Summary: Studies show that doctors often fail to help those living with chronic pain, as they are living with multiple chronic ailments. These chronic overlapping conditions (COPCs) are more challenging to manage than chronic pain caused by a single health issue. Hence, a patient may simultaneously have IBS, arthritis, fibromyalgia, depression, and other issues. However, due to a shortage of pain specialists, one doctor is treating one disease, and the other specialist manages another condition. This results in inadequate pain relief. Moreover, doctors fail to manage other symptoms like mood issues, sleep disorders, and more associated with COPCs.
Chronic pain is a significant problem and isn’t easy to manage. Many people need to take painkillers for years, and yet they do not get adequate symptomatic relief. Not to say that in many cases, doctors are not able to cure the condition.
There are many reasons why chronic pains are so difficult to manage and cure. One of the less realized or neglected reasons is the presence of multiple ailments. Doctors tend to treat the most common causes of pain; however, they may miss other less significant causes coexisting with that one primary cause. It is a condition called chronic overlapping pain conditions (COPCs).
COPCs are more common in females, and thus they are more likely to present with pains that are difficult to diagnose and treat. In addition, chronic pain is often associated with other signs and symptoms like mood swings, fatigue, sleep disorder, and cognitive disorders in women.
When multiple conditions exist, they influence each other, thus worsening the pain. In addition, they amplify the impact of each other. This means worsening systemic and localized pain, reduced treatment effectiveness, poor health, and psychological outcomes, increased disability, and markedly diminished quality of life.
Further worrisome is the trend. Even in young Americans, COPCs are quite common. However, this number rises to 75% in those older than 65 years of age. It seems that most people are living with multiple chronic and painful conditions.
Doctors say that to manage chronic pain effectively, we need to develop a better understanding of COPCs. We need to stop looking at individual pain causes and instead consider COPCs a complex multisystem illness.
COPCs cause two kinds of issues: generalized sensory sensitivity causing increased sensitivity to pain and internal symptom, and hyperalgesia in multiple body regions.
Additionally, the person suffers from SPACE (sleep disturbances, pain that is widespread, affect is negative, cognitive dysfunction, and energy depletion).
One of the reasons why COPCs remain so poorly identified and treated is the deficit of pain management specialists in the US. It means that people living with multiple health conditions are treated by different specialists. For example, one doctor may treat irritable bowel syndrome (IBS), other urogenital disorders, and yet another jaw pain.
Another challenge in treating these conditions is that each patient requires a personalized treatment approach, as everyone lives with different sets of painful conditions. Thus, one may be living with diabetes, low back pain, and cystitis, and another with IBS, depression, and sleep disorders.
Researchers say that managing such patients requires different skills, and doctors must focus on detailed history. Moreover, doctors should not focus only on the pain, but they must also learn about other issues like sleep problems, mood, cognition, and fatigue. In addition, they may try to learn more about sexual dysfunction, quality of life, and more.
Treatment of these conditions must start with US FDA-approved drugs for ten major COPCs (chronic low back pain, migraine, fibromyalgia, endometriosis, cystitis, IBS, and so on). When treating these conditions, doctors need to choose approaches targeting the central nervous system, including medications like anticonvulsants, antidepressants, muscle relaxants, and other medications.
Additionally, doctors would need to consider non-pharmacological means like physical and occupational therapy to improve patients’ functionality. Psychological counseling is another aspect to consider. As people with COPCs are living with mood disorders and maladaptive thinking.
Finally, doctors need to explore complementary medicine, including acupuncture, massage therapy, yoga, and chiropractic care.
By Gurpreet Singh Padda, MD, MBA