Combination Therapy Needed to Fight Chronic Pain

June 23, 2011 -- The last decade brought advances in our understanding of chronic pain, but this has not translated into better treatments yet, an analysis shows.

The analysis was published in The Lancet.

It found that treatments for chronic, non-cancer pain such as low back pain, arthritis, headache, and fibromyalgia don't do enough to alleviate pain or restore functioning in the majority of people.

And don't expect any one pill to do the trick, says the report's author, Dennis C. Turk, PhD, an anesthesiologist and pain specialist at the University of Washington in Seattle. "There is this expectation that you will wave a wand and there will be a new pill or new surgery to alleviate your pain, and that is not likely to happen."

"Chronic pain is a complex problem, and the only way to treat it is with a combination of treatments because no one treatment is sufficient," he says. Combination therapy may mean multiple medications or medications plus lifestyle changes, psychological treatments, and/or rehabilitation and physical therapy.

Likening chronic pain to diabetes, Turk says "there are a lot of things to do in addition to medication, as in diabetes, where you also watch your weight and test your urine and blood."

It will involve a more holistic approach, he says. "We have a tendency to try to diagnose people in silos and treat everyone with knee osteoarthritis (OA) the same way," he says. But "we need to treat people as a whole and not just knees." Social, emotional, and environmental factors all play a role in how we experience pain and painful conditions.

One Treatment Not Always Enough

Roger Fillingim, PhD, associate professor in the College of Dentistry at the University of Florida in Gainesville, says that there have been advances in understanding the biology of pain and in awareness of pain as a pressing public health issue in recent years.

But "this hasn't translated into terribly effective treatments of chronic pain, and we will need more multidisciplinary treatments in order to provide more optimal clinical outcome for patients in pain," he says.

The truth is "for many forms of chronic pain, a single treatment is not sufficient to improve quality of life to the point where a patient will be satisfied," he says.

"That pill doesn't exist," he says. "There may be medication that helps alleviate some of the pain, but that needs to be accompanied by other treatments including physical rehabilitation and behavioral or psychological intervention to help people cope with their pain in a more effective manner."

Lesley Arnold MD, a psychiatrist at the University of Cincinnati, takes a more "glass is half-full" view of our accomplishments in treating chronic pain.

"We do have more options today," she says, citing several FDA approvals in recent years for new drugs to treat fibromyalgia and OA.  But "we do need more studies of combinations of medications to see what works well together and most importantly, we need studies looking at nondrug therapies."

"We don't have a good way of accessing the central nervous system to tell us why people are in pain," she says.