by Dr. Jordan Karp
Chronic pain is one of the most frequent reasons for seeking medical care. A 2010 survey of United States residents estimated chronic pain at 31 percent. Getting older, divorced or separated and being female all contribute to suffering from chronic pain. Some other factors, such as being overweight and smoking also contribute to chronic pain. Chronic low back pain, neck pain and osteoarthritis are the most common types of pain and increase with age.
Chronic pain often results from changes in the spinal cord and brain after serious injury or an ongoing degenerative process such as arthritis. In some conditions, such as the widespread pain of fibromyalgia, there is not a clear reason for the disorder. Anxiety, stress, depression, anger and fatigue may decrease the body’s production of natural painkillers. Moreover, those symptoms may amplify sensations of pain, causing a vicious cycle of pain. Unrelenting pain can suppress the immune system so that people are more susceptible to infections and cancer.
Older African-Americans may experience more pain-related mood problems than White patients. A 2007 study showed that African-Americans and Hispanics were more sensitive to cold and heat pain than Whites. It is unclear if these differences in pain threshold are based on racial or socioeconomic differences.
Dr. Carmen Green, an anesthesiologist and prominent researcher of racial disparities in pain treatment at the University of Michigan, reported that African-Americans receive less than adequate pain care prior to referral to a specialty pain service. This puts a large proportion of the population at risk of under-treatment of pain. Dr. Green has reported that in emergency rooms, pain treatment clinics, and cancer centers, minorities receive lower quality pain care than non-Hispanic whites.
What are options to improve the treatment of pain, in particular chronic pain, among African-Americans? Education and advocacy within the African-American community may be the most effective approach. Here are some suggestions for becoming an educated and successful patient.
1. Understand your diagnosis. Much of the confusion of treating pain comes from not having a precise diagnosis. If your pain has lasted more than 3-6 months, you are living with a chronic pain syndrome. The most common chronic pain conditions are back pain, knee or hip arthritis, and numb or burning feet, often associated with diabetes. Having a precise diagnosis will help you advocate for yourself or a loved one to receive the best care.
2. Advocate for yourself. If you do not have a Primary Care Physician, get one. You can interview doctors and shop around until you find one with whom you feel a connection. Make it known at the first visit that pain is an important problem for you. It is ok to ask the physician if they feel comfortable helping you manage your pain. If your current PCP is not helping you enough (for example, if your pain interferes with your sleep, if you are in pain more often than not, if pain is severely affecting activities or your ability to function safely at home), request a referral to a multidisciplinary pain clinic. The best pain clinics are those that employ a multidisciplinary team comprised of pain physicians, physical therapists, occupational therapists, pain psychologists and anesthesiologists.
3. Try out treatments. Every person living with pain requires a unique approach to treatment. There is no “one-size-fits-all” approach to managing pain. Most successful treatments combine both pharmacological (medications) and non-pharmacological interventions. Non-pharmacologic interventions include exercise, weight loss, getting restorative sleep, limiting use of alcohol, reducing stress, and making sure other medical problems such as diabetes and hypertension are under good control. Increasing numbers of people, especially older adults or those who do not want to take medications, have found that acupuncture, Tai Chi, massage, yoga and meditation all help them live more effectively with chronic pain. While there is no cure, the severity of pain and pain’s interference with activities can be markedly improved.
4. Encourage loved ones to get help. Many people with chronic pain conditions have sought the care of numerous providers without finding relief. This often leads to worse pain, physical deconditioning, insomnia, daytime fatigue, irritability, depression, and a feeling that nothing will work to improve their pain. I have seen several people who have given up seeking care for their pain, and instead spend their days and nights in bed or on the couch immobile. Help your loved one find a PCP who will listen and work with them to create a pain management program.
Chronic pain robs people of a quality life. Treatment is available. Get help.
(Dr. Karp is a geriatric psychiatrist, faculty at the University Of Pittsburgh School Of Medicine and Medical Director for Geriatric Psychiatry at UPMC Pain Medicine at Centre Commons. He directs two studies of pain in older adults, one for knee arthritis and one focused on low back pain with depression. For information about participating in Dr. Karp’s research studies, please call 412-246-6006.)