Last month's article on the subject of how to live with chronic pain defined "chronic" as that which "continues longer than six months, and is not completely relieved by medication or medical treatment," from the American Chronic Pain Association (ACPA).

"The beast" creates depression, fear, shame and isolation. Many treatments are available, but finding the right one can be daunting.

Before any treatment is considered, you need a diagnosis. The "beast" loves prey that, for instance, buys expensive devices for hip pain when the actual problem lies elsewhere.

"We frequently see patients who are misdiagnosed and therefore do not receive appropriate treatment," said Dr. Joel Richnak, a local psychiatrist and rehabilitation specialist. "They go through a plethora of unguided, expensive treatment for extended periods of time, even if they are demonstrating no response.

"The first issue that needs to be addressed is to determine what the primary pain generator is," Richnak said. "From there, treatment can be directed and targeted towards the diagnosis.

"Treatment is focused on conservative approaches with two goals: The first is to address the particular pain syndrome; the second is learning how to manage it."

Using back pain as an example, a specialist may begin with a combination of physical therapy and anti-inflammatory medications. If this doesn't work, he may utilize trigger point injections, usually in conjunction with other treatments such as physical therapy.

"It's important to monitor the treatment for response," Richnak added. He limits the therapy and, if it isn't effective, moves on to something else. "It is important to realize the vast majority of people do respond to conservative treatment."



Localized treatment

Spinal injections and medication can move the therapy forward with more conservative treatment fails.

"Spinal injection therapy for the treatment of chronic pain is two-fold," local anesthesiologist Dr. Gary Glaze said. "One: Local anesthetic can block the transmission of pain signals ... and break the cycle of pain. The diagnostic portion can allow the pain practitioner to identify the pain trigger, or originating site."

Injection of anti-inflammatory steroids can decrease inflammation, temporarily relieving pain from three days to several months. But some people get no relief. Even if the results are significant, the patient usually is limited in the number of injections over a period of time.



Customize medication

The beast is smart, but people are smarter, and they have developed medication to add to the arsenal.

"Too often, the pharmaceutical needs of the chronic pain patient are misunderstood or unmet", said David DeMartini, a local pharmacist. "Narcotic analgesics often are the mainstay, but their regimen need to be customized."

"It's kind of a dancing game," DeMartini admits. "Everyone is different. The correct dose is everything, and there are many novel approaches."

Ironically, one of the "new" approaches to pain management is, "... really very old, well researched and well-established," according to Dr. Steven Feinberg, M.D., in his article on recent chronic pain treatment in the American Chronic Pain Association's Spring 2008 Chronicle.

His article describes treating the patient as a whole person. One person may find physical therapy provides only short-term relief but finds aromatherapy helpful. Another may appreciate massage, another Ayurvedic medicine. For another, nothing seems to work.

Next week, we'll talk about more new-old strategies for beating back the beast, including exercise, acupuncture, stress relief and other therapies.

Laurel Gavin is a writer and playwright who has lived in the area for 22 years and has worked in the health care field.