Ten years ago I could get physiotherapy appointments in weeks; now people wait months. As we struggle to control their pain, patients frequently develop depression and anxiety.
We have a prescription drug problem. In September, Public Health England (PHE) published a report highlighting the alarming rise over the past decade in prescriptions for powerful opiate painkillers, antidepressants, and anti-anxiety medications. We are following America, where these potentially addictive prescription drugs have overtaken heroin as a cause of death through overdose. PHE has exhorted doctors to be more circumspect about initiating and continuing treatment with these agents. If only it were that simple.
We’re familiar with acute pain, caused by a broken bone, or an operation. This responds well to standard analgesic drugs, and as damaged tissues repair themselves, the pain gradually fades. Far more challenging is chronic pain.
“Chronic” is used to denote long-lasting or persistent pain. There may be damaged tissues that cannot repair, so pain signals never abate. Joint arthritis is a good example; the most common form, osteoarthritis, is age-related, so is ever more prevalent as our life expectancy increases. Conditions such as diabetes can affect nerve fibres, causing them to fire erroneous pain signals; we are in the midst of a type 2 diabetes epidemic. And chronic pain can arise even when tissues are apparently healthy: fibromyalgia is a common example.
In these instances, the central pain processing pathways in the brain and spinal cord have become overreactive: other innocuous types of sensory information are experienced as pain. A crucial feature of this aberrant pain processing is that standard analgesic drugs provide limited or no relief.
Unsurprisingly, people with chronic pain consult their doctors repeatedly. As we struggle to control their pain, patients frequently become frustrated and develop depression and anxiety. Their experience of pain is compounded by …read more
Source:: New Statesman