represents the multi-disciplinary approach of this field and embraces its diverse scope in its memberships of practitioners from various medical disciplines.
American Academy of Physical Medicine and Rehabilitation (AAPMR)
http://www.aapmr.org
One IBM Plaza, Suite 2500
Chicago, IL 60611-3604
Tel: (312) 464-9700
Fax: (312) 464-0227
Email: info@aapmr.org
The national medical society for physiatrists, who are physicians specializing in restoring function for those with acute and chronic pain, musculoskeletal problems, traumatic pain and more. This website provides general information on PMR medicine, the conditions it may be useful in treating, and a physician directory, categorized by state.
International Association for the Study of Pain (IASP)
http://www.iasp-pain.org
111 Queen Anne Avenue North, Suite 501
Seattle, WA 98109-4955
Tel: (206) 283-0311
Fax: (206) 283-9403
Email: iaspdesk@iasp-pain.org
The IASP is an international non-profit multi-disciplinary organization dedicated to furthering research on pain and improving the care of patients with pain. This website provides an extensive listing of web resources from the USA and 25 other countries.
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SELF-HELP AND REFERRAL ORGANIZATIONS
American Chronic Pain Association (ACPA)
http://www.theacpa.org
P.O. Box 850
Rocklin, CA 95677
Tel: (800) 533-3231
Fax: (916) 632-3208
Email: ACPA@pacbell.net
Although partially funded by corporate sponsorships, the ACPA is a non-profit organization that supports and provides information for people with chronic pain and their families. The ACPA focuses on general information for patients and healthcare providers with mostly conventional resource links.
American Pain Foundation (APF)
http://www.painfoundation.org
201 North Charles Street, Suite 710
Baltimore, MD 21201-4111
Email: infor@painfoundation.org
A non-profit organization that is partially funded by corporate sponsors which serves people with pain through information, advocacy, and support. Goals include improving the quality of life of people with pain by raising public awareness, providing practical information, promoting research, and advocating increased access to effective pain management. Click on Useful Links About Pain to access web resources for Complementary and Alternative Medicine.
The Institute for the Study and Treatment of Pain (iSTOP)
http://www.istop.org
Lower Floor
5655 Cambie Street
Vancouver, BC V5Z3A4
Tel: (604) 264-7867
Fax: (604) 264-7860
Email: istop@istop.org
iSTOP is a non-profit organization dedicated to understanding and treatment of soft tissue pain. The doctors and physical therapists at the iSTOP clinic are trained in Intramuscular Stimulation (IMS) to treat soft tissue pain. IMS involves dry needling with acupuncture needles in affected areas of the body to release "muscle shortening", thereby treating underlying pain.
The National Pain Foundation (NPF)
http://www.nationalpainfoundation.org
300 E. Hampden Avenue, Suite 100
Englewood, CO 80113
Email: aardrup@nationalpainfoundation.org
Funded partially by corporate sponsorships, the NPF is a non-profit organization established to advance functional recovery of persons in pain. The NPF provides a virtual community for pain patients, their families and friends, offering an interactive medium for peer-reviewed information and resources. They explore both conventional and complementary approaches to pain management.
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TREATMENT AND RESEARCH CENTERS
See also the Professional Organizations section for links to provider directories.
Cleveland Clinic
Pain Management Department
http://www.clevelandclinic.org/painmanagement/
The Cleveland Clinic
W.O. Walker Building/C25
Cleveland, OH 44195
Tel: (216) 444-PAIN (7246) or (800) 392-3353
Dedicated to serving the rehabilitation and intervention needs of people with acute or chronic long-term pain, the department provides comprehensive specialized care with an interdisciplinary team approach.
Columbia University Pain Management Center
http://cpmcnet.columbia.edu/dept/anesthesiology/pain/index.html
The Inpatient & Outpatient Chronic Pain Service
622 West 168th Street (PH5-Room 500)
New York, NY 10032-3784
Tel: (212) 305-7114
Fax: (212) 305-8883
This center consists of a multi-disciplinary group of professionals dedicated to alleviating pain through a comprehensive medical and behavioral approach. Services offered are medical management, acupuncture, energy work, musculoskeletal treatments, percutaneous electrical nerve stimulation, biofeedback, stress management, and many more conventional and alternative therapies. The center also has an inpatient acute service and pediatric pain service.
Marianjoy Rehabilitation Hospital
Integrative Pain Treatment Center
http://www.marianjoy.org/stellent/groups/public/documents/www/mj_006892.hcsp
17W682 Butterfield Road
Oakbrook Terrace, IL
Tel: (630) 268-1394
This center offers a 21-day integrative program that focuses on helping people manage chronic pain so they can be restored to a lifestyle of comfortable function and mobility. A holistic approach is used to focus on the patient’s personal goals. The following methods are used: biofeedback, medication management, stress management, physical therapy and fitness, soft tissue mobilization, manual medicine, and relaxation techniques. The center also offers single-service therapies on an outpatient basis for people with acute or subacute pain.
