HJAR Jan/Feb 2021

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2021 19 pain management Q&A How do you categorize pain, and which type of pain is most difficult to treat? JOHNATHAN GOREE, MD: There are many ways to categorize pain. I most commonly use this one: acute v. chronic pain. Acute pain is pain that is short-lived and can be directly attributed to a surgery or injury and improves as the injury or surgery heals. This pain is normally more easily con- trolled, and opioids are effective. Chronic pain is pain that has been present for a longer period of time and remains even after an injury heals or is due to repetitive injury to the same location. If we encounter pain to the same area for weeks andmonths, there are changes at the cellular level that change how our body, nerves and brain pro- cess pain. This makes chronic pain much more challenging to treat, and often this type of pain does not respond as well to opioids. JULIO OLAYA, MD: Pain can manifest as acute and chronic. When we talk about acute, we usually refer to nociceptive pain that can be caused by any kind of trauma (e. g., touching a hot surface, being punc- tured by a sharp object, pain after a surgical procedure, etc.). When we refer to chronic pain, one of the most common is neuro- pathic pain, and it can be caused by dam- age to the nerves that transmit sensation and mobility signals to our body. The causes of the damage to the nerve conduction are multiple: peripheral, central, traumatic, isch- emic, post-stroke, infection, inflammation, cancer therapy, compression, etc. Due to the nature of these kinds of pain, a multidis- ciplinary approach is required, making it much more difficult and complex to treat. Is being in more pain an inevitable part of aging? If so, what can be done about it? GOREE: I do not believe that pain is an inevitable part of aging. There are, of course, certain aspects of aging that can contribute to pain. These include lack of mobility, development of arthritis, decreased activity, etc. However, just because someone becomes an older adult doesn’t mean that they should have to suffer with pain. With proper care, exercise, nutrition and general health maintenance, the body can function without chronic pain throughout life. OLAYA: The degenerative process that we as humans experience is part of the aging process, and when this progress (especially after our 50s), pain will be a manifestation that is practically a common denominator among all of us. What can be done about it? Now, not everyone will manifest pain with the same intensity or severity. It has been observed that those who lead a healthy life- style, meaning have a healthy diet, regular exercise, stretching, not smoking and avoid- ing being overweight, have less limiting and incapacitating pain than the ones who are not part of a regular exercise program and are overweight. These factors, in particular, are the No. 1 causes of chronic pain in the world. What are the challenges of treating pain in young individuals versus older? GOREE: I, personally, find that the chal- lenges are the same. Whenever I treat a pa- tient with chronic pain, I look to find out what their functional goal is. For younger patients, this goal, or “baseline,” might be different from some of my older adults. But the work, including medications, interven- tions and rehabilitation, to get patients to that goal is often similar. OLAYA: Typically, the younger population presents with pain to a pain clinic after an accident, which could be a motor-vehicle accident, a work-related injury or an injury during a physical activity. Pain that does not subside after a reasonable period of healing is defined as chronic pain. Unfortunately, there are many factors involved that could perpetuate the pain and the idea that the best approach to control pain involves “pain killers” (opiates), making them think that these magic pills are going to resolve the pain without understanding that these meds will only mask the real cause of the pain without resolving it. Also, among the younger population, there is a higher likeli- hood of using opiates as a source of pleasure and avoidance of their reality. The elderly population manifests pain due to a degen- erative and aging process. In general, this group of patients have a more mature ap- proach and are more aware of the risks and very dangerous side effects that the opiates represent, though we do find addiction and dependence as well. What is your opinion of regenerative medicine, and are you currently us- ing it in your practice? GOREE: I consider regenerative medicine to be the use of methods to regrow, repair or replace damaged tissue. When this is discussed in pain circles, we are normally Pain – we’ve all felt it. Chronic pain – that is a different story all together. Anyone who says “just take an aspirin” hasn’t been on the receiving end of this unfortunate affliction. In this anti-opioid-prescribing environment, how can chronic pain patients be best helped? Here is what the specialists say: