Finding Relief for Chronic Pain

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We all experience pain in a different way, making it impossible to standardize measurement and difficult for doctors to diagnose and treat. If you’ve been suffering with chronic pain, maybe for years, can the latest technology and the wisdom and experience of a pain specialist bring you relief? Maybe so. In this program featuring doctors from the UW Medicine Center for Pain Relief, you’ll hear how experts are using cutting edge technology, along with a combination of therapy methods to find the true source of patients' pain and in many cases give them their lives back.

Angela Weaver also joins the program. Angela suffered from chronic head and neck pain for over two years, while visiting countless doctors who could not locate the source of the pain. When it seemed as if nothing could be done, Angela was finally connected with Dr. Andrea Trescot, who Angela says, "literally gave me my life back." Dr. Trescot, Professor of Anesthesiology & Pain Medicine at the University of Washington Medical Center, explains the processes she used to find the source of Angela’s pain.

Dr. Alex Cahana, Medical Chief of the Division of Pain Medicine in the Department of Anesthesiology & Pain Medicine at the University of Washington Medical Center, chimes in to discuss how pain is categorized and the appropriate strategies for treating the different types of pain. He also talks about the mental health aspects of pain and the factors that can influence pain levels. Both Dr. Trescot and Dr. Cahana stress the importance of finding the source of the pain early and the new techniques for evaluating chronic pain. If you or someone you know is struggling with chronic pain, this program is a great resource to help you get the best care.

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Produced in association with UW Medicine

Transcript

Andrew Schorr:

If you’ve been suffering with chronic pain, maybe for years, can the latest technology and the wisdom and experience of a pain specialist bring you relief? Maybe so. Stay tuned for answers on Patient Power.

Hello once again and welcoming to Patient Power. I’m Andrew Schorr. This program, like so many we’ve done, is sponsored by UW Medicine where we connect you with leading medical experts and inspiring patients.

When you think about conditions that affect millions of people one that rises to the top of course is suffering from pain, often chronic pain, and in some cases debilitating pain. Some people say, ‘Well I’ll just live with it.’ Some people find it’s difficult to live with, and they look for all sorts of home remedies or over-the-counter products that maybe can help somewhat. I know my wife when she gets a headache takes a bath. Other people do other things. And then some people finally bring it up with their doctor or maybe they did years ago. Maybe it helped. Maybe years ago it didn’t.

Where are we now with pain management? Because after all you should not have to suffer. Helping us understand that is a professor of anesthesia in pain medicine at the University of Washington and a member of the new center for pain relief at UW Medicine, and that’s Dr. Andrea Trescot. She is Director of the Pain Fellowship Program there at the University of Washington as well.

Dr. Trescot, we’re really talking about millions of people who experience pain.

Dr. Trescot:

Actually we are. It’s been estimated that as many as a third of the U.S. population suffers from chronic pain of some kind.

Andrew Schorr:

So let’s talk about the kinds of pain. I think of headache and certainly backache, but there are lots of other sorts of pain that people have too.

Dr. Trescot:

Absolutely; everything from the head to the toe literally. So we treat neck pain; chest wall pain; abdominal wall pain; pelvic pain; pain of an extremity, an arm or a leg. It used to be that pain doctors focused just on the spine, and in fact one of my friends said that 50% of the work he did was in the low back and 50% of the work he did was in the neck, and the rest was everything else, but we’re expanding our techniques and expanding our expertise into these other areas of pain because we found that the principles that we’re learning, the concepts that we’re utilizing, the new approaches that we’re doing apply to other areas of the body as well.

Andrew Schorr:

Dr. Trescot, a lot of people maybe complained of pain somewhere in their relationship with their doctor or other providers, and they said, ‘Well you’re just going to have to live with it,’ or maybe they were told it was in their head. I know it can sometimes be in your head, but they were sort of dismissed. How do you view it at your center?

Dr. Trescot:

First of all, pain is what the patient says it is. The difference in how people respond to pain is now appearing to be genetic. It’s appearing to be related to chemicals that are in the brain. The pain you get, for instance, when you have a depression, and you get the same stimulus, you feel that more or rate it higher than if you had the same pain when you weren’t depressed, and so we know that depression/anxiety will contribute to how people respond to pain, and we’re beginning to recognize that there are previously un-understood concepts about pain and about how pain gets generated and perpetuated because it is a normal activity of the body. It’s a protective activity of the body. You step on a nail, you pull off from that, the injury keeps you from walking on the foot until it heals. Unfortunately chronic pain is a situation where that acute process no longer is a functional one, and pain then becomes the problem instead of a healing issue.

One of the biggest tragedies is that physicians are not taught about pain. It is absolutely reprehensible to me that physicians get out of medical school with no understanding and no training regarding pain approaches and pain medicine.

As a good example, if I had chest pain my primary care doctor would send me to the cardiologist who was a specialist in identifying why I have that chest pain, would put me on appropriate medicines for that chest pain, may do the interventional diagnosis like a catheterization and then might be able to do a stent that prevents me from needing any surgery, and I only go to see the cardiothoracic surgeon if the medications have failed, if I’ve got a very clear diagnosis of exactly where the problem is, and if it is a surgical diagnosis; it’s something that would be expected to get better with surgery.

On the other hand if I have low back pain my primary care doctor would send me for physical therapy, and the problem with physical therapy is that the physical therapy for some causes of low back pain are different than the physical therapy for other causes of low back pain. If you haven’t made the diagnosis you can’t do the right physical therapy, and you don’t get better. Then if you fail physical therapy they send you to see a surgeon, and a surgeon looks at an MRI and says, ‘Ah, I see something to operate on,’ or, ‘I don’t see something to operate on.’

Now we’re recognizing that MRIs don’t show pain. We looked at a group of people in off the street who’d never had back pain in their entire life, stuck them in the MRI scanner, and 60% of them have herniated or bulging discs. When we showed those films to surgeons 40% of those x-rays were offered surgery without ever having had pain. So you can imagine if their pain was coming from something that wasn’t showing up on an MRI and they got operated on the thing that wasn’t causing their pain they wouldn’t get any better.

So we’ve got this huge number of people who are going to surgeons and either being told, ‘Come back when your pain is that you can’t walk,’ or they’re being told that their problem is coming from something that shows up on an MRI, and that’s not where it comes from.

We’re now looking at pain medicine as being the diagnosticians. We’re now the people who can identify where your pain is coming from by physical exam, a very specialized physical exam, and then putting numbing medicine right on that structure.

So I’m going to use another analogy. If you had a tooth that was bothering you, and you took an x-ray and there were a bunch of cavities, the dentist would tap on the tooth, find the tooth that was tender, put numbing medicine on that tooth, and if that made the pain go away now you know that’s where the problem is coming from, and now you can do the filling or the root canal or even pull that tooth with a good expectation that you’ll get relief.

On the other hand, if you’re just looking at this mouthful of cavities, you get all your teeth pulled, and if the pain wasn’t even coming from the tooth then you’re still having the pain and no teeth.

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