In a literature review of existing studies in the recent issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), lead author Richard Uhl, M.D., chief of the Division of Orthopaedic Surgery at Albany Med, wrote that non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and others, and various opioids such as morphine, have not been shown to alleviate chronic pain, which afflicts an estimated 100 million Americans.
Chronic pain, or pain that persists beyond an expected period of healing, is often caused by several simultaneous conditions such as degenerative bone or neurological conditions, and often impacts the lower back, pelvis or abdomen.
Dr. Uhl, who also practices at Capital Region Orthopaedic Associates, said that anticonvulsants (medications to prevent seizures) can have remarkable effects on many forms of chronic bone and joint pain, but that a number of safe and effective nonnarcotic options for chronic pain, including topical agents and non-drug therapies such as psychotherapy and biofeedback, can be effective as well.
“For some people with chronic pain, the anti-seizure medications are extremely effective — much better than narcotics,” Dr. Uhl said, noting that drug efficacy varies significantly between patients, and that physicians should work with patients to tailor treatments to their individual needs.
“As orthopaedic surgeons, we are experts in the management of acute injuries to the extremities and spine,” Dr. Uhl said. “But given the prevalence and the profound economic implications of chronic pain, orthopaedists need to be aware of the many readily accessible, economical, safe and effective treatments for chronic pain.”
The article outlined a wide range of management options for chronic pain and noted that chronic pain often coexists with depression, anxiety and other conditions that, when treated with antidepressants, have been shown to be effective for alleviating chronic pain.
The article notes that evaluating the source of the pain is critical to finding an effective treatment. It also advises physicians to consider structural or organic diagnoses that may be outside the routine scope of their practices that are sometimes confused for chronic pain and mistakenly treated as such, such as vascular issues, fibromyalgia and other treatable conditions.
The study’s co-authors, all from Albany Med, include resident Timothy T. Roberts, M.D.; Michael T. Mulligan, M.D., associate residency program director in the Division of Orthopaedic Surgery; Andrew H. Dubin, M.D., a board-certified physiatrist with an interest in the treatment of pain; and resident Dean N. Papaliodis, M.D.
Albany Medical Center, northeastern New York’s only academic health sciences center, is one of the largest private employers in the Capital Region. It incorporates the 734-bed Albany Medical Center Hospital, which offers the widest range of medical and surgical services in the region, and the Albany Medical College, which trains the next generation of doctors, scientists and other healthcare professionals, and also includes a biomedical research enterprise and the region’s largest physicians practice with more than 400 doctors. Albany Medical Center works with dozens of community partners to improve the region’s health and quality of life. For more information: www.amc.edu or www.facebook.com/albanymedicalcenter.
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