Summary: Almost 40% of adults are living with chronic pain. However, many of them may progress to intractable pain. A kind of pain that would not benefit from traditional drug therapy and may require treatments like opioid therapy. Therefore, health experts think doctors and patients need to better understand intractable pain for a timely diagnosis of the condition. Studies suggest that some individuals are more likely to progress to intractable pain. Intractable pain is not something new, but its prevalence is increasing. Thus, many doctors see it as a distinct health condition. However, the term “intractable pain” is still not well recognized even in the medical world.
Studies show that almost 40% of people these days are living with chronic pains. Some may have musculoskeletal conditions, others post-surgical pain and other fibromyalgia. In some, chronic pain is quite severe and would not respond well to conventional therapy, including opioids. Such people are said to be living with intractable pain1.
Fortunately, now doctors realize to classify intractable pain as something different. It is a painful condition that is quite challenging to treat and often requires different treatment approaches. These are the individuals who might benefit from prolonged opioid use or procedures like a nerve block.
Therefore, now many states in the US are recognizing “intractable pain” as something different. Some states have passed the law recognizing this disease entity as a condition that justifies opioid prescription by doctors1.
Of course, not all people living with chronic pain are suffering from chronic pain. In most instances, doctors can help well by using conventional drug therapy. In addition, most would benefit significantly by using non-steroidal anti-inflammatory drugs. Nevertheless, some fail to respond to the treatment.
Studies suggest that some people are at a greater risk of intractable chronic pain. For example, one survey of 28 individuals living with intractable pain found that 20 of them were females. So, it means that the female gender is a significant risk factor for the condition.
Similarly, age is another risk factor. Young people are less likely to develop intractable pain, as they have good hormone status, and less likely to be living with chronic ailments. Thus, studies suggest that most people living with intractable pain were first diagnosed with the condition in their late 30s. The average age of people living with intractable pain is in the mid-fifties.
Moreover, intractable pain does not have a sudden onset. Most of these people are those who have been living with chronic pain for years. And, they remember quite clearly when their pain became intractable. This means that they started experiencing pain most of the time, and the usual treatment stopped helping them sufficiently.
Other signs found in those living with intractable pain is a decline in physical function in all cases, most require sleep medications, and they also report mental health issues. When it comes to laboratory findings, hormonal abnormalities, and high inflammatory markers, can be found in all the patients. In addition, one-third of these patients also have elevated blood glucose levels.
Further, it is worth understanding that those diagnosed with intractable pain have multiple health conditions. Thus, some common conditions they live with are adhesive arachnoiditis, Ehlers-Danlos syndrome, cervical neck neuropathy, reflex sympathetic dystrophy, interstitial cystitis, traumatic brain injury, rheumatoid arthritis, and stroke.
Researchers further studied the patients living with intractable pain. They found that apart from the above findings, 60% presented with a quad: constant pain, trouble sleeping, sugar craving, and cold hands and feet. Intractable pain is challenging to diagnose and manage, as most individuals with such pain are living with multiple health conditions. Moreover, most of these conditions are challenging to treat. Thus, in many, chronic pain progresses to intractable pain. For doctors, it is vital to identify when chronic pain has become intractable and provide treatment accordingly as ill-managed pain may cause worsening physical and mental health.
By Gurpreet Singh Padda, MD, MBA