Untreated Chronic Pain is Acute Pain


Cannon describes how adrenalin, “Liberated Normally in Fear, Rage, Asphyxia and Pain,” a reflex response to pain and major emotion, leads to hyperglycemia necessary “for putting forth supreme muscular efforts,” and to vascular changes that shunt blood away from vital organs in the gastrointestinal and urinary system in order that “the ‘tripod of life’ – the heart, lungs and brain (as well as the skeletal muscles) – are, in times of excitement… abundantly supplied with blood…”

In a New York Times Magazine article in 2001, Dr. Daniel Carr, director of the New England Medical Center, put it this way:

“Some of my patients are on the border of human life. Chronic pain is like water damage to a house – if it goes on long enough, the house collapses,” [sighs Dr. Carr] “By the time most patients make their way to a pain clinic, it’s very late. What the majority of doctors see in a chronic-pain patient is an overwhelming, off-putting ruin: a ruined body and a ruined life.”

Following our discussion in the preceding section, the medical consequences of untreated pain are legion. In addition to the direct morbidity of pain induced physiologic stress, including chronic hypertension, ischemic cardiac disease, renal insufficiency, stroke, and gastrointestinal bleeding, we must also consider often profound decrements in family and occupational functioning, and iatrogenic morbidity consequent to the very common mis-identification of pain patient as drug seeker. The overall deleterious effect of chronic pain on an individual’s existence and outlook is so overwhelming that it cannot be overstated. The risk of death by suicide is more than doubled in chronic pain patients, relative to national rates…

What happens to patients denied needed pharmacological pain relief is well documented. For example, morbidity and mortality resulting from the high incidence of moderate to severe postoperative pain continues to be a major problem despite an array of available advanced analgesic technology.[6] In a study of pain following hip fracture, undertreated pain was demonstrated to significantly increase the risk of delirium…

One very important reason that untreated pain is a medical emergency, particularly in the United States, has nothing to do with neuropathology or cardiovascular complications or even the current state of the medical art. Chronic pain patients are routinely treated as a special class of patient, often with severely restricted liberties – prevented from consulting multiple physicians and using multiple pharmacies as they might please, for example, and in many cases have little say in what treatment modalities or which medications will be used…

It is well known that chronic pain can result in anxiety, depression and reduced quality of life. Recent evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact everyday behavior especially in risky, emotionally laden, situations.[19] The areas involved include the prefrontal cortex and the thalamus, the part of the brain especially involved with cognition and emotions, and it is these same areas that were found in 2004 to undergo striking atrophy in chronic back pain patients, compared to normal controls…

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