Still, when you talk to experts in chronic pain, you don’t hear much talk about finding a cure. “You can’t just say, ‘Let’s fix pain,’ because so many different things cause pain,” Edwards said. “We can say, ‘We want to look for the genetic mutation for X disease, we want to cure X type of cancer,’ whatever the case may be. But pain isn’t viewed from a curative standpoint.”
Instead, conversations about pain tend to include more modest words like “treatment” and “management.” That’s in part because chronic pain is not a discrete disease, but a complex web of overlapping conditions, with an equally complex web of causes and accelerators. “There’s no panacea,” says Cowan, who is CEO of the American Chronic Pain Association. “So many people are looking for that one magical thing to help them better manage their pain.”
She compares a person in pain to a car with four flat tires: Finding the right medication may fix one tire, but the person may require treatments like counseling, acupuncture, and stress management to inflate all four. She successfully treated her pain in the late 1970s with a multidisciplinary pain-management program, an approach that typically combines approaches like occupational therapy, psychological care, and nutritional counseling. Over the following decades, however, she watched the treatment consensus shift to procedures like nerve blocks, and then to opioids. The number of multidisciplinary programs has plummeted.
That frustrates some doctors who work with patients in pain. “Medicine is focused on treating symptoms, not the actual root cause,” said Dr. David Hanscom, a Seattle spine surgeon who works with patients on managing factors that contribute to pain, like stress and anxiety. Some popular types of spinal surgery, he says, have a greater chance of increasing pain than they do of solving it. “You cannot treat these people in isolation,” he said. “That’s the exact opposite of what medicine is supposed to be.”
Some recent research is working to find physical evidence of pain by using functional magnetic resonance imaging, or fMRI technology — brain scans. Tor Wager, an associate professor of psychology and neuroscience at the University of Colorado Boulder, led a study published in January in which volunteers’ arms were subjected to intense heat while their brains were being scanned. Wager found that pain operates in the brain in two different ways: There was an immediate response to physical pain, and a separate response when he asked subjects to rethink their pain in various ways.
Wager is hopeful that research like his will help medical professionals learn “how to stop blaming the person.” Just because a doctor can’t find a clear source of pain in, say, a patient’s back doesn’t mean the patient’s pain isn’t real. In fact, it could simply be a type of pain that responds better to something like cognitive-behavioral therapy than to yet another drug. “We spend billions of dollars a year focused on the discovery of drugs that work on the periphery — in the back, or in the skin [for example],” he said. “But those drugs are only going to be successful in a certain subset of patients.”
Meanwhile, chronic pain patients do their best to find the relief they can. Brenda Van Hoose finds occasional relief through massages, and takes vitamin B in the morning to boost her energy. “There’s no time that I’m not in pain,” she said with a sigh of resignation. “I don’t see myself pain-free unless the almighty God heals me. … It’s a matter of managing it, and I’m doing pretty well right now.”