By Tamara Passut, USAHC-VNovember 9, 2017
VICENZA, Italy -- The level of pain tolerable to one person will most likely not be the same to another. It is important to know about, and differentiate from, two forms of pain: acute and chronic.
Acute pain is a short-term response to tissue damage or injury. For example, stubbing a toe, a sore throat, a burn or breaking a bone are associated with acute pain. For this kind of pain, one may just "walk it off" or seek some help from an anti-inflammatory drug such as Ibuprofen or a pain reliever such as Acetaminophen. Acute pain also goes away within a few minutes to a few weeks.
Chronic pain, however, has been the source of many stories about treatment options in the news media and medical journals.
Mark Mollner, family nurse practitioner and pain champion for the Primary Care Clinic on Caserma Ederle, sees patients on a regular basis who experience chronic pain. Chronic pain is pain that lasts longer than three to six months.
"While chronic or persistent pain may have started as a result of tissue injury, it is not usually associated with ongoing tissue damage," said Mollner. "The main goals for pain management related to chronic pain are to minimize the overall level of pain while not harming the patient, and minimize the effects of the pain on the person's life."
The Opioid Crisis, discussed in many public forums, reflects the difficulties medical providers have had in treating patients with chronic pain while trying to help patients live as pain-free as possible.
"In the late '90s, there was a sense that we, as healthcare professionals, were not effectively treating pain. And at that time several extended-release opioids had been developed and brought to market when narcotics were commonly prescribed for just about all pain. Now the use of narcotics has skyrocketed," said Mollner.
Narcotics use, especially on a daily basis, can have many side effects to include constipation, sedation, cloudy thinking, delayed reaction times, poor or disrupted sleep, osteoporosis and decreased testosterone.
"Over the last 20 years we have seen the problems associated with chronic narcotic use including abuse, addiction, diversion, overdose and worsening pain in the patient," said Mollner. Just like with other drugs, the more you use, the more you will need to get the same effect.
Since everyone is different, medical providers recognize that there is a need for a variety of chronic pain reduction methods and treatment options. Some options have been found to be just as helpful in pain relief with little to any side effects. First, providers need to assess what can be done to completely fix whatever has caused the pain. Many tests and studies may be done to identify the cause and apply the treatment to cure the patient, not just treat pain symptoms.
For the symptom of pain, there are many proven alternatives to narcotic pain relief. Some of these include physical therapy through exercise, stretching, Tai Chi, massage, tens units, dry needling, traction, ultrasound, Cognitive Behavioral Therapy, acupuncture, interventional injections and functional recovery programs.
The first stop for anyone having pain longer than three months is to establish a relationship with a primary care provider. It may be helpful also to revisit a treatment that did not work in the past because pain changes, and if there is no new tissue damage, perhaps some recovery has taken place or the treatment will be different at a new location.
Mollner emphasizes, "Just because you are not prescribed narcotics does not mean that we don't believe you have pain and we aren't treating your pain. We have lots of options to offer to help patients with chronic pain and those options are more effective and safer in the long run."
(Passut is the Patient Advocate and Public Affairs Representative for USAHC-Vicenza.)