CHRONIC PAIN
Sometimes the pain of an injury or disease never completely disappears with healing, or headaches or
other pains appear for no apparent reason and then recur or never subside. Such
chronic pains are a major health problem in the entire industrialized world; in the United States, one-third of the population will at some time experience persistent or recurring pain that requires medical therapy. When pain persists indefinitely, the nature of the sensations changes with time and the patient tends to become increasingly discouraged, helpless, and hypochondriacal. Many surgeries to which sufferers resort only make the situation worse, as does the overuse of prescription medication. Multidisciplinary pain clinics have been established in the United States and other nations, however, and teams of medical specialists, psychologists, and social workers are often able to help patients with chronic pain.
RELIEF OF PAIN
Many ways exist for controlling or relieving pain. The use of anesthetics for surgery is familiar, and acupuncture and hypnosis have also been tried. For other relief of pain, analgesic drugs such as aspirin, acetaminophen, and ibuprofen can be used in cases where inflammation is present. Opioid drugs work by mimicking the naturally produced substances that activate pain-inhibiting systems in the brainstem and spinal cord. These drugs bind to sites throughout the brain and body and can cause undesirable side effects such as nausea and confusion. With prolonged usage, patients also require larger doses and might become addicted. Historically, such addiction fears have led doctors and nurses to treat acute pain rather sparingly, but these fears are coming to be seen as largely unfounded. In consequence, acute-pain services now often include patient-controlled analgesia through installed intravenous pumps, as well as physician injection of morphine directly into areas adjacent to spinal receptors, thus avoiding side effects. Electrical-stimulation treatments, massage, and other such therapies are also thought to act by closing pain gates at the spinal cord, as well as improving the microcirculation of blood where the pain is located.