What Is Chronic Pain?

By Dr. Sam Mirza

It is exactly what it says. It is a disease, like any other: diabetes, high blood pressure, heart disease, etc. Chronic pain is a symptom, but it becomes a disease when it lasts for months, years, or a lifetime. Under these circumstances the patientís pain needs to be treated as a disease. Long duration pain becomes a disease called chronic pain regardless of the disease or disorder of origin. Such chronic pain starts rejecting ordinary and usual means of pain relief. It becomes a part of day to day life of the sufferer. By doing so it begins to effect the patientís daily activities, habits, mood, job, relationships, eating, sleeping, etc. The patient becomes tense, anxious, short tempered, panicked, depressed and in serious cases, even suicidal. This happens as a result of the individualís continuous suffering and a lack of understanding on the part of patient him/herself, the patientís significant other, family, friends, and worst of all, the patient's doctors.

Different names and labels are often falsely applied to the chronic pain patient, such as: weak, complaining, whiner, crybaby, malingerer and even, druggy, narc, addict, drug seeker. Such labels are given despite a complete lack of empathy for the patientís condition. Many people may not even know the exact meanings of labels such as addict or drug seeker. These labels are applied because the patient requires pain-relieving medications throughout the day and night. Chronic pain sufferers require prescriptions for the relief of pain, and are not receiving pleasure or euphoria from these drugs. This is what separates those with chronic pain from drug addicts. Of course he/she is going to be happy when his/her pain is relieved through the use of drugs. This joy at relief should not be confused with addiction or abuse.

The other factor that scares the people around the patient is a phenomenon called, ďtoleranceĒ. This means that over a certain period of time the patient will need an increased dosage of the same medicine to get the previous level of relief, e.g. 20 to 30 to 40 to 50 mg and so on. This process often frightens the patient, their family and their doctors.

But the patient is NOT AN ADDICT, regardless of their tolerance to increasing dosage, as long as the medicine is being taken solely for the purpose of pain relief. Other criteria to use in judging a chronic pain patientís situation is to see if the medicine, besides relieving pain, is helping to restore the patientís daily activities, function, mental and emotional status. If these aspects of the patientís life are improving, then everyone around the patient should be pleased instead of concerned. Pain relieving medications are to a chronic pain patient as insulin is to a diabetic. Another factor to consider is whether everything possible is being done to treat or cure the disorder/disease that is causing the chronic pain.

If there is no understanding of the chronic pain patientís unique situation, the patient will only become worse both physically and emotionally. When hurtful and false labels are applied the patient will lose self-esteem, become guilt-ridden and self-abusive. The patient will also become isolated. The individual becomes a never visited island of self-pity in a dark ocean of pain and suffering. The pity of such situations is that the solution is no farther away than an understanding and concerned physician. A physician who may or may not be a chronic pain expert but is always committed, reassuring, patient, understanding and persistent. He or she is the one who not only prescribes medication but also listens to the patientís concerns, talks openly with the patient, and can understand and communicate the depth of the patientís situation. He or she does not only treat the pain, but is involved with the entire well being of the individual. He or she is not a ďknow it allĒ doctor, rather he/she recognizes and admits personal limitations. All alternative approaches to treatment should be carefully considered and explored. The most suitable route should be chosen in consultation with the patient. The patient should always give their consent to the plan of treatment.

In order for this process of consultation to be successful, the patient must educate him/herself in every aspect of chronic pain. The patient has to be direct and honest with the doctor. There must be bilateral and mutual trust and respect between the doctor and the patient. The physician should also make him/herself available to helping the patient properly express the issue of chronic pain to the significant persons in their life. The spouse, children, family and friends of the patient must learn to be supportive versus critical if any method of treatment is to succeed. Chronic pain is a disease that affects the entire family. The crucial nature of the physicianís role cannot be overstated. Every chronic pain patient is over-burdened with pain and fear. A simple statement from a doctor such as, "Please donít worry. I will not let you suffer from pain." can make a huge difference in the patientís state of mind. Once the patient believes such a statement, his or her anxiety will decrease. The relief of such anxiety breaks a viscous cycle: pain equals anxiety equals more pain equals more anxiety and so on.

It is always the patientís obligation to be honest and truthful with the physician treating their chronic pain. It is a sad fact that every day many kind and empathetic doctors are losing their licenses and livelihood by being conned into prescribing narcotics to individuals falsely claiming to suffer from chronic pain. The patient must also appreciate the kind of burden a good pain doctor is carrying on his/her shoulders. His/her time and efforts are a valuable and finite resource. Such a doctor needs to be protected from false claims and monetarily rewarded for his/her time and effort. It is by no means easy to treat chronic pain. It can be as frustrating for the doctor as for the patient.

I hope this will benefit chronic pain patients and their families.

God bless you,

Dr Sam


 Dr. Sam has a practice in Daytona Beach and Melbourne, Florida. Dr. Sam has been in practice over 30 years, first as a doctor of internal medicine for 30 years and now he has a pain control practice in Florida.  When I wrote to ask him for permission to use this chronic pain article he wrote me back and this is part of his letter:

ďI am an authority ON NO DISEASE OR CONDITION in medicine but somehow He guides me in how to take care of my patients and thank God most of them are doing well regardless of their diseases. You know we doctors in actuality cure maybe 1 to 5%  patients, the rest ... the majority get better even without us because the ailments were minor, a few get helped by us, many get worse by us, the rest unfortunately face the ultimate no matter what we do.  Yet we get all the credit. My belief is that a few kind words of encouragement, support, hope, reassurance work magic. Most of the serious diseases are either untreatable or incurable except the DISCOMFORT AND THE SUFFERING, THE PAIN which these disease cause . 50% of that is reduced by kind words the other 50% can be reduced by the available medicines and surgical advances.Ē

 My wish for all of you reading this is that you will find your own Dr. Sam.  But Iím afraid they are few and far between.