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Sunday, October 31, 2010
Thursday, October 28, 2010
- Disseminate information about acute pain worldwide
- Educate pain researchers as well as health care professionals who see the issues associated with acute pain first-hand in their interactions with patients
- Increase awareness of acute pain among government officials, members of the media, and the general public worldwide
- Encourage government leaders, research institutions, and others to support policies that result in improved pain treatment for people with acute pain
Tuesday, October 26, 2010
Twenty years after Ian Semmons was badly injured trying to prevent a robbery, he is still in pain. Thrown down a flight of stairs, he'd shattered his back and ankles.
Despite two-and-a-half years of operations and rehabilitation — and strong painkillers — he lived in constant agony from his shoulders to his ankles.
'At its worst, it was like having big, sharp needles thrust into your body,' recalls the former risk management consultant.
Ian is one of nearly 10 million Britons who suffer from chronic pain, which is defined as continuous, long-term pain of more than 12 weeks.
Worryingly, a new survey has found that people in the UK wait, on average, three years for a diagnosis of what's causing their pain, and a further three years before the pain is adequately managed.
In many cases, chronic pain affects sufferers' ability to work: four in 10 are unable to work at all, according to the Pain Proposal European Consensus Report funded by Pfizer. Pain is a natural response to injury.
Rather like sending a telegram, the damaged nerves transmit tiny messengers called neurotransmitters to the spinal cord — the body's superhighway — and then to the brain, which decides how to respond.
As the injury heals, the messages become less intense and less frequent, and finally stop. But this mechanism can go awry. Like a broken record, it keeps repeating itself, re-sending the messages of pain long after the reason for stimuli has passed.
A quarter of people affected by chronic pain suffer from depression, and many feel their pain is so bad that at times they want to die.
Yet sufferers are very much neglected in the UK, because GPs are uninformed about chronic pain and designated pain clinics, says Dr Beverley Collett, a consultant in pain medicine at the University Hospitals of Leicester and chair of the Chronic Pain Policy Coalition.
'Many healthcare professionals don't know enough about chronic pain,' she says.
'During their five to six years of medical school, doctors spend just 13 hours on pain. Nurses spend just 10 hours, and physiotherapists manage to clock up 35 hours.
'But this is simply not enough time to understand this complex problem.'
Yet there is more reason than ever for young medics to take this part of their training seriously, she says, as experts are at last discovering that chronic pain is not just the body failing to heal, or, worse, a psychosomatic 'cry for help'.
'For a long time, patients who complained of chronic pain were labelled with depression,' says Dr Collett. 'Now, we are realising they may be suffering what we call a hyper-excitable response within their bodies.
'This means that nerves in the area of original damage have become so sensitive to stimulus they keep reporting sensations back to the brain — even when nothing is going on to warrant a message. In turn, the brain interprets that message as pain.'
Once activated, this has a knock- on effect, causing other nerves to fire off pain messages, too.
In many cases, chronic pain affects sufferers' ability to work: four in 10 are unable to work at all
How well chronic pain is managed depends very much on how well your GP understands the condition — and whether you live close to one of the UK's few chronic pain clinics.
Like many patients, it was three years after the initial incident before anyone recognised that Ian's acute condition had become a long-term pain problem. He'd been effectively left to manage, with his GP prescribing the strongest painkillers month after month.
By the time he was referred to a pain clinic, after changing GPs, the active fortysomething man had become angry and frustrated — unable to work or even to play with his then five-year-old daughter Becky.
His marriage had broken down, as his wife was unable to cope with the change to her husband.
'It was only when I got to see a consultant in pain medicine that anyone explained to me that I was going to be in pain for the rest of my life. Ironically, this was more of a mental boost than it sounds, as he told me I had to accept that I was not going to "recover" in the accepted sense, and that I had to get on with my life again.'
But the real improvement came 14 months later, when Ian was referred to a psychiatrist. 'I had reached rock bottom by the time I saw him. I had even taken to hiding a pack of very strong painkillers so that I could end my life if it all got too much.
'But the counselling helped me to move forward and finally to reduce the amount of medication I took, which itself was making me moody and physically uncomfortable.'
