Last summer, David Handkins' arthritic knees (see cover story) hurt so much that he had to hire someone to mow the family lawn. This summer may be different; he is making lifestyle changes and had knee surgery.
He's lucky that his pain can be named and treated. Of the 75 million Americans who have chronic pain, only 1 in 4 receive proper treatment, according to the American Pain Foundation.
In fact, pain is one of modern medicine's most misunderstood, underdiagnosed and untreated health problems. Pain experts consider it a national epidemic, and Congress officially declared 2001-2010 the Decade of Pain Control and Research.
Elusive pain
Pain is defined, by scientific groups that study it, as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage."
And that sweeping description is part of the problem, says Michael Clark, a psychiatrist and director of the Chronic Pain Treatment Program at Johns Hopkins University School of Medicine. "There is no one-size-fits-all definition for pain. It's a very personal experience."
Sharp. Jabbing. Burning. Nagging. People can use the same words to describe different sensations. And one man's twinge is another man's -- or woman's -- agony because pain thresholds vary. (Interestingly, experiments show that men generally have a higher threshold of pain than women.)
Yes, we all know when we're feeling pain; often we can direct doctors to what we think is the source. And doctors are adept at looking for damage and symptoms, testing a hypothesis and reaching for the right medicine. But when a pain's cause is elusive, doctors in the past too often "figured if we don't know what's wrong with you, you're crazy. If there's no test for it, it doesn't exist," says Jacob Teitelbaum, director of an Annapolis (Md.) research center devoted to chronic pain and fatigue and author of a widely read paperback, "From Fatigued to Fantastic" (Penguin/ Avery, $13.95).
"People with rheumatoid arthritis were once told there was nothing wrong with them, despite having thick, swollen joints," he says. "Chronic pain is finally moving past that point and getting some understanding."
The clinical chase
The body can break down in "all kinds of wonderful ways," Clark says.
Damage to muscles and other tissues cause pain, as do neurological factors or distress to a nerve. Disease causes pain. Sometimes our behavior -- running or drug use -- brings it on. It also can be traced back to psychological problems, which present themselves as pain.
Personality factors, such as low pain tolerance, also play a role.
For optimum results, all of these factors -- tissues, neurology, disease, behavior, psychology and personality -- need to be addressed together. When they are, the diagnosis might be such recently identified pathologies as chronic fatigue syndrome, fibromyalgia syndrome, myalgic encephalomyelitis or myofascial pain syndrome -- four incompletely understood conditions that have pain as a common denominator.
Fibromyalgia, for example, causes fatigue, aches, sleeplessness, brain fog and a low sex drive, yet, Teitelbaum says, sufferers often are told it's "all in your head." They may feel depressed, helpless and discouraged, and metabolic changes plus inactivity can produce substantial weight gain -- in Teitelbaum's experience, he says it's an average of 30 pounds.
Whatever your symptoms, chronic pain sufferers should ask to be referred to a board-certified pain specialist, says Tedd Mitchell, M.D., USA WEEKEND's medical columnist. Specialists often provide a team approach for more complete care and appropriate treatment. Clark says pain treatment should be decided after your doctor knows "who you are and your case and your particular condition from every angle."
But up to 90% of chronic pain sufferers will improve, Teitelbaum says, if doctors simply treat problems in four broad areas of health. (Go to www.endfatigue.com to see his research study.) There four areas on which to focus: poor sleep, hormonal deficiencies, persistent infections and poor nutrition.
Personalized painkillers
The field of biotechnology is now looking at the physiology of pain -- the systems that detect something wrong and send a pain message to the brain -- and the neurotransmitters and receptors involved in that process.
Researchers have discovered that one, the mu opioid receptor, comes in hundreds of varieties. Each variety responds to different pain relievers -- from morphine to aspirin. One day, doctors may be able to do a simple test to determine which painkiller will work best for an individual sufferer, a process that until now has been mostly trial and error.
