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Pain specialists know that, historically, pain has been under-treated, even dismissed, because it's invisible. There is no scientific way to measure it. It mysteriously continues after the injury has healed or the disease is over, and because doctors didn't know what to do about it.
Today, there is some good news. As of Jan. 1 of this year, medical facilities risk losing their accreditation if their doctors and nurses don't assess a patient's pain regularly, just the way they record other vital signs, and then control that pain to the best of their ability. The new standards have been described as the "Bill of Rights" for pain sufferers.
But not only will these standards help patients be more comfortable, pain researchers know that patients recover much faster if they are in little or no pain. Pain researchers know another thing, too: that left untreated or under-treated, acute pain can be transformed into chronic, permanent pain.
Nerves can become damaged, causing the spinal cord to literally rewire itself. It then sends false signals to the brain that there is pain, even after there shouldn't be. That is why stopping the pain before that process can begin is so crucial.
Chronic pain is the hardest to treat. But at places like the University of California-San Francisco Pain Management Center, pain specialists go a long way to making it bearable.
Doctors like Pamela Palmer use an arsenal of weapons to fight intractable pain. Small amounts of opiates like morphine delivered to the source of the pain (rather than large amounts taken orally), nerve blocks, physical therapy and psychology, even acupuncture and bio-feedback. They know how pain can ruin a person's life, and they will do anything and everything they can, not to cure it, but to keep it under control.
UCSF also has a Pain Clinical Research Center where Dr. Michael Rowbotham and his colleagues head up several pain research studies. One of them looks at shingles -- the agonizing condition caused later in life by the chicken pox virus. The purpose of the study is to ascertain why some shingles patients recover completely and have no pain once the virus has run its course, and others develop what's called "post-herpetic" pain (chronic nerve pain that remains after the shingles condition is over).
Since nerve damage pain rarely responds to opiodes like morphine, researchers hope that by finding some answers to the causes of shingles pain, they may have answers to other nerve damage pain, and some alternative drugs to treat them.
Then there are the snails - yes, a lowly sail may provide one answer to the question of precision pain relief.
Allan Basbaum heads the Department of Anatomy at the University of California-San Francisco, and he hopes that the same toxins that snails use to paralyze their prey can be modified for human use. He is working toward that end with a Salt Lake City, Utah, company called Cognetix. Cognetix Inc. discovers and develops novel therapeutics derived from marine organisms.
"Why do they work in a human or an animal?" Basbaum asks. "Because the same receptor that exists in the prey of the snail...exists in my spinal cord and your spinal cord. The trick is to find the right dose. The good news is that the basic science of pain mechanisms have now identified a slew of new targets, new therapeutic targets. That's exciting."
The fields of pain management and pain research have grown tremendously in the last decade or so, and they may well expand exponentially as the almost 80 million baby boomers march toward old age. Dr. Palmer thinks the boomer generation simply will not tolerate the kinds of discomforts their parents and grandparents tolerated, and that fact will be one of the engines driving pain research.
The other is money. According to the CBS News Poll, 65 percent of Americans suffering from chronic pain take prescription or other medications daily. It's now big business, and money talks.
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