Side-effects of strong painkillers include constipation, insomnia and nausea — and Ian had suffered the whole range.
'With counselling, I started to focus on what I could do, not what I couldn't. My daughter motivated me, too. I didn't want her to miss out on having a dad.'
A crucial part of his recovery probably can't be replicated by most patients: he married his former physio, 47-year-old Judith, and the couple now have a 12-year-old son, Thomas.
But Ian, now 60, admits that 20 years on from the original incident, he is still in pain every day — and knows he always will be.
'I still need regular operations to relieve scar tissue, and I have rotten arthritis, too. But I mostly only use a stick these days, not crutches, and rarely take more than paracetamol.'
Ian went on to found the country's largest general pain charity, Action On Pain, and now campaigns for better service. 'Over 90 per cent of callers to our helpline don't even know pain clinics exist,' he says.
Dr Collett says it's essential patients see a pain specialist in conjunction with other experts.
'In Leicester, we are well equipped with a wide multi-disciplinary team, from anaesthetists to physiotherapists, as well as specialist pain nurses and consultants, but that is just not true everywhere.'
Saturday, October 23, 2010
Wednesday, October 20, 2010
To his surprise, it was an elite runner, Kim Smith, a blond waif from New Zealand. She has broken her country's records in shorter distances and now she's running half marathons. She ran the London marathon last spring and will run the New York marathon next month.
That day, Ms. Smith seemed to be struggling. Her breathing was labored and she had saliva all over her face. But somehow she kept up, finishing just behind Stefan and coming in fifth with a time of 1:08:39.
And that is one of the secrets of elite athletes, said Mary Wittenberg, president and chief executive of the New York Road Runners, the group that puts on the ING New York City Marathon. They can keep going at a level of effort that seems impossible to maintain.
"Mental tenacity — and the ability to manage and even thrive on and push through pain — is a key segregator between the mortals and immortals in running," Ms. Wittenberg said.
You can see it in the saliva-coated faces of the top runners in the New York marathon, Ms. Wittenberg added.
"We have towels at marathon finish to wipe away the spit on the winners' faces," she said. "Our creative team sometimes has to airbrush it off race photos that we want to use for ad campaigns."
Tom Fleming, who coaches Stefan and me, agrees. A two-time winner of the New York marathon and a distance runner who was ranked fourth in the world, he says there's a reason he was so fast.
"I was given a body that could train every single day." Tom said, "and a mind, a mentality, that believed that if I trained every day — and I could train every day — I'll beat you."
"The mentality was I will do whatever it takes to win," he added. "I was totally willing to have the worst pain. I was totally willing to do whatever it takes to win the race."
But the question is, how do they do it? Can you train yourself to run, cycle, swim or do another sport at the edge of your body's limits, or is that something that a few are born with, part of what makes them elites?
Sports doctors who have looked into the question say that, at the very least, most people could do a lot better if they knew what it took to do their best.
"Absolutely," said Dr. Jeroen Swart, a sports medicine physician, exercise physiologist and champion cross-country mountain biker who works at the Sports Science Institute of South Africa.
"Some think elite athletes have an easy time of it," Dr. Swart said in a telephone interview. Nothing could be further from the truth.
And as athletes improve — getting faster and beating their own records — "it never gets any easier," Dr. Swart said. "You hurt just as much."
But, he added, "Knowing how to accept that allows people to improve their performance."
One trick is to try a course before racing it. In one study, Dr. Swart told trained cyclists to ride as hard as they could over a 40-kilometer course. The more familiar they got with the course, the faster they rode, even though — to their minds — it felt as if they were putting out maximal effort on every attempt.
Then Dr. Swart and his colleagues asked the cyclists to ride the course with all-out effort, but withheld information about how far they'd gone and how far they had to go. Subconsciously, the cyclists held back the most in this attempt, leaving some energy in reserve.
That is why elite runners will examine a course, running it before they race it. That is why Lance Armstrong trained for the grueling Tour de France stage on l'Alpe d'Huez by riding up the mountain over and over again.
"You are learning exactly how to pace yourself," Dr. Swart said.
Another performance trick during competitions is association, the act of concentrating intensely on the very act of running or cycling, or whatever your sport is, said John S. Raglin, a sports psychologist at Indiana University.
