Plagued for decades by chronic back problems, lupus and several other painful health conditions, Mary Crossman, 59, a retired geriatric nurse in Federal Way, Wash., hardly remembers a day when she hasn't hurt. Over the years, she's tried to find relief with over-the-counter medications, prescription pain pills, physical therapy "and just about everything else they can offer," she says. "Some days I'm OK. Others, I can barely get up and move."
An estimated 100 million Americans suffer from chronic pain each year, according to a landmark 2011 report by the Institute of Medicine. Back injuries are a common cause, but there are many others, including arthritis, shingles, nerve damage from diabetes, and the aftereffects of surgery. The United States spends up to $635 billion annually to treat chronic pain. Yet millions go on suffering. While there is still no magic bullet, researchers have gained important new insights into the nature of pain and the process that turns the acute pain from an illness or injury into persistent, chronic pain.
"Given exactly the same injury, some people get well. Others develop chronic pain. The question is why," says A. Vania Apkarian, a neuroscientist at the Northwestern University Feinberg School of Medicine in Chicago. In the first study to look at what happens in the brain when chronic pain develops, he and his colleagues followed people who had just suffered a back injury, using brain scans. The team found that the brain's architecture actually changes in response to persistent pain. More startling still, the scientists discovered that the greater the interaction of two specific areas of the brain — the medial prefrontal cortex and the nucleus accumbens — the greater the chance that patients will develop chronic pain.
"The injury itself is important, of course," says Apkarian. "But what's happening in the brain predicts with 80 percent accuracy who will go on to develop chronic pain." Apkarian hopes the discovery will lead to new drugs that could head off the switch from acute to chronic pain.
The most effective approach to pain
For now, the most effective way to ease chronic pain is a holistic approach that involves both body and mind — one that begins with a dose of reality. "A lot of patients come to us hoping that we can get rid of their pain," says Richard W. Rosenquist, M.D., an expert in pain management at the Cleveland Clinic. "But the reality for many patients is that we can't. We can't cure their arthritis. We can't make them young again. But we can help them manage chronic pain and get back to their lives."
Indeed, many experts now encourage chronic pain sufferers to focus less on their pain and more on function. "I used to routinely ask chronic pain patients to rate their score on a scale of 1 to 10," says Rosenquist. "Now I want to know what people would like to do that they can't do because of their pain. Then we can look for ways to help them manage the pain and do what they want to do."
The benefits of exercise
Staying as active as possible is crucial. In fact, recent research shows that physical activity — done safely — is one of the most effective treatments for chronic pain.
In a 2012 study by researchers at the Hospital for Special Surgery in New York, 200 patients with osteoarthritis who participated in a weekly exercise program reported a significant drop in pain and an improvement in quality of life. The program included tai chi, yoga, dance and other forms of exercise, tailored to people with osteoarthritis. Other studies have shown that exercise eases chronic back pain. Almost any form of activity seems to help. When scientists at Tel Aviv University compared six-week programs of brisk walking versus strength training workouts in patients with chronic low-back pain, both improved functioning and reduced pain.