When we feel pain it is not simply the result of nerve signals acting like electricity through a wire to turn on the lights. Pain is the product of complex neurological processes we are only beginning to understand, but what we have learned is fascinating. We now understand that the brain actually creates sensation, vision, hearing, taste and smell. Information already in the brain combines with messages from incoming nerve signals to construct what we see, hear, smell, taste or feel. Memory, emotion, learning or any of the other processes the brain is concerned with are therefore integral to perception. Think of the brain as a living, changeable, information-processing organ that produces the sensation of pain.
Based on this, pain can be thought of as a complex experience that encompasses sensation, emotion and cognition. The pain from an arthritic joint for example, is not simply a product of how inflamed the joint is. Whatever else is going on in the central nervous system will influence the perception of pain.
Multidisciplinary treatment of chronic pain recognizes the complex nature of pain and that chronic pain is a disease on its own. It may arise from injury or illness but then takes on a separate life. In rheumatoid arthritis for example, pain can persist even when the rheumatic disease process is controlled. There is now consensus in the research literature that combinations of physical, psychological, pharmacological and surgical treatments are superior to any one kind of treatment alone when treating chronic pain. (For more, see What is Pain? – Series )
While it may be the best approach to pain management, multidisciplinary treatment rarely provides cures. Our ability to treat pain is limited by our incomplete understanding of its underlying neurological and physiological mechanisms. There is no convincing evidence that any therapy, multidisciplinary or not, has ever been 100 percent effective for 100 percent of patients. In scientific studies, “successful” treatment is often defined as a 30 percent to 50 percent reduction in pain. Therefore, many studies report success legitimately but also show we still have much to learn.
With this in mind, health care providers and patients need to be more realistic with their therapeutic claims and expectations. Improvement is best achieved when as many of the factors as possible that may be affecting pain are addressed in treatment. No matter how effective a pill, surgical procedure, herbal remedy, exercise, psychotherapy, diet or bodywork may be, all are far from perfect. When joined together to improve quality of life for those with pain, the distance from perfect gets shorter.
For patients this may mean giving up on finding a magic bullet and getting to work on the things they can do. Active exercise and relaxation/meditation techniques have repeatedly been shown to help chronic pain but only if they are practiced diligently (They are also less expensive than many dubious treatments marketed so vigorously on the internet and television). Patients need to be honest with themselves. Is the opioid analgesic they depend on really improving their quality of life? Are they so prejudiced against pharmaceutical or herbal remedies that they forgo helpful treatment without informing themselves properly? Maybe the distress they feel would respond to good psychological intervention – it would not mean that their pain was “only” psychological. Psychotherapy can offer valuable coping mechanisms that make dealing with pain easier. (Learn more in Pain and Fear-Series )