Chronic pain management: therapy, drugs and needles.

In 1931, the French medical missionary Dr Albert Schweitzer wrote, “Pain is a more terrible lord of mankind than even death itself”. Seventy years on, chronic pain sufferers cannot agree more with this statement, while clamouring for help from family physicians and specialists, and even ‘therapists’ who promise to offer pain relief using unconventional methods or bizarre potions. Some persons would even contemplate suicide in order to avoid suffering pain for the rest of their lives.Chronic pain is a complex condition in both pathological and neurobiological terms. The causes are diverse, and may even be unknown in some instances. Why does a patient with fi bromyalgia exhibit so much pain? Why does one who had an anatomically successful discectomy continue to have intractable radicular (i.e. sensory nerve root) symptoms? Why does a depressed patient show more pain than another patient with the same condition? In medical school we learnt that pain is a symptom and, instinctively, we search relentlessly for an underlying problem so that we can solve it. Often, a prolonged and expensive search for a cause and a cure stands in the way of managing chronic pain. Chronic pain has long been viewed by many doctors as less important clinically than other chronic diseases like hypertension, diabetes mellitus, heart disease, and stroke, because “nobody dies from chronic pain”. However, some studies have shown central neuroplastic changes in patients with chronic pain, much like the changes that occur with learning and memory.