The Underlying Causes of Chronic Pain Need Treatment, Not Just Symptoms
/By Dr. Forest Tennant
In today’s healthcare system, a single disease or condition is usually given to a person as the cause of their severe chronic or intractable pain. These common labels include Complex Regional Pain Syndrome (CRPS), adhesive arachnoiditis, pudendal neuropathy, traumatic brain injury, small fiber neuropathy, and osteoarthritis.
The singular diagnosis is usually the more prominent cause of pain – and is often required for record keeping, insurance coverage, justification for medicinals, and for diagnostic testing.
An emerging fact, however, is that the person who has severe chronic pain and requires daily symptomatic relief almost always has pain in more than one body system or anatomic site. For example, in a recent study we found that persons with adhesive arachnoiditis have an average of three to four other painful conditions. This reality is best called by an older medical term: “multi-system disease.”
A multi-system disease is one that has a single cause that affects multiple body systems. Historically, an infectious bacteria or virus has been the cause of multi-system disease. The best known are syphilis and tuberculosis. The former originates in sex organs and the latter in the lung, but both infections can travel through the blood, infecting and forming disease in multiple body systems, such as the brain, spinal cord, and adrenal gland.
In the late 20th century, diabetes and autoimmune diseases such as systemic lupus became known as causes that may affect multiple body systems. In this century, it has been discovered that genetic connective tissue diseases such as Ehlers-Danlos syndrome, Lyme disease, and the Epstein-Barr virus may affect multiple body systems and produce chronic pain.
Some patients develop severe chronic pain as a result of trauma or injury to a single body system, such as the brain, spine, joints and nerves. The pain may initially remain localized to that one body system. The majority of persons in pain treatment, however, subsequently develop pain in other anatomic locations or body systems.
The genetic, infectious, and autoimmune causes of multi-system disease appear to all be progressive, with a proclivity to affect, over time, additional tissues and systems. Our view is that the progressive nature of multi-system disease may not just cause intractable and disabling pain, but may also lead to the impairment of physical and mental functions that severely incapacitate an individual. Suicide or a shortened lifespan may be involved in severe cases.
Modern day pain treatment is fundamentally about symptomatic relief. This includes opioids, neuropathic agents, anti-inflammatory drugs, and electromedical measures. It’s time that we recognize that the underlying causes of chronic pain should also be treated, and not just the symptoms. This is a clarion call to recognize multi-system diseases, determine their underlying cause, and simultaneously treat them and the pain that they cause.
Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. Readers interested in learning more about his research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can subscribe to its research bulletins here.
The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.
On August 16, Dr. Tennant is hosting a free seminar in Westminster, Colorado on the latest research and treatments for adhesive arachnoiditis. Visit the conference website or click on the banner below for more information. All attendees are encouraged to register by August 1.