In studies of college runners, he found that less accomplished athletes tended to dissociate, to think of something other than their running to distract themselves.
"Sometimes dissociation allows runners to speed up, because they are not attending to their pain and effort," he said. "But what often happens is they hit a sort of physiological wall that forces them to slow down, so they end up racing inefficiently in a sort of oscillating pace." But association, Dr. Raglin says, is difficult, which may be why most don't do it.
Dr. Swart says he sees that in cycling, too.
"Our hypothesis is that elite athletes are able to motivate themselves continuously and are able to run the gantlet between pushing too hard — and failing to finish — and underperforming," Dr. Swart said.
To find this motivation, the athletes must resist the feeling that they are too tired and have to slow down, he added. Instead, they have to concentrate on increasing the intensity of their effort. That, Dr. Swart said, takes "mental strength," but "allows them to perform close to their maximal ability."
Dr. Swart said he did this himself, but it took experience and practice to get it right. There were many races, he said, when "I pushed myself beyond my abilities and had to withdraw, as I was completely exhausted."
Finally, with more experience, Dr. Swart became South Africa's cross-country mountain biking champion in 2002.
Some people focus by going into a trancelike state, blocking out distractions. Others, like Dr. Swart, have a different method: He knows what he is capable of and which competitors he can beat, and keeps them in his sight, not allowing himself to fall back.
"I just hate to lose," Dr. Swart said. "I would tell myself I was the best, and then have to prove it."
Kim Smith has a similar strategy.
"I don't want to let the other girls get too far ahead of me," she said in a telephone interview. "I pretty much try and focus really hard on the person in front of me."
And while she tied her success to having "some sort of talent toward running," Ms. Smith added that there were "a lot of people out there who were probably just as talented. You have to be talented, and you have to have the ability to push yourself through pain."
And, yes, she does get saliva all over her face.
"It's not a pretty sport," Ms. Smith said. "You are not looking good at the end."
As for the race she ran with my son, she said: "I'm sorry if I spit all over Stefan." (She didn't, Stefan said.)
Saturday, October 16, 2010
The agency's decision endorses doctors' use of Botox to treat patients who suffer from a severe form of migraine involving headaches on at least 15 days a month. Britain's drug agency approvedBotox for the same use this summer.
Botox is already approved by the F.D.A. to treat uncontrolled blinking; crossed eyes; certain neck muscle spasms; excessive underarm sweating; and stiffness associated with muscle spasticity in the elbows and hands. It also is approved for cosmetic purposes — to smooth lines between the eyebrows.
Botox had worldwide sales last year of about $1.3 billion, divided equally between medical and cosmetic uses.
But Allergan said sales of Botox for chronic migraine and other medical uses would soon eclipse sales of the drug as a wrinkle smoother. Allergan is also studying the drug for a variety of new medical uses, including overactive bladder, said Dr. Scott M. Whitcup, the company's executive vice president for research and development.
"For the business, Botox has been an incredible medication. We call it our pipeline in a vial," Dr. Whitcup said. "People still think about it as a cosmetic product, but the therapeutic indications in the next five years will far surpass its cosmetic use."
Industry analysts have forecast worldwide sales of the drug for the severe migraine condition at $250 million to more than $1 billion annually by 2015.
Unlike the occasional headache, the chronic migraine condition is often accompanied by nausea, vomiting, dizziness, intense sensitivity to light and noise, and moderate to severe pain.
The audience for Botox headache shots could be significant because some chronic migraine patients do not improve when they take the pills that are now the standard treatment, neurologists said. Treatments include pills like Topamax, taken daily to prevent migraine, and the triptan family of drugs, taken to ease an existing migraine.
Botox is a purified form of botulinum toxin, a nerve poison produced by the bacteria that causes botulism. Injections of Botox typically act to temporarily blunt nerve signals to certain muscles or glands. Researchers are still exploring how the drug works on migraines. Dr. Whitcup said one theory was that it blocked pain signals from reaching nerve endings.
A Botox migraine treatment generally involves a total of 31 injections in seven areas — including the forehead, temples, the back of the head, the neck and shoulders. To treat the chronic condition, injections are given about every three months.
