Summary: Almost 40% of adults are living with chronic pain. Many of them may move on to intractable pain. This is pain that does not get better with standard drug therapy and may need treatments like opioid therapy. So health experts think doctors and patients need to know intractable pain better, so it gets caught in time. Studies suggest that some people are more likely to move on to intractable pain. Intractable pain is not new, but it is getting more common. So many doctors see it as its own health condition. Yet the term “intractable pain” is still not well known, even among doctors.
Studies show that almost 40% of people today live with chronic pain. Some may have bone, joint and muscle problems, some pain after surgery, and some fibromyalgia. In some, chronic pain is quite severe and does not respond well to standard therapy, including opioids. These people are said to be living with intractable pain.
Doctors now class intractable pain as its own condition. It is hard to treat and often needs a different approach. These are the people who might benefit from long-term opioid use or procedures like a nerve block.
So many states in the US now treat “intractable pain” as something different. Some states have passed laws that name it as a condition that justifies doctors prescribing opioids.
Of course, not all people with chronic pain have intractable pain. In most cases, doctors can help with standard drug therapy. Most would also gain significantly from non-steroidal anti-inflammatory drugs. Still, some do not respond to the treatment.
Who is most likely to develop intractable pain?
Studies suggest that some people are at a greater risk of intractable chronic pain. For example, one survey of 28 people living with intractable pain found that 20 of them were female. So being female is a significant risk factor for the condition.
Age is another risk factor. Young people are less likely to develop intractable pain, because their hormones are in good shape and they are less likely to have long-term illnesses. Studies suggest that most people with intractable pain were first diagnosed in their late 30s. The average age of people living with intractable pain is the mid-fifties.
Intractable pain also does not start suddenly. Most of these people have lived with chronic pain for years. And they remember clearly when their pain became intractable. The pain was there most of the time, and the usual treatment stopped helping enough.
People with intractable pain show other signs too. Physical function declines in all cases. Most need sleep medication. They also report mental health problems. Lab tests find hormone problems and high inflammatory markers (blood signs of inflammation) in all the patients. And one-third of these patients also have high blood glucose.
People diagnosed with intractable pain also have several health conditions at once. Common ones include adhesive arachnoiditis, Ehlers-Danlos syndrome, cervical neuropathy, reflex sympathetic dystrophy, interstitial cystitis, traumatic brain injury, rheumatoid arthritis, and stroke.
Researchers studied these patients further. Beyond the findings above, 60% had a set of four: constant pain, trouble sleeping, sugar craving, and cold hands and feet. Intractable pain is hard to diagnose and manage, because most of these people have several health conditions. Most of those conditions are hard to treat. So, in many, chronic pain moves on to intractable pain. Doctors must spot when chronic pain has become intractable and treat it to match, because poorly managed pain may make physical and mental health worse.
Frequently asked questions
What does intractable pain mean?
Intractable pain is chronic pain so severe that it no longer responds well to standard therapy, including standard drug treatment. It is not new, but it is getting more common. Many doctors now treat it as its own condition. Some states have passed laws that name intractable pain as a condition that justifies opioid prescribing. The term is still not well known, even among doctors.
What is the difference between chronic pain and intractable pain?
Most chronic pain responds to standard care, and many people do well on anti-inflammatory drugs. Intractable pain is the part that stops responding. It rarely starts suddenly. Most people have lived with chronic pain for years and can remember when it changed. The pain was there most of the time, and their usual treatment stopped helping enough.
What is an example of intractable pain?
People with intractable pain usually live with several conditions at once. Common ones include adhesive arachnoiditis, Ehlers-Danlos syndrome, reflex sympathetic dystrophy, interstitial cystitis, traumatic brain injury, rheumatoid arthritis and stroke. Each is hard to treat on its own. That is one reason chronic pain in these patients moves on to intractable pain.
What are the signs of intractable pain?
In the patient studies described here, physical function declined in every case. Most people needed sleep medication, and they reported mental health problems. Lab work showed hormone problems and high inflammatory markers in all of them. One-third had high blood glucose. Sixty percent shared four features: constant pain, trouble sleeping, sugar cravings, and cold hands and feet.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
