Ways to help manage chronic pain

Musculoskeletal pain of the bone, joint and muscles is one of the most common reasons for primary care visits in the United States. According to a literature review appearing in a recent issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), chronic pain, or pain that persists beyond an expected period of healing, is estimated to affect 100 million Americans.

The majority of chronic pain complaints concern the musculoskeletal system, but they also include headaches and abdominal pain. "As orthopaedic surgeons, we are experts in the management of acute injuries to the extremities and spine. As a specialty, however, we are admittedly less adept in the management of chronic musculoskeletal pain," says lead study author Richard L. Uhl, MD, an orthopaedic surgeon at Albany Medical Center in Albany, N.Y. "Given its prevalence, and the profound economic implications of chronic pain on both healthcare costs and lost productivity, we have a duty to be proficient in its diagnosis and care."

The Bare Facts

• Low back pain affects up to 80 percent of Americans at some point in life, and consistently ranks among the top five most common reasons for all healthcare visits in the U.S.
• Chronic knee, hip, and shoulder pain from degenerative processes also is common, as are chronic neuropathic pains from advanced diabetes.

Orthopaedic surgeons and primary care physicians encounter patients who suffer from chronic pain almost daily.

A Surprising Study Finding
Non-steroidal anti-inflammatory drugs (NSAIDs)—easily the most commonly recommended or prescribed medication by orthopaedic surgeons—are not especially effective in many chronic pain scenarios. "While far from the everyday 'arsenal' of orthopaedic surgeons, antidepressants and anticonvulsants (medications to prevent seizures) can have remarkable effects on many forms of chronic bone and joint pain. There are many readily-accessible, economic, safe and effective treatments for chronic pain," says Dr. Uhl.

Chronic Pain Management Options
Ways to help manage chronic pain include:

• Avoiding reasons for acute pain by using safety precautions including appropriate techniques and, above all, common sense when performing every day activities (e.g., driving), fitness routines (e.g., weight-lifting), or work place routines (e.g., operating heavy machinery).
• Avoiding behaviors (e.g., tobacco use), appropriately treating mood disorders (e.g., depression or anxiety), or controlling diabetes and other health issues may reduce one's risk of developing chronic pain.
• Evaluating the source of the pain. Chronic pain from an undiagnosed tumor or infection won't improve until the underlying condition is addressed. "The majority of chronic pain cases are related to slow, degenerative joint processes; nerve impingement, compression, or damage; or simply unknown or unclear sources," says Dr. Uhl.
• Physicians and patients cooperating as a healthcare team. The authors offer a simplified treatment guide for specific pain scenarios, but recommend that all physicians tailor treatment for each individual patient.

February 2014 Full JAAOS Table of Contents

• Correspondence: Posterior Malleolus Fracture
• Application of Biologics in the Treatment of the Rotator Cuff, Meniscus, Cartilage, and Osteoarthritis
• Arthroscopic Subscapularis Repair
• Surgical Treatment of Metastatic Long Bone Fractures: Principles and Techniques
• Management of Chronic Musculoskeletal Pain
• Composite Bone Models in Orthopaedic Surgery Research and Education
• Fresh Osteochondral Allograft Transplantation for the Knee: Current Concepts Review