It is not expected to be heard from doctors, especially the well-meaning doctors of Haider Waraichi, a doctor at Brigham Hospital and an assistant professor at Harvard Medical School.
The "wrong education" of Western medicine is "from emotional state to pain by turning the person into a patient, the therapist into a donor, and separating the body from the mind. He claims that it is happening.
Many years of fighting debilitating back pain have largely hampered his medical career. Today he brings his experience as both a doctor and a patient to his examination of the nature and history of pain. Condemning the failure of modern medicine, he seeks a more holistic and interdisciplinary approach.
This conversation has been edited and summarized for clarity.
CNN: What is the biggest misconception people have about pain?
Dr. Heiderwaraichi:Almost everything we know about pain and how to treat it is wrong. Both patients and doctors have been taught that chronic pain is essentially long-term acute pain. However, while acute pain rises from the spinal cord to the brain, chronic pain can often fall from the brain, often without a trigger from below.
The fallacy that treatment of acute pain works for chronic pain Partly led to an opioid epidemic and hampered treatment that people may have given more relief.
Western medicine sought to limit pain strictly to physical sensations, based on the tools that had to deal with them. But pain is not purely physical.
CNN: What is pain, if not a physical sensation?
Warraich:Science suggests that many patients know that it is true. Pain is a combination of physical sensations, trauma, and memory. Brain imaging revealed that the emotional brain is far more involved in the experience of chronic pain than acute pain. For the nervous system, chronic pain most often resembles the emotions we feel in parts of the body.
By considering pain as a purely physical phenomenon, treatment is limited to tablets and procedures, and people are likely to receive mental health interventions, if not more effective. I will prevent it. The ideal approach to pain management is interdisciplinary.
CNN: What does that mean?
Warraich:The main function of pain is to direct all energy and attention to it by inducing fear that your body is under threat. That is. For example, when I had severe back pain, I was worried that exercise might paralyze me or my spine might break in half. Alternative modality helps to reconstruct what we think about pain. The
Evidence supporting the effectiveness of alternative therapies such as these is often more compelling than the many common procedures and prescriptions we usually provide to patients.
CNN: Why is the standard pain protocol left so crude with such a powerful science that supports alternative approaches?
Warraich: One limiting factor is that doctors and nurses are very unlikely to be living with a serious illness. They are like chefs who have never tasted their food. Based on our training as doctors, our thoughts can be stiff.
Some healthcare providers do not take the patient's pain seriously, so patients are worried that the pain will soon go away the moment they cause an emotional condition. ..
Until the doctor's approach changes, patients accept that mental health, depression, anxiety, previous traumatic history, etc. are closely related to how injured our body. I have a hard time.
It's not so realistic when you realize that pain is actually exacerbated by psychological factors.
CNN: You write that "the brain doesn't have a dedicated center of pain," but also explains that chronic pain can reorganize the nervous system. doing. How.
Warraich:One of the processes that allows pain to transition from acute to chronic is the development of central sensitization. As we get hurt, our bodies actually become more sensitive to more pain. As we become more aware of pain, this process can actually cause pain and discomfort in previously non-painful areas and activities.
Differentiation of pain management is very important. This is because effective treatments can change over time.
CNN: How does our history affect our pain experience?
Warraich:In addition to biology, context dictates changes in pain. This means that our situation plays an important role. For example, pain from a rib fracture may heal, but it feels different from pain from metastatic lung cancer after a lifetime of smoking.
Pain is an event in our biography influenced by social and cultural forces. Unfortunately, suffering causes suffering. Extensive studies have shown that adversity childhood experiences and other acute stressors increase the risk of greater pain. Even if you grew up in a violent neighborhood or home, or were bullied at school, you can be sensitive to trauma.
CNN: What long-term effects does chronic pain have on people?
Warraich:It confuses a person's identity and how they move through life. People can feel their bodies as enemies. Chronic pain reflects imprisonment. It essentially puts you in that cage and keeps you in the current prison. It can be difficult to plan for the future and can quickly shorten your life.
CNN: What advice do you have for people dealing with chronic pain?
Warraich:First of all, there is no silver bullet. There is never one pill, procedure, therapy or exercise to get rid of your pain.
I urge the painful patient, her caregiver, and her doctor to be open to all possible options. Keep in mind that what works for one person may not work for another.
Other advice I give-I wish someone could give me when my pain was at worst-is: Don't skip activities that bring you joy. Attempting to minimize pain can quickly shrink the world.
The more you pay attention to or try to get rid of the pain, the more intense it becomes. Allowing pain to reach the driver's seat only exacerbates your suffering. It may be unpleasant at first, but focus on living your life. This approach works to separate fear from wounds.
CNN: How do the siled properties of medicines affect pain management?
Warraich:The fractured nature of medicine affects pain more than any other condition I have studied. Unlike cancer and heart disease, where we have made remarkable progress, the problem of chronic pain is actually expanding. Today, more people are suffering than ever before. To make matters worse, for many, our treatment was more harmful than good.
CNN: That's a big statement. How.
Warraich:I wish it was an exaggeration. Whether you talk to patients or look at studies, we see the healthcare system failing people with chronic pain in many different ways.
Take opioids. At the request of pharmaceutical companies, opioids were often given to people with chronic pain without data to support their effectiveness.
We have infiltrated the medical education essentially created by these companies and ignited the crisis that the United States is prescribing more than 30% of the world's opioids. .. Other people.
On the other hand, in a randomized trial study of people with moderate to severe back and joint pain, those who received opioids for chronic pain included ibuprofen and others. It has been shown that the pain is actually greater than those who received less powerful painkillers.
CNN: Does the US health insurance system play a role in this?
Warraich:Underlying the reason why pain management is so bad.Access to exercise, treatment, and interdisciplinary care, even if the insurer promptly approves someone's tenth procedure or surgery, both of which may be much less supportive and cost-effective. Limit.
The pain crisis continues to burn due to the asymmetric access and restrictions of insurance companies.
Chronic pain patients require more empathy, kindness and time from their doctor than most other conditions. But we have created a system built solely for profit and efficiency. Hospitals make more money from procedures and providing prescriptions is much quicker than careful care. Instead of alternative therapies, both of these types of interventions have exploded-including those supported by better evidence-because they are neither efficient nor profitable.
CNN: Is there hope for people with chronic pain?
Warraich:I started writing this book in a desperate place. But now I am confident that there are more interventions we can offer. When given the opportunity, doctors and nurses can provide empathy and kindness. Science makes it very clear for many patients that this attention constitutes an essential treatment to help them overcome their pain.
We know that the placebo effect accounts for essentially three-quarters of the effectiveness of all analgesics. The effectiveness of placebo arises because of a medical ritual, or empathy.
If healthcare providers can return from technicians to therapists, a real transformation of effective pain management will be possible.
