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Journalist Foreman advocates more attention for chronic pain

Published: October 31, 2014
Section: News


On Tuesday afternoon, Oct. 28 in the Women’s Studies Research Center (WSRC), a group of senior scientists, lecturers and students gathered to listen to nationally syndicated medical journalist Judy Foreman. She delivered a lecture titled “Chronic Pain in America: How are We Managing?” Foreman focused the talk on her recent book, “A Nation in Pain: Healing Our Biggest Health Problem.”

Foreman, a former affiliated scholar of the WSRC, was a staff writer at The Boston Globe for 23 years, where she wrote a weekly health sense column for The Globe’s Health & Science section. She has also done freelance work for The Boston Globe, The Los Angeles Times, The Dallas Morning News and many others, and was a guest reporter for The Times of London for six months. She has appeared on WBUR and has been the host of a weekly call-in webcast on health issues for Healthtalk.com

Foreman said she became interested in the chronic pain topic about five years ago when she started suffering from severe neck pain. She said the pain interrupted even the smallest of tasks, such as picking up a pencil after having dropped it on the floor. In addition to suffering, she was also curious as to why the pain existed and why it became so excruciating.

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such of such damage,” she stated, the definition defined by the International Association for the Study of Pain.

Over the course of the book, which took five years to complete, she interviewed more than 200 scientists, neuroscientists, doctors, patients, lawyers and bureaucrats. The key finding throughout these interviews was that “chronic pain is still incredibly misunderstood and maltreated in this country,” according to Foreman.

Foreman went on to explain a few statistics that matched what she found in her interviews. She said that, statistically speaking, more people suffer from chronic pain than heart disease, diabetes, cancer and AIDS put together. In 2011, the Institute of Medicine (IOM) reported that there are 100 million American adults living with chronic pain, but an estimated 10 to 30 percent have such severe pain that “their lives are basically wrecked because they are disabled by the pain.” Foreman also points out that the “100 million” is an incorrect figure, as this does not include children, people in the military or people in nursing homes. There are major financial implications for this as well, and in the same IOM report, the estimated costs for chronic pain in America each year range from $560 to $635 billion. Yet Foreman points out that the “Feds do not fund it and there is no institute on pain research or pain.”

She explained the psychological effects that chronic pain has on the American population. She mentioned that the suicide rate for people with chronic pain is twice what it