The Unfortunate Truth about Chronic Pain

The unfortunate truth, the thing no one wants to hear, the words all patients dread, is that chronic pain is like any other chronic disease - diabetes, hypertension, COPD, hepatitis, depression, epilepsy. With few exceptions, it something someone has to live with for the rest of her life. Although patients with low back pain, sciatic radiculopathy, undiagnosed abdominal discomfort, chronic regional pain syndrome, fibromyalgia, migraines, metastatic cancer, and other pain syndromes come to pain clinic hoping for a magic silver bullet, we don't have one, not even close. That's hard news. It's frustrating, disappointing, aggravating, and scary.

Because many types of chronic pain are lifelong conditions, the treatment isn't cure. We call ourselves pain management, not pain cure clinic. And the management of pain means setting expectations, creating goals, changing beliefs, and modifying lifestyles. In the same way that a diabetic can no longer binge on ice cream and cookies, in the same way a patient with hepatitis must get routine liver ultrasounds, in the same way an epileptic needs to watch stress and sleep, a chronic pain patient has to learn to live with her hurt. We make it manageable with our medications and interventions, but it's a partnership where the patient has to learn to cope, continue to exercise, and brace for the long run.

Here's the other awful truth: our interventions aren't great. Whether it is gabapentin for neuropathy or botulinum toxin injections for migraines or intrathecal pumps for metastatic cancer, our response rates aren't stellar. Pain is so diverse, so subjective, so complex that we're shooting in the dark a lot of the time. We can't explain why one treatment works for one patient but not for another. There are millions of dollars of research going into understanding pain networks, but for now, this is the reality.