Mayo Clinic
Pain Centers and Clinics: Turn to the Specialists
http://www.mayoclinic.com/health/pain/PN00047
This article provides an overview of specialized pain treatment, how to find a clinic, and what to think about before choosing a facility.
Scripps Center for Integrative Medicine
http://www.scripps.org/Services.asp?ID=269
10820 N. Torrey Pines Road
La Jolla, CA 92037-1036
Tel: (800) SCRIPPS
This center offers pain relief programs that integrate several approaches to address the behavioral, emotional, spiritual and physical dimensions of pain. Personalized pain management programs may include: psychosocial evaluation, stress management, and 8-week comprehensive integrative pain management program, acupuncture, biofeedback, massage therapy, spirituality classes and much more.
Stop Pain
http://www.StopPain.org
Beth Israel Medical Center
First Avenue at 16th Street
New York, NY 10003
Tel: (877) 620-9999
Fax: (212) 844-1503
Email: stoppain@chpnet.org
This organization is from the Beth Israel Medical Center Department of Pain Medicine & Palliative Care, which is part of a non-profit hospital system in New York City. Click on pain medicine to learn about common chronic pain disorders, integrative treatment strategies, prescription and non-prescription medications, and new innovations in pain research. Click on Clinical Trials for further links to trials conducted at Beth Israel and beyond.
University Hospital Pain Management Center
State University of New York Upstate Medical University
http://www.upstate.edu/uh/anesthesia/pain/
550 Harrison Center, Suite 112
Syracuse, NY 13210
Tel: (315) 464-4259
Fax: (315) 472-8513
The Pain Management Center has offered comprehensive therapies for nearly thirty years for a variety of pain syndromes. The center offers an acute care team and a chronic pain treatment team. Clinical research and education are ongoing integral parts of the center.
University of Maryland Integrative Medicine
http://www.compmed.umm.edu/PatientCare.html
Kernan Hospital 2nd Floor
2200 Kernan Drive
Baltimore, MD 21207-6697
Tel: (410) 448-6361
Fax: (410) 448-1873
Email: jcronise@compmed.umm.edu
This site offers patient care from specialists in Integrative Medicine in an environment supported by the University of Maryland Integrative Medicine research program, providing patients with individualized treatment options. Chronic pain therapies offered include acupuncture, craniosacral therapy, homeopathy, mind/body therapies, reflexology, stress management, and more. This center is a National Institutes of Health Center of Excellence for Research in Complementary and Alternative Medicine.
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MedlinePlus
http://www.nlm.nih.gov/medlineplus/pain.html
This site is a service of the U.S. National Library of Medicine and the National Institutes of Health. Features a variety of topics on pain, including alternative therapies.
National Institutes of Health Pain Consortium
http://painconsortium.nih.gov
NIH Pain Consortium
National Institutes of Health
9000 Rockville Pike
Bethesda, MS 20892
Tel: (301) 496-4000
Email: NIHinfo@od.nih.gov
The consortium was established to enhance pain research and promote collaboration among researchers across the many NIH Institutes and Centers that have programs and activities addressing pain. Click on Pain Information Index to view NIH publications on various pain issues, or NIH Clinical Trials to link to www.ClinicalTrials.gov
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Center Watch
http://www.centerwatch.com
Use this site to find information about clinical research, including listings of more than 41,000 active industry and government-sponsored clinical trials, as well as new drug therapies in research and those recently approved by the FDA.
Clinical Listings
http://www.clinicaltrials.gov
This site is a service of the U.S. National Institutes of Health and developed by the National Library of Medicine. It provides regularly updated information about federally and privately supported clinical research in human volunteers. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. The information provided on ClinicalTrials.gov should be used in conjunction with advice from health care professionals.
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WEB RESOURCES
NOTE: Promotional and commercial sites are not included in this listing unless they provide significant impartial information resources.
Bandolier: The Oxford Pain Internet Site
http://www.jr2.ox.ac.uk/bandolier/booth/painpag/index2.html
Bandolier is a journal of evidence-based medicine. This website focuses on systematic reviews with pain as an outcome, including downloadable articles and numerous links to other pain-specific topics.
Chronic Pain Support Group
http://www.chronicpainsupport.org
A forum for people living with chronic pain to seek support through chat rooms and message board.
Mayday Pain Project
http://www.painandhealth.org
A listing of conventional and alternative medicine Internet resources for general and specific types of pain.
Pain.com
http://www.pain.com
This educational and informational Internet source for pain practitioners and patients, provides directories for support groups, pain clinics, and various other resources. Although this site is supported by pharmaceutical companies, there are several links to organizations and sites that are focused on alternative medicine.
Pain Links
http://lambornepain.hypermart.net/paindoc.html
A listing of accredited pain management clinics.
Whole Health MD
http://www.wholehealthmd.com/
American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, lifestyle options, and much more.
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First Posted: February 3, 2006
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