Industry analysts estimated that the migraine treatment would cost $1,000 to $2,000, depending on the amount of the drug used and the physician's fee. Some private insurers are likely to cover the migraine treatment now that it has received F.D.A. approval, analysts said, although patients may have to cover a significant co-payment.
"The cost is prohibitive for some," Randall Stanicky, a vice president for global research at Goldman Sachs, said in an interview earlier this year. "But given the debilitating challenges of having migraines more than 15 days a month, if Botox can cut down on that, it's clearly going to be a big opportunity."
Other analysts have expressed skepticism that doctors and patients would embrace the drug, arguing that Botox has a marginal effect on headaches compared with a placebo.
"The true drug effect is minimal," Corey Davis, an analyst at Jefferies & Company, said in an interview earlier this year.
Patients in one study financed by Allergan, for example, typically experienced about five fewer headache episodes a month than they had before the study — no matter whether they had injections of Botox or a placebo.
After Allergan reviewed the results of that first study, the company changed the primary end point — the scientific goal post — on a second study so that it would focus on the drug's effect on the number of headache days rather than the number of headache episodes that a person experienced each month. Dr. Whitcup said it was easier for patients to remember how many headache days as opposed to how many headache episodes they had every month.
The second study reported that patients who received Botox injections typically experienced about 2.3 fewer headache days than the placebo group, a statistically significant difference. But the placebo group also experienced considerable improvement — a common feature in pain studies — raising questions among some doctors about the magnitude of the Botox effect.
Dr. Whitcup said Botox had consistently beaten the placebo at different time points in the study and that patients had reported an improvement in their daily functioning and quality of life.
Although the F.D.A. approved the drug for the chronic condition, the agency said in its statement Friday that Botox had not been shown to work for the occasional headache or migraine.
Common side effects were neck pain and headaches. But neurologists point to a more welcome side effect for some — fewer wrinkles.
Friday, October 15, 2010
Outside neurology and his family, Sean Mackey doesn't have many hobbies. The one exception is his monstrous flat-screen television and large film collection. Driving to Stanford, California, on the day I am to visit Mackey's lab for testing, I am reminded of a scene from his favourite movie, The Princess Bride. In the film, the villain, Count Rugen, straps the hero Westley into a sinister apparatus and confesses a "deep and abiding interest in pain". Then he tortures the hero in the name of science.
It turns out that this is not far from what is in store for me.
Mackey heads the Pain Management Center at Stanford School of Medicine where, as part of his research on ways to relieve pain, he routinely inflicts it. Widely seen as one of the field's rising stars, Mackey is part of a movement to upend the way scientists look at pain, drawing the focus away from the nerves that sense it, towards the brain that processes it. His primary tool is functional magnetic resonance imaging (fMRI), which can create images of the brain responding as the body is hurting. The trick now — and one focus of Mackey's work — is to understand whether a person can consciously change the way the brain processes and perceives pain. That's where I come in. The plan is to put me inside the fMRI scanner, apply burning heat, and see whether I can train myself to regulate my pain.
As part of his studies, Mackey has found himself struggling with a question facing the fMRI field as a whole: when is the technique ready for use outside the lab? One of his former colleagues has started a company that plans to offer patients the fMRI 'feedback' pain-control technique that Mackey was involved in developing. But Mackey has distanced himself from the company in these early stages, based on what he has observed elsewhere. "I've seen too many treatments that are the next latest and greatest thing out there that people get really excited about. Everybody gets on board and initially the results are fantastic. And then as time goes by we start to see that the results are not as good as initially proposed," he says. "And then you find out that it doesn't work at all."
Walking into his office near the Stanford Hospital, Mackey is more reminiscent of a corporate executive than a brain researcher. He is a cheery, focused ball of energy, with a quick smile and a firm, reassuring handshake. He regularly wears a suit in the lab. He says it fights the stereotype that all anaesthesiologists — he trained as one — wear "pyjamas" to work.
