Cortez pain management specialist Dustin Cole, MD, sees individuals suffering with chronic pain every day in his office.
“If I had a magic pill to make chronic pain go away I’d happily find another line of work,” said Cole. Unfortunately, treating chronic pain usually requires more than a pill. “The goal is to help patients manage their pain. It’s often unrealistic to expect complete relief, and the longer the pain goes on the less likely it is to go away completely,” said Cole.
According to the Institute of Medicine of The National Academies more than 100 million Americans suffer from chronic pain. That’s almost one-third of the U.S. population. The most commonly reported types of chronic pain are low back pain – the leading cause of disability in people under 45 – followed by headache/migraine pain, neck pain, and then facial pain. Chronic pain in hips, knees, and shoulders is also common, especially in older adults.
In his practice, Cole focuses on understanding how chronic pain impacts patients and how they can maximize function and do what they need and want to do each day. He says often times a patient’s first question is whether he’s seen their MRI scan.
“We’re in a culture of technology,” said Cole. Before looking at or ordering tests, Cole wants to know a patient’s history. “I need to listen to their story, do a thorough examination, and then look at X-rays or other imaging studies in that context,” said Cole. “Diagnostic imaging is a tool, but it’s not the answer. When you’re talking about chronic pain it’s just a piece of the puzzle.” A thorough diagnostic workup is essential before offering any type of treatment or management plan.
Cole utilizes a conservative approach centered around appropriate procedures, physical therapy and tailored medical treatment. Physical therapy can be very helpful and is frequently the most important component of a treatment plan. Therapists have extensive training and can help significantly, but patients have to be active participants in their therapy to get the most benefit.
Medications can play a significant role in chronic pain management but, interestingly, narcotics are not usually the best option. “We have a vast array of safe and highly effective medications for specific types of pain. We tailor medication to the type of pain, such as nerve or joint pain,” said Cole. Narcotics work well for acute pain, but there is little evidence that they are effective for chronic pain.
Interventional measures help some patients. Cole uses epidurals, nerve blocks, joint injections and nerve-burning procedures when necessary. Most spine procedures are performed at the hospital, while joint injections and other procedures are performed in Cole’s office, often using ultrasound. “Ultrasound helps me guide the needle to avoid nerves, blood vessels, and other important structures and to ensure precise medication placement,” said Cole. The use of ultrasound can provide more accurate diagnostic information and better, safer pain relief.
Surgery is often the last resort for patients with chronic pain. “In general, I tell patients there are two reasons to have surgery. The first is when more conservative treatment has failed and the pain is so debilitating that they want to consider surgery. The second reason is when there is a progressive neurological deficit,” said Cole. In the latter case, a patient might be experiencing severe weakness, numbness, or tingling in the legs or loss of bladder or bowel control. These symptoms are usually caused by a problem in the spine. “My bias is to be as conservative as possible,” said Cole, “but sometimes surgery really is the best option.”
Cole frequently recommends complementary and alternative therapies to his pain patients, such as acupuncture and osteopathic manipulation. Often overlooked when it comes to taking a holistic approach to pain management is the psychological impact it has on patients and their loved ones.
Some chronic pain sufferers become very identified with their pain, making it the central focus of their lives. Others downplay how much they are suffering. Cole finds it helpful when patients bring a friend or family member to appointments.
“Pain doesn’t just affect the patient. It impacts families, co-workers, and everyone in the patient’s life,” said Cole. “A patient will say ‘I’m doing OK, I’m getting through the day,’ but the spouse will report that the patient is spending more time on the sofa, isn’t able to do regular activities around the house, and doesn’t want to go out to dinner or go for a walk anymore,” said Cole.
The world of someone who suffers with chronic pain can become very small, says Cole. “They shrink back from things they used to enjoy. Patients stop doing normal activities or things they previously enjoyed for fear of increased pain or worsening the cause of their pain. This is called fear avoidance behavior.”
This, says Cole, is a vicious cycle. Doing less and less in an effort to avoid pain makes the situation worse.
“Inactivity leads to less function and more pain,” said Cole. Living in a tiny world that revolves only around pain does not have to be the norm for chronic pain sufferers, but expanding beyond that small world and having a full and meaningful life requires effort. “It requires a commitment to focusing on what a patient can do despite the pain rather than focusing on the pain itself and what a person is not able to do,” said Cole.
“I tell patients they get to choose their journey,” he said. Most helpful is adopting a healthy lifestyle that includes good nutrition, regular exercise, enough sleep, managing stress and sometimes losing weight. Anxiety and depression are common in patients with chronic pain, and ignoring these issues can lead to even more suffering.
“It’s tricky to recommend that someone see a therapist, because they might think I’m suggesting the pain is in their head,” said Cole. “That’s not the case at all. The pain is real, and treating any associated anxiety and depression can help significantly.”
A mental health specialist can work with patients using cognitive behavioral therapy, biofeedback, and teaching techniques such as guided imagery, stress management, and meditation. “These things may not make the pain go away, but they are safe, effective, inexpensive tools that help patients cope with pain,” said Cole.
Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez, Colo. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal health care provider.