Pain treatment myths

By Sara Phillips

Pain and pain treatment are mysterious things. Despite having fully healed from injury, many people continue to experience pain. When it lasts three months or more, it’s described as “chronic pain” and doctors are starting to believe it’s a separate condition from the injury that might have caused it. Certainly, doctors take a different approach with chronic pain. Short-term pain is usually addressed with pain killers. But over prescription of these has led to the ‘opioid crisis’ gripping the USA and spilling to other countries.

Stemming from the belief that chronic pain is caused by a constantly shifting combination of biological, psychological and social factors, doctors treat pain management as a multifaceted challenge. And while biology and psychology are — relatively — straightforward to tackle, adjusting social factors is far more difficult. 

One of the more pernicious social factors are myths. The myth that newborns don’t feel pain led to infants having open heart surgery without anaesthetic. As recently as 2015, the myth that babies don’t feel pain was still being dispelled.  

Myths perpetuate people feeling pain, when their pain could have been relieved, or at least managed, if they had more critically weighed up different approaches. 

Even the multifaceted approach to pain is itself subject to the myth that all pain is physical. As Professor Michael Nicholas, as pain expert at the University of Sydney wrote in the Pain journal last month, “across a range of current treatments for different chronic pain conditions, many treatments remain essentially unimodal with relatively little acknowledgement of other factors that might need to be addressed.”

Another Cosmos perspective: Physicians heal thyself

Pain is officially defined by the International Association for the Study of Pain as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

Pain is the most common reason people seek health care and the leading cause of disability in the world. 

Chronic pain affects more than 30 percent of people worldwide.

Professor Michael Nicholas, Director of Pain Education and Pain Management Programs at University of Sydney says: “We now know that more comprehensive approaches that address biological, psychological and social contributors to persisting pain are more effective than treatments that target just the painful parts of the body.”

Professor Nicholas says treating chronic pain requires more than pain killers.

“In the 40 years since 1982, researchers from many countries have confirmed that scans or physical examination often bear little or no relationship to the experience and impact of pain reported by patients. Even when there is evidence of injured or sensitive tissue, there is often considerable variation between patients on the impact of such changes. 

At the same time, evidence has grown that psychological processes, such as attention, beliefs about the pain, and the person’s current mood, as well as behaviour patterns (for example, avoiding activities expected to be painful) can also contribute to the experience and impact of pain.

“The same is true for the social context. For example, just having a workers compensation claim for injury has been associated with worse outcomes from surgery than not having an insurance claim. This doesn’t mean people with an insurance claim are feigning their injury; it may reflect the fact that they face different pressures and demands compared to people without insurance claims. Another review of low back pain studies found that level of education and socioeconomic status can affect the experience and impact of pain.”

(You might like to hear Professor Nicholas speak about communicating with patients.)

The Placebo effect

Lewis Crawford, University of Sydney PhD Candidate, Brain and Mind Centre PhD candidate, asks if it possible to trick the brain into thinking a placebo will help reduce pain?

“The signs are good. Pain is more than a sensory experience. It is an innate survival mechanism with the power to protect and teach us how to engage with the world around us. 

Regardless of how they work, placebos are already in place in most clinics today, serving to support the effectiveness of routine medical treatments. 

The inherent deception required to elicit placebo analgesia may mean it is never an ethical option for practising doctors. 

But the research shows the effectiveness of most pharmacological and non-pharmacological therapies can be enhanced with specific steps: positive patient-experimenter interactions; previous effective encounters with certain brands of medication; as well as open and thorough explanations of the potential effectiveness of treatments. These together form the power of the placebo.” 

Written by Sara Phillips. Originally published under Creative Commons by 360info.