According to Mackey, the suit also tells patients that he takes his work seriously. They may be recovering from knee surgery, they may be wounded veterans or they may have a rare neurological condition that can cause excruciating full-body pain. According to the International Association for the Study of Pain, one in five people endures moderate to severe chronic pain. "I have seen it take people who are otherwise normal and turn their lives upside down and absolutely destroy them," says Mackey. Or as his colleague Ian Carroll, another Stanford anaesthesiologist, puts it: "It's like the black hole of the brain. It dominates it and forces everything to spin around it."
Opiate painkillers and other prescription drugs, officials say, are driving addiction and crime like never before, with addicts singling out the homes of sick or elderly people and posing as potential buyers at open houses just to raid the medicine cabinets. The crimes, and the severity of the nation's drug abuse problem, have so vexed the authorities that they are calling on citizens to surrender old bottles of potent pills like Vicodin, Percocet and Xanax.
On Saturday, the police will set up drop-off stations at a Wal-Mart in Pearland, Tex., a zoo in Wichita, Kan., a sports complex in Peoria, Ariz., and more than 4,000 other locations to oversee aprescription drug take-back program. Coordinated by the Drug Enforcement Administration, it will be the first such effort with national scope.
The take-back day is being held as waves of data suggest the country's prescription drug problem is vast and growing. In 17 states, deaths from drugs — both prescription and illegal — now exceed those from motor vehicle accidents, with opiate painkillers playing a leading role. The number of people seeking treatment for painkiller addiction jumped 400 percent from 1998 to 2008, according to the federal Substance Abuse and Mental Health Services Administration.
And from rural New England to the densely populated South, law enforcement officials are combating a sharp rise in crime tied to prescription drugs.
"We're seeing people desperately and aggressively trying to get their hands on these pills," said Janet T. Mills, the attorney general in Maine. "Home invasions, robberies, assaults, homicides, thefts — all kinds of crimes are being linked to prescription drugs."
In Harpswell, Me., a masked man broke into the home of a 77-year-old woman in June, knocked her to the ground and snatched her Oxycontin pills at knifepoint. And in Hyannis, Mass., three men armed with a knife, a bat and a revolver broke into a home in 2008, bound the owner's hands and feet with duct tape and tore through drawers and cabinets until they found her husband's Oxycontin.
In other states, the authorities say, pill thieves have infiltrated open houses.
"One will distract the Realtor," said Matthew Murphy, assistant special agent in charge at the D.E.A.'s New England field division in Boston, "while the other goes and rifles through the medicine cabinet looking for pain medication."
Skeptics, pointing to the dearth of evidence that gun buybacks have reduced the gun crime rate, question whether even a national take-back effort will have much impact. And they question whether most people will bother to participate when the take-back programs, unlike the gun programs, do not offer a reward for turning in pills.
There is also the reality that many people intentionally hang on to pain or anxiety medicine for future use.
"They might say, 'I'll take back my Oxy but not my Vicodin,' " said Neale Adams, the district attorney in Aroostook County, Me. He said "easily a third" of the indictments there were related to prescription drug trafficking and abuse.
The officials coordinating Saturday's drug take-back program acknowledge that even with a few thousand drop-off points, it will capture but a tiny fraction of the addictive drugs lining the nation's medicine cabinets.
Nor will it address root causes of addiction, like the overprescribing of powerful drugs. In New York City, the number of oxycodone prescriptions filled at pharmacies rose by 66 percent from 2007 to 2009, with a high density of prescriptions per population in middle-class strongholds like Staten Island and Chelsea.
But Steve Bullock, the attorney general in Montana, said the program was a worthy tool, nonetheless.
"It raises the awareness that we tend to hoard these drugs and hang onto them," he said. "And raising that awareness is one more step in dealing with the overall problem."
In lobbying the public to participate, law enforcement officials and others who battle prescription drug abuse try to educate people on just how lethal keeping pills around can be.
"It's really no different than having a loaded gun just lying around the house," said Joanne Peterson of Raynham, Mass., who started a support group for relatives of prescription drug abusers after her son tried a friend's Oxycontin and became addicted.
While the primary goal of the take-back day is to reduce the volume of pills in households, there may also be environmental benefits. The collected drugs will be incinerated instead of flushed down toilets, which can release them into the water supply.
