Anesthesiology and Reanimation Specialist Prof. Dr. Serbulent Gökhan Beyaz gave important information about the subject. Living with chronic pain is facing daily challenges for basic needs and simple tasks that others take for granted in their lives. Living that challenge every day. If you ask patients with asthma or COPD (Chronic Obstructive Pulmonary Disease) what it means to breathe hard, what would they answer? Even if the whole world is human, nothing matters when one is not healthy or when one's health deteriorates. A person realizes the value of his health only when he loses it.
Chronic pain is like that. Such as spending every day and every minute of it painful, staying out of bed in pain every morning, not being able to turn from one side to the other in bed without pain, having constant headaches, not being able to walk long distances or going to the market without the help of someone else… Sometimes even the help of others does not work and they relieve that pain. you feel in your body. It is so difficult to describe and explain chronic pain by the patient and to explain it medically by the physician that the mistakes made by the society and many physicians generally mean not believing in the pain of the person, being stigmatized differently because it does not improve or not being able to heal, and thus being judged by not being able to fight or cope with chronic pain. As a result, when the cause of the pain cannot be determined, the physician, the patient's relatives and even the patient are marked as depressed. Of course, pain has a psychological aspect, but every time the cause of the pain cannot be determined, it is easiest to associate it with psychology, I think. Either we cannot medically explain the cause of the pain or we are focusing on the misdiagnosis. This means that the patient has weakened mental health over time and lives with a lost self-esteem, absenteeism from school or work, deterioration of family and social relations, and many socioeconomic disadvantages.
The studies that have emerged about chronic pain in recent years have refuted the common perception of chronic pain that suggests reduced activity following injury to organs and tissues in the body. Instead, chronic pain is often a product of abnormal neural signaling, that is, a disruption of normal nerve conduction, and is a complex treatment in which the psychological and mental status of the person with biopsychosocial dimensions is taken into account, as well as drug and interventional pain treatments with many branches. Many physicians and patients are unaware of treatment options; therefore, they try to treat chronic pain by relying on only one drug therapy. Despite limited evidence-based medical knowledge, the use of costly neuromodulation (electrical stimulation of the nervous system) techniques is also increasing. Over-dependence on drugs or devices, aggressive medical industry marketing, lack and difficulty of accessing multidisciplinary services such as physiotherapy or psychology, shorter and sloppy consultations are challenges in resolving chronic pain. In low-income and middle-income countries, limited access to red prescription drugs, fear of using red prescription drugs, and cultural beliefs about pain are other barriers.
The opioid (red prescription drug) crisis is significant in two ways. From the patient's point of view, patients feel more stigmatized with the idea that they are angry, abandoned, and have nothing else to do, and how they will continue their lives with pain and suffering if these drugs do not help. For enforcement authorities, it activates clinical and regulatory initiatives to block or more tightly control all opioid prescribing. The right balance needs to be struck. For some people (for example, those with cancer pain), the use of mostly opioid-derived drugs may be necessary, while for others it may be appropriate to remove or limit opioid prescriptions. However, in both ways, it should be supported with the right drug safety measures and when needed, it should be able to switch to a very comprehensive treatment plan with addiction treatment.
Chronic pain needs to be re-evaluated. We have no doubt that if physicians want to benefit patients with chronic pain, it is critical that, rather than complete pain relief, it is critical that they turn to teamwork to understand patients' pain, change patients' expectations, and help them set realistic, personalized goals that prioritize function and quality of life. Collaborative decision making can enable people to manage their pain through more nuanced discussions about treatment options and risk-benefit ratio. Patients need reassurance that they will be believed, respected, supported, and not blamed if a treatment doesn't work. Therefore, language is a powerful tool for interaction and encouragement. Talk to patients effectively.
Chronic pain management is difficult in low-income and developing countries due to the absence of pain clinics. It should be community-based, with design provided by a large team of well-trained, multidisciplinary healthcare professionals. Pain clinics should be contacted to support more complex cases. For example, the Basic Pain Management course has proven useful in over 60 countries.
Scientific studies on chronic pain should include the benefits, harms and costs of the methods to be used in treatment, and clinical studies should also include patient priorities. It should seek effective and feasible solutions that integrate epidemiological and population studies with noncommunicable diseases, healthy aging and rehabilitation. Health policy makers and regulators should prioritize chronic pain by seeing the cost of not doing something about it, namely inaction. Measures are needed to raise awareness of chronic pain and clear up misunderstandings among the wider public.
Chronic pain is real. It deserves to be taken more seriously.
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