What is Chronic Pain and how to treat chronic pain?

More than 75 million Americans suffer from chronic pain. Although pain acts as a warning sign of disease or injury, chronic pain is not protective and can be debilitating. In the United States alone, medical treatment and lost workdays due to chronic pain cost an estimated $70 billion per year.

Pain medicine experts agree that the successful management of chronic pain requires a multi-disciplinary approach. In the past decade there have been remarkable advances in the field of pain management, from a better understanding of the basic science to state-of-the-art drug delivery systems. The complexities of treating chronic pain are enormous since the physical, psychological and spiritual causes of each patient’s pain are unique.

Chronic pain can result from one or a combination of factors including stress, illness, nerve injury and surgical complications. According to John J. Bonica, M.D., an anesthesiologist known as the “founding father of the pain field,” chronic pain is any pain that persists more than a month beyond the usual course of an acute injury, process, or disease. In his book, Management of Pain, Dr. Bonica describes chronic pain as “A pathological process that causes continuous pain or the pain recurs at intervals for months or years.”2


In the ideal world, each person with chronic pain would have a thorough medical evaluation with a pain specialist and be treated with a combination of psychological, pharmacological and alternative therapies. Unfortunately, many comprehensive pain management programs are going down the tubes because they are not cost effective. We are not lacking in strategies, but as a society there is not a push to get through the barriers that prevent real multi-disciplinary pain management. More and more practitioners are being trained in pain medicine, but access to care is an ongoing problem for patients with chronic pain.

In a survey conducted by The American Pain Society, only 25 percent of patients with moderate to severe pain were evaluated by a specialist. Most people with chronic pain receive treatment from their primary care physicians who, for the most part, are untrained in the field. This is not necessarily the doctor’s fault. There is very little formal education on the topic of pain management. According to the American Medical Association, only four schools currently include end-of-life care in their curriculum. Furthermore, most residency training programs, with the exception of anesthesiology, do not require pain management rotations. Doctors learn to provide pain management in a very haphazard way. There is a lot of practice variation because doctors are all trained differently. For example, anesthesia, surgery, neurology, primary care and psychiatry look at pain from very different perspectives.

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