The “Right” Goal When Managing Pain

It is logical to prioritize the reduction of pain as the main objective in pain treatment. Nevertheless, a recent editorial in The New England Journal of Medicine compellingly argues for a broader perspective when assessing the success of pain management, suggesting that factors beyond pain intensity should be considered.

The balancing act of managing chronic pain

The challenge lies in the fact that chronic pain significantly impacts various aspects of individuals’ lives, and treatments aimed at alleviating this pain can also have diverse effects. Even the most effective pain-relieving medications often come with unpleasant side effects, and non-drug interventions and complementary therapies may produce multiple outcomes.

Prioritizing pain reduction without considering other outcomes may lead to unintended harm. The editorial suggests that an exclusive focus on lowering pain intensity, coupled with a moral imperative to alleviate pain, may have contributed to the opioid crisis. The widespread increase in opioid prescriptions, cases of misuse, and related overdose deaths over the past few decades is cited as evidence.

Surveys reveal that individuals with chronic pain are concerned about more than just reducing pain intensity. They prioritize enjoying life, emotional well-being, increased physical activity, improved sleep, reduced fatigue, and engagement in social and recreational activities. Balancing these goals against the potential drawbacks of pain treatment is crucial.

For instance, opioids like oxycodone may effectively reduce pain intensity and aid in falling asleep, but they also bring about fatigue, constipation, memory issues, and the risk of abuse and overdose. The assessment of benefits and harms is subjective and varies among patients, with some experiencing minimal risks and significant pain reduction, while others face side effects that hinder daily activities.

The future of pain management

The authors of the editorial propose that pain management treatments should be both individualized and multimodal, combining various therapies to achieve optimal benefits with minimal harm. Scientific research supports this perspective, emphasizing the need for personalized, comprehensive approaches. For instance, an individual with chronic low back pain, a history of alcohol abuse, and depression might benefit from a combination of non-opioid pain relievers, cognitive behavioral therapy, and an antidepressant. Another person with similar back pain may find relief with a mix of daily low-dose opioids and weekly acupuncture.

Success in pain treatment is highly individualized, and what works for one person may not be effective for another. The field of pain management requires more research to identify which patients are more likely to benefit from specific treatments, a concept known as “phenotyping.” This categorization could pave the way for personalized pain management, enhancing clinical care and minimizing treatment-related harms.

In conclusion, the editorial suggests that combined therapies addressing pain reduction and quality-of-life goals, coupled with a renewed focus on individualized treatment, are crucial advancements in pain management. These approaches represent important steps toward fulfilling the responsibilities to patients experiencing pain.