Incineration is the best way to dispose of controlled prescription drugs, Mr. Murphy said, but the cost of contracting with private disposal companies can be prohibitive. Some communities have gotten creative: in Bella Vista, Ark., the police department bought a small incinerator specifically to destroy pills. And in West Lafayette, Ind., a pet crematory incinerates pills collected by the police at no charge.
Gary Boggs, executive assistant in the office of diversion control at D.E.A. headquarters in Washington, said the agency hoped to coordinate national drug take-back days twice a year until federal law allows other options for safe prescription drug disposal. Several bills before Congress would loosen regulations on who can collect used drugs.
Meanwhile, a growing number of state legislatures are considering bills that would require drug manufacturers to help coordinate and pay for the collection and disposal of leftover prescription drugs.
Bernard Strain of Philadelphia, whose teenage son Timmy died last year after taking prescription methadone pills that had been sitting in a medicine cabinet, said pushing for drug collection programs had become his crusade.
Timmy had been prescribed Percocet after burning his hand on a lawnmower, Mr. Strain said. When his pain persisted, his girlfriend's mother offered him two pills that he thought were extra-strength Percocet but turned out to be methadone, another powerful painkiller. He died that night.
"This is about saving even just one life," said Mr. Strain, who will help supervise a take-back site in Philadelphia on Saturday. "If we can dispose of cans and bottles and oil from our car properly, why can't we dispose of something the size of a dime that can kill you?"
Researchers from Stanford University studied the link between love and pain by scanning the brains of 15 college students who all professed to being deeply in love. The eight women and seven men were placed in brain scanners that tracked their body's response to pain — in this case a heated probe placed on the palm of the hand.
Then the researchers studied the brain's pain response under three different conditions. In one scenario, the study subject looked at a picture of an acquaintance. In another, the student looked at a picture of his or her beloved. And because other research has shown distraction also can relieve pain, the student was given a distracting word task — in this case, they were asked to name sports that don't use balls.
Looking at a picture of a loved one reduced moderate pain by about 40 percent and eased severe pain by about 10 to 15 percent, compared to viewing the picture of an acquaintance. The distraction task also provided similar levels of pain relief, but researchers noted that the analgesic effects of love and distraction occurred in different pathways of the brain. Love-induced analgesia was associated with the brain's reward centers, while the pain relief resulting from distraction occurred mostly along cognitive pathways, the researchers said. The findings were published online in the journal PLoS ONE.
Other studies have shown that romantic love activates the brain's dopamine system, much as addictive behaviors like gambling or drug use do. Researchers speculate that looking at a photo of a romantic partner prompts the dopamine system to interact with other brain systems that release natural opioids, or painkillers, in the body, similar to those credited with the "runner's high" that can occur with exercise.
The findings add to scientists understanding of how the brain responds to discomfort and could lead to new treatments for people suffering from chronic pain. Dr. Sean Mackey, chief of the division of pain management at Stanford and senior author of the study, said the findings support the theory that pain patients may find some relief by seeking out pleasurable activities.
"Find things to give you pleasure in life, whether it be through the one you love or going and listening to great music or reading a good book," Dr. Mackey said. "It suggests that activating this intrinsic reward system ultimately can reduce your pain."
Dr. Mackey said the research should also help doctors better assess the condition of their patients, particularly those who are finding relief "that doesn't involve a pill or procedure." In his own practice he now not only encourages pain patients to seek out distractions but to also focus on pleasurable activities.
"It's caused me to change the education and how I talk with my patients and how they understand it," he said.
Dr. Mackey says he also now pays more attention to the role that a relationship may be having on a patient's health.
"When patients are doing markedly better and I find out they are in a new passionate relationship, I may be less likely to think it's the new medication I put them on," he said. "I realize that maybe it has nothing to do with me."
Thursday, October 14, 2010
Except, it turns out, how we're treated for it varies greatly.
Blacks and Hispanics are more likely than whites to deal with untreated pain and less likely to get adequate care for it, studies show. And minority patients who don't get proper pain treatment early on are likely to suffer depression and post-traumatic stress disorder down the road, says Dr. Carmen Green, a pain specialist and professor of anesthesiology at the University of Michigan.
