En español | After 25 years of performing open-heart surgeries, I can handle just about any complication that comes along. The one thing I cannot predict, though, is how my patients will respond to postoperative pain. That's because every person heals and feels differently and any trauma disrupts blood flow and nerve signaling in unique ways.
Photo by Darren Braun
In recent months I have seen an explosion of research and focus on pain, in large part because of a new report from the influential Institute of Medicine. It calls on government, academia and physician groups to develop a nationwide plan to treat and manage pain, which affects 100 million Americans and costs $635 billion annually.
Here is the game-changing development: Doctors now believe that chronic pain is not merely a symptom of another condition; rather, it's a separate disease and should be treated as such. In some cases chronic pain is the result of inflammation. But in others it has a more complex yet little-understood cause, one that's tied in to how the brain processes pain signals. With long exposure to physical pain, nerves may actually hard-wire that pain into a kind of neurological memory, so even when the original cause of the pain is gone, you still hurt. Pain might even be genetic. Researchers at the University of Cambridge in England recently identified the HCN2 gene as a regulator of chronic pain, providing another potential drug target for pain management.
The typical treatment for chronic pain has been medications, including over-the-counter drugs-- like ibuprofen and aspirin, which target inflammation-- as well as prescription narcotics such as codeine and morphine, which block pain signals. But a recent report by The Bravewell Collaborative found that 75 percent of integrative medicine clinics reported success in treating chronic pain by combining traditional pain management with complementary therapies like acupuncture and massage. One interesting treatment is myofascial trigger-point needling, a technique similar to acupuncture that focuses on specific areas of muscle that trigger pain.
Comprehensive pain management today also targets the mind. At the Stanford University Center for Integrative Medicine, multiple studies have shown that medical hypnosis can successfully reduce or even eliminate pain. Plus, there's evidence that positive thinking affects pain. At Johns Hopkins University in Baltimore researchers recently found that chronic-pain sufferers who think infrequently about their pain sleep better and have less day-to-day pain than those who dwell on it.
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