Chronic pain has ballooned into the most common (4 out of 5 medical visits) and expensive ($60 billion/year) medical problem in Canada today. The impact on the sufferer themselves is equally devastating and usually results in a poorer quality of life than that affected by chronic heart or lung diseases. The suicide rate among chronic pain sufferers is twice the national average.
There is a sense of paralysis in medicine today as how to understand chronic pain and collaborate in the search for solutions. The pervasive perspective holds that chronic pain is the “pain warning system gone awry”, relentlessly generating pain signals for no apparent reason. Investigations usually come up empty or, worse still, point to innocent body changes that are not causing pain (e.g. arthritis). Subsequently, a diagnosis of neuropathic pain or inflammation of the nearest organ system (arthritis, cystitis, tendinitis, fibromyalgia) is made and the patient is converted to chronic pain management – having to learn to live with this unknown internal wretchedness for the rest of their lives.
This wouldn’t be too bad if the current treatments were even moderately effective. The truth is the opposite, with many useful active interventions being out of financial reach of patients and many of the available drugs (e.g. oxycodone, fentanyl) making things decidedly worse.
Where did we go wrong?
I believe that we have taken a wrong turn in our understanding and treatment of pain. It is time to take another look at things, examine what we know and really think about this social disaster that the medical community is allowing to continue. Chronic pain is ruining too many lives as it clogs and bankrupts our healthcare system.
Muscle pain is recognized in the medical literature as being the most common cause of chronic pain. The few studies done confirm the incidence of myofascial pain to be up to 80% in patients attending chronic pain clinics. I believe it is higher, likely over 90%. Patients with myofascial pain are seldom diagnosed with this disease. For every muscle or group of muscles that are affected and causing pain, there is an alternative diagnosis. When muscle involvement is widespread, a diagnosis of fibromyalgia is made.
Unfortunately, there is little agreement as to the cause of muscle pain or the best way to treat it. While the “muscle lobby” struggles to gain a common knowledge base, the “neuropathic pain lobby” is leading the charge in both research and treatment – and the profits are channeled back into more of the same. Research studies continue to be done in the field of neuropathic pain. The (barely) successful studies are used as evidence (in an evidence-based medical world) to promote the ongoing use of neuropathic pain drugs such as gabapentin. Drug companies continue to make and spend billions of dollars in the pursuit of switching off “out-of-control pain nerves”, steadfastly ignoring the source of pain! Sadly, ignored muscle pain does not go away.