Researchers don't know whether the pain imbalance is due to caregiver bias, cultural differences, physiological variances, or a combination of factors, but they do know one thing: Pain is not colorblind.
"There is an unequal burden of pain," Green said.
A recent study by Green of 200 chronic pain patients in the University of Michigan health system found that black patients were prescribed fewer pain medications than whites and that women were given weaker pain medications than men were given. The research published in the Journal of Pain showed that, on average, a minority pain patient would be prescribed 1.8 pain medications compared to 2.6 drugs for non-minority sufferers.
And once they do get a prescription, they have a harder time getting it filled, Green found in an earlier study, also in the Journal of Pain. Only 54 percent of pharmacies in minority neighborhoods had the most common painkillers in stock; in majority-white neighborhoods, 87 percent of pharmacies did.
Green's studies add to two decades' worth of research that shows even when pain is indisputable, such as in late-stage cancer and with broken bones, minorities get less help for their suffering.
That means a lot of unnecessary pain for people like Deborah Chenault-Green (no relation to Dr. Green), a black woman who suffered through seven years of intense pain before finally being diagnosed with herniated discs in her back and neck, as well as multiple sclerosis.
Chenault-Green, now 55, saw countless doctors at inner-city hospitals in her hometown of Detroit, but all they offered her were over-the-counter pain pills. She felt like the doctors weren't taking her pain seriously — or worse, thought she was faking just to get narcotics.
"I can kind of understand where they're coming from because they do get a lot of people who are looking for pain pills, but they kind of blanket everybody," Chenault-Green said. "For seven years I went through doctors looking at me sideways and saying 'Here's a prescription for Motrin.'"
The pain got so bad she was unable to leave her house or even concentrate on anything for a long period of time. She began to question her own sanity, as doctor after doctor sent her home with no solution for the relentless pain.
"I went through depression, I went through thoughts of suicide," Chenault-Green said. "I thought, these are the doctors, so maybe I am crazy, maybe something is wrong with me."
Her experience is echoed by another recent study by Green showing a pronounced link between pain and depression among black men.
Things finally changed for Chenault-Green when the inner-city hospital she'd been going to stopped taking her insurance. She went to a doctor in the suburbs whom she'd seen years before. He heard her symptoms and immediately sent her to a neurologist, who ordered a CT scan and MRI, which identified the herniated discs in her back and neck (for which she had surgery in 2002). Now she's living mostly pain-free.
"I say to this day it was by the grace of God they stopped taking my insurance," Chenault-Green said.
Racial disparities exist in all areas of health care. One reason pain is different is that there's no test for it; the experience of pain is subjective, and the process of identifying and treating pain relies totally on the interaction between patient and doctor.
The rushed pace of modern health care may be partly to blame, said Nomita Sonty, assistant professor of anesthesiology and psychiatry at Columbia University and leader of the American Pain
"With the emphasis being on getting patients in and out of clinics quickly, practitioners do not have the time to spend with those who may need just a little longer to be understood due to language, cultural and other barriers," Sonty said.
Many doctors don't get great training on how to identify and treat chronic pain, much less how to address racial disparities in practice, said Green, the pain specialist and University of Michigan professor.
"From a research standpoint we are probably 40 to 50 years behind in pain research" compared to other areas, Green said. "We need to address pain in a very different way."
Some state medical licensing boards require a continuing education course on health disparities, Sonty said, and she said she would like more medical schools to include pain disparities in their core curriculum. Health-care providers are becoming aware of the problem, she said, but progress is slow.
"There has been some momentum in the direction of decreasing disparities in health care, but we still have a long ways to go," Sonty said. "We need to establish a national agenda for addressing pain disparities."
Green said the best thing that any pain patient can do, regardless of race, is to keep searching until they find a doctor who will listen and take their pain seriously.
"People need to realize the importance of pain," Green said. "It saps you of your energy, your mood, your time with family and friends. But there are things that we can do. There are people who get their lives back."
One of those people is Chenault-Green, the singer and actress is active in her community and currently directing a play at the Wayne State Arts Theater — something she could not have dreamed of a few years ago.
"I'm really doing great," Chenault-Green said. "Back then, my focus wasn't on anything except the pain I was in. Now my focus is on fulfilling my dreams."