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Silent epidemic is still a whisper

Decade of pain control and research draws to a close

Created date

September 21st, 2010

Congress declared this the Decade of Pain Control and Research, effective January 1, 2001. Although pain is among the most common reasons people visit the doctor, it hadn t received much scientific attention. In 2002, the National Institutes of Health developed the Pain Consortium in response to the Congressional call for research. On the agenda at the consortium s annual meeting in 2009 was an update on over-the-counter pain relievers. That year, the American Geriatrics Society issued a recommendation that nonsteroidal anti-inflammatory drugs (NSAIDs) a group of medications that includes ibuprofen (Motrin and Advil) shouldn t be used for treating pain among the 75-plus age group because of cardiovascular and gastrointestinal dangers. Treating pain is one of the hardest things we do, says Tom Morris, D.O., whose practice exclusively treats older adults. Back pain is one of the most common things we see. The NSAIDs have some significant dangers associated with them, so we end up using opiate medications. Morris says that the goal is to restore the quality of life for the patient, and there are various ways of approaching this. Aside from traditional medications, there are alternative methods, including meditation, acupuncture, hypnosis, and nerve stimulation therapy. With the recommendations against using NSAIDs, doctors treating older adults also often turn to opiate-based pain relievers like oxycodone (Percocet). For the general population, there is a risk of becoming dependent on these substances. For older adults, there is also a greater likelihood of falling and fracturing something. There s stuff I don t like to use and there are some medications to be avoided, yet there are times you re using them because that s what s best for the patient, says Morris. I ll give you an example. I had a very tiny patient who needed a stronger sedative. She was absolutely not sleeping and having some anxiety. I used one of the medications to be avoided, but it was my last choice. It worked like a charm no side effects, and now the person is sleeping great and functioning. That s why they call it practice, and that s what medicine is: It s applying what we know and individualizing it to the patient and there s a lot we still don t understand. Pain management is so difficult in part because pain is reported by the patient and there isn t a way of diagnosing it that is 100% effective. It is an imperfect process with the tools we have, says Morris. Among sufferers and practitioners alike, there is frustration over the gaps in understanding about both diagnosis and treatment. Still, the Decade of Pain Control and Research has generated some forward motion. One of the major accomplishments in the past ten years is the identification of the capsaicin receptor, now known as TRPV1, as the key pain-sensing molecule in animals and humans, says Pain Consortium member Wen G. Chen, Ph.D., program director at the National Institute on Aging. Since then, there has been a flourishing area of research to understand how pain is detected, processed, and experienced by our nervous system at the molecular and cellular levels. How to manage chronic pain pharmacologically for older adults is a topic we are currently very interested in pursuing, Chen adds. The issue of pain and aging has been largely ignored in the past because many older adults consider pain a normal process of aging.