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Dr. Daniel B. Carr | g Force

A high regard for pain

(Alonso Nichols/Tufts University)
August 8, 2011

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Q. A federal panel released a report earlier this summer saying that pain costs the United States $635 billion a year in medical expenses and lost productivity at work.

A. About one in five adults has chronic pain. [It is] a huge burden on the health of society. It’s now becoming recognized at the highest levels of organized medicine that [pain] is a problem. Patients’ voices are being heard.

Q. You said that pain had largely been overlooked by the medical establishment because it is a subjective experience and was therefore hard to count or see through a microscope.

A. Pain has huge emotional and social dimensions. It’s not the same thing as measuring someone’s blood sugar. For generations, this has made the medical enterprise a little reluctant to approach pain.

Q. But that’s changing now that our imaging tools are allowing us to take a closer look at - and actually see - the effect of pain on the brain?

A. We’re becoming better at explaining processes that used to be fuzzy. Science’s comfort with complex processes that are not easily predictable [is increasing]. The world of pain studies is benefiting from that.

Q. Because pain is such a personal experience, what is the role of the patient in making clear how much pain they are feeling?

A. One of the important things to come out of [the last decade of research] is that it is actually a responsibility of the patient to point out if they have pain, if it interferes with their function, and if it changes. It does not mean you’re being a wimp, but it can be extremely helpful in the therapeutic treatment of pain.

Q. Are there any new drugs to effectively treat pain?

A. The new advances have been fairly slow to come out. There’s a ladder [used to] educate people in a very simple way [about pain medication]. On the first step are things like aspirin or Tylenol. If the first step’s not working, you add a weak opioid, like codeine. If that doesn’t work, you switch to a strong opioid, the prototype of which is morphine. All those things have been around in one way, shape, or form for thousands of years.

Q. Why is it we’re not making more medical progress against pain?

A. Pain is a symptom that people have experienced since before there was history. Probably over the course of the 20,000 years that people have carried forth folk observations, everything on the planet that people could get their hands on has either been chewed or inhaled or whatever to treat pain. You can see why it is so hard to find truly new things.

Q. What about so-called alternative or complementary therapies, some of which have been around for hundreds, if not thousands of years?

A. Non-drug methods to some degree are effective, like distraction, relaxation, heat, cold, acupuncture, meditation. But for the majority of patients with moderate to severe pain, they will be receiving some type of medication.

Q. Pain remains undertreated in many patients. Is that out of fear of addiction, or something else?

A. We have this profound ambivalence that we see in all herd animals, which we are, where if there’s an injured member of the group, the behavior fluctuates between trying to nurture the individual, but also stigmatizing the individual - marginalizing the individual who can’t help them get food or protect themselves.

KAREN WEINTRAUB

This interview has been edited and condensed. Karen Weintraub can be reached at karen@karenweintraub.com.

WHO
Dr. Daniel B. Carr
WHAT
Carr, an expert on pain research, directs the Program in Pain Research, Education and Policy at the Tufts University School of Medicine.

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