June 27, 2012
Dr. Michael Brant-Zawadzki
"Quit your bellyaching, that pain's all in your head!" Mom would say: No skipping school that day. Pain can serve certain needs. It has many causes, some?clear, others not. We've all sprained an ankle. Ouch! Tiny sensors in our bodies send signals constantly, but when assaulted, ring alarm bells through our nerves, up the spinal cord, instantly to our brain's pain processors, where what happens depends on our pre-wiring: The "flight or fight" system is activated – our heart races and breathing speeds up. Our emotions get awakened. We might shout or cry.
Most of us have occasional aches and pains. Some suffer fromchronic pain disorders, like Fibromyalgia, the cause of which is elusive. The brain's processing of signals from the pain sensors throughout our bodies is programmable.MRI studies suggest chronic pain patients activate brain circuitry differently from others. Brains can resist pain, at other times be 'crybabies'. The interaction of our genetics and experiences modifies our individual pain response.
ABC News recently reported the explosion in narcotic prescriptions, with pharmacies dispensing 111 tons of medications in 2010, equaling 40 pills of Percocet and 24 pills of Vicodin for every person in the U.S. Lethal overdoses have skyrocketed, with more people dying from prescription overdoses than in car accidents. Vicodin is the most prescribed medication in the U.S. Why? These drugs are extremely beneficial, dramatically improving quality of life for those with recent trauma, after surgery, or invasive cancer, for instance. Doctors were urged to be more empathetic and liberal in using such drugs, despite misgivings regarding potential abuse. These drugs can produce feelings of intense well-being, while triggering biological processes that become accustomed to the drug, causing pain and bodily dysfunction when withdrawn, promoting dependence.
Take back pain. If surgery is needed, it begets pain medication. When stopped, pain may reappear, begetting more drug, building up greater and greater tolerance requiring higher doses for effect, clouding decisions as to why pain persists: Unnecessary additional surgery, and/or addiction may result.
Seniors show a rising rate ofaddiction; and the ready availability of prescription drugs in households has promoted an increasing recreational use by teens. Abuse of alcohol and prescription drugs have led to a crowding of emergency rooms and hospital beds. Recently, the media bleated about an L.A. doctor being arrested for murder – her patient overdosed on prescribed narcotics. That can happen when drugs turn you into a "new man," but the first thing the new man wants is more drugs, as George Carlin quipped. It seems a slippery slope exists between an empathetic doctor trying to balance a patient's needs with the risks of addiction.
Our culture and our media glorify the addicted lifestyle, yet the picture isn't pretty. Amy Winehouse's anthem to "Rehab" ended badly. Charlie Sheen's recent transformation from popular actor to someone with whom you don't want to re-enact scenes from "Deer Hunter" speaks volumes. Sheen's self-medicated, bipolar (manic/depressive) personality disorder cries out not for adulation, but rather, a comprehensive approach to his behavioral health problem.
Society's need for expert and comprehensiveaddiction and behavioral health treatment centers? such as Hoag's is growing dramatically. A team approach with pain specialists, addiction medicine doctors, psychotherapists, even non-traditional providers like acupuncturists and Yoga instructors can reprogram brain circuitry.
Yes, mom ... that pain is all in our head. One way or another.
Dr. MichaelBrant-Zawadzki is executive medical director of theHoag Hospital NeurosciencesInstitute?.
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