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Fighting Chronic Pain

New treatments are in the pipeline, but what works best now?

Antidepressants can help those with chronic pain

Treating the psychological consequences of chronic pain is equally important. Acute pain is typically a symptom of injury or disease. But when pain persists, it becomes a disorder in its own right, with its own set of symptoms, researchers say. These often include depression and anger. Many pain centers now offer psychological counseling, stress-reduction techniques and anger management courses. Antidepressant medications such as duloxetine (Cymbalta) and desipramine (Norpramin) have proved particularly helpful for some chronic pain sufferers. The pills not only improve mood but also seem to take the edge off pain.

Pain medications, used judiciously, are often the first line of defense. But it's important to be realistic about how much relief they can offer. "At best, people get about a 20 to 30 percent reduction in pain from opioid pain medications," says Rosenquist. Like many pain specialists, he cautions against using escalating doses to ease pain, a practice that can lead to dependence.

Yoga, meditation, massage and more

Complementary approaches such as yoga, massage, meditation, biofeedback and acupuncture also help some patients feel better. A recent study of acupuncture, for instance, found that it helped ease pain in patients with osteoarthritis of the knee. Massage therapy may be helpful for lower-back pain. "But the available evidence is very limited on what works and what doesn't," says Michael Weinberger, M.D., who directs the Pain Management Center at New York-Presbyterian Hospital. Like many pain specialists, he takes a pragmatic approach. "If something helps a particular patient feel better, I encourage them to use it."

New meds in the pipeline

As for new medications, some promising drugs that attack pain in novel ways are in the research pipeline, according to Clifford Woolf, M.D., professor of neurobiology at Harvard Medical School. One approach would block pain signals at their source. Researchers also now know that a predisposition to chronic pain is partly inherited. Eventually, treatments may be found that can turn off those genes.

Retired nurse Mary Crossman knows better than most the accommodations required to make it through the day. "I use a heating pad, which helps. On especially bad mornings I may take a pain pill or two. I try to schedule activities around the times I feel good," she says. She tries to walk every day and keep up her social connections.

But when pain flares up, "I sometimes just have to say no, I can't do that today." Like most chronic pain sufferers, Crossman has had to accept that she'll never be completely pain-free. But, she says, "I've learned that I can live with that."

The problem with pain meds

Prescription opioid painkillers are now the leading cause of drug overdose deaths in America, taking more lives than heroin and cocaine combined. To better control the flow of pain drugs, an advisory panel to the Food and Drug Administration in January recommended tighter restrictions on a group of popular pain medications that includes Vicodin and Lortab, meds that contain hydrocodone and acetaminophen. They would be placed in the most highly regulated drug category, which now includes oxycodone pain meds such as OxyContin and Percocet, along with morphine and opium. Pills in this category are much harder to obtain, with each refill requiring a new prescription.

Aside from the risk of addiction or overdose, pills with the opioids oxycodone and hydrocodone pose other hazards, especially when taken over the long term. Studies show they increase the risk of falls, a real concern for older patients. They also can cause men to lose interest in sex. Paradoxically, opioid pain medications can actually increase sensitivity to pain, a condition called hyperalgesia. "In some patients on these drugs, all their other pains begin to hurt more," says C. Richard Chapman, professor at the Pain Research Center at the University of Utah. The potential dangers of opioid pain meds are so serious that some leading pain clinics now focus on getting patients off pills. At the Mayo Clinic's Pain Rehabilitation Center, for instance, one of the program goals is tapering chronic pain sufferers off all pain meds. Some 57 percent of patients entering the program take opioid painkillers. Fewer than 7 percent are on opioid medications when they leave.

Peter Jaret is a freelance writer in Petaluma, Calif., who writes for many national publications.

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