By Mary Ann Hellinghausen
Illustration by Malcolm Garris/PhotoDisc
February 1, 1999

It’s a rare visit when a healthcare professional does not hear a patient complain about pain, often the most obvious symptom of a particular condition. Many times a simple analgesic will handle the pain until its cause heals.

But for people who have chronic pain—from trauma, failed surgeries, or disease—pain can become an "invisible disability," taking away their ability to function and work, disrupting their families, and ultimately ruining their lives.

Heightened awareness

Although many pain management specialists say there is a long way to go, awareness of pain management options is growing among healthcare professionals and people living with pain. "Twenty years ago, people with chronic pain were told, ‘You’re going to have to learn to live with it,’ " said Penney Cowan, founder and executive director of the American Chronic Pain Association in Rocklin, Calif. "Today there are a lot more alternatives that people can turn to for pain management, and there’s a real awareness movement among the medical community and the general population."

Cowan credits her triumph over the pain caused by fibromyalgia, an arthritis-like affliction of muscles and tendons around the joints, to three weeks of intense treatment at a multidisciplinary pain management program. "I realized I could decrease pain and increase my level of function," she said, adding that a combination of biofeedback and physical therapy helped her manage her pain.

Thousands of chronic pain sufferers are turning to pain clinics across the country for help, many of which rely on a multidisciplined approach to pain management. Experts say there are not enough such clinics, however, and some caution that anyone can claim he or she is a pain specialist, whether qualified or not. "Some clinics say they’re multidisciplinary, but everybody gets acupuncture or a morphine pump," said Margo McCaffery, MS, RN, FAAN, a Los Angeles consultant in nursing care for patients with pain. In her forthcoming book, Pain Clinical Manual, to be published this month, McCaffery lists questions patients should ask before going to a pain clinic. "You need to know what that clinic really does,’’ she said.

The Texas Tech University Health Sciences Center Pain Clinic in Lubbock often is a last resort for people with chronic back pain, neck pain, or pain in the joints at the knee, foot, and shoulder, said Kathy Jones, PT, a staff physical therapist at the clinic.

"Each patient is evaluated by three disciplines—medicine, psychology and physical therapy—to establish a plan of care," she said. "It’s important to have a multidisciplined approach rather than a passive approach."

Alternative therapies

Physical therapy can be important in getting patients who are hesitant to move in ways that will create more pain to start moving again and develop stamina, said John Ayers, MS, director of rehab services at Forest Park Institute in Fort Worth. A fairly new development in the treatment of pain in the United States is DBC Active Spine Care (documentation based care), a spinal rehabilitation system developed in Finland. "The system is unique—it has special devices that isolate the spine and controls movement," Ayers said. "We’re able to develop a dynamic stabilization through a range of motion that patients are able to tolerate."

In addition to exercise, many patients find that alternative therapies—such as biofeedback, tai chi chuan, yoga, acupuncture, and massage are effective. Another therapy is Craig PENS (percutaneous electrical nerve stimulation), developed by William F. Craig, MD, who consults at Forest Park Institute. It has been effective in reducing pain by electrically stimulating nerve roots, helping nerve pathways forget how to transfer pain, said Carol Maxwell, RN, director of patient care at Forest Park.

The use of narcotics for pain management, particularly in patients with chronic, nonterminal pain, continues to generate controversy. "The newest thing in chronic, nonmalignant pain is the growing realization that the use of opioid-based drugs is safe and effective," McCaffery said.

Research has shown that fears of addiction are baseless, she said, and that runaway tolerance to opioids is not a problem. "Fewer than 1 percent will get addicted as a result of taking opioids for pain control," McCaffery said. "And stable pain leads to stable doses." Research also has shown that proper use of such narcotics does not damage vital organs and has minimal side effects.

Nursing role

Experts in the field say nurses are an integral link in patients’ pain management processes. "I see the nurse’s role as a facilitator, bringing all the pieces together and enabling patients to achieve their goal of getting their lives back," Maxwell said.

Nurses have a vital role because in most cases they have the most communication with the patient. "You need to be able to listen and understand where they’re coming from," said Ann Edmunds, RN, head nurse at the Texas Tech University Health Sciences Pain Clinic. "You also need really good assessment skills because often you’re communicating for them [to the physician]."

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Related Sites

Centers For Pain Management

The American Society of Pain Management Nurses
(888) 342-7766

The American Pain Society
(847) 375-4715