People with chronic pain have usually seen a family doctor and several other specialists as well. Eventually they are referred to neurologists, orthopedists, or neurosurgeons. The patient/doctor relationship is extremely important in dealing with chronic pain. Both patients and family members should seek out knowledgeable specialists who neither dismiss nor indulge the patient; physicians who understand full well how pain has come to dominate the patient's life and the lives of everyone else in the family.
Many specialists today refer chronic pain patients to pain clinics for treatment. Over 800 such clinics have opened their doors in the United States since a world leader in pain therapy established a pain clinic at the University of Washington in Seattle in 1960.
Pain clinics differ in their approaches. Generally speaking, clinics employ a group of specialists who review each patient's medical history and conduct further tests when necessary. If the applicant is admitted, the clinic staff designs a personal treatment program that may include individual and group psychotherapy, exercise, diet, ice massage for pain (especially before bedtime), electrical stimulation techniques, and the use of a variety of analgesic but nonnarcotic drugs. The aim is to reduce pain medication and so improve the patient's pain problem that when he or she leaves the hospital it is with the prospect of resuming more normal activities with a minimal requirement for analgesics and a positive self-image.
Contrary to what many people think, pain clinic patients are not malingerers or hypochondriacs. They are men and women of all ages, education, and social background, suffering a wide variety of painful conditions. Patients with low back pain are frequent, and so are people with the complications of diabetes, stroke, brain trauma, headache, arthritis, or any of the rarer pain conditions. The majority of patients participate for 2 or 3 weeks and usually report substantial improvement at discharge. One young man who had suffered painful chest injury as a result of a factory accident said he literally "felt taller" after his pain clinic experience.
Followup at 3- and 6-month intervals, and at lengthier intervals thereafter, is an essential part of the program, both to evaluate the long-term effectiveness of treatment and to initiate a further course of treatment or counseling if necessary.
Pain clinics have the virtue that they bring together people with pain problems that have left them feeling isolated, helpless, and hopeless. But not everyone with a pain problem may need the support of a group or residence in a hospital. The important factors are that the pain patient -- and the family -- understand all the ramifications of pain, and the many and varied steps that can now be taken to undo what chronic pain has done. As a result of the strides neuroscience has made in tracking down pain in the brain -- and in the mind -- we can expect more and better treatments in the years to come. The days when patients were told "I'm sorry, but you'll have to learn to live with the pain" will be gone forever.
The following organizations are directly concerned with pain problems. They are excellent sources of additional information, research updates, and specific help and referrals:
The Chronic Pain Lettter is a bimonthly review of new pain treatments, books, and resources for people who live with pain. For subscription information, write:
In addition, many organizations concerned with specific
diseases, such as arthritis or heart disease, provide information
and advice about attendant pain problems.
While there is no official certifying agency accrediting pain clinics throughout the country, there are many excellent clinics, often affiliated with university-associated medical centers.
Your family doctor or university medical center may be able to refer you to reputable clinics nearby. If not, physicians can write to the
which publishes a worldwide pain clinic directory.
For additional information concerning NINDS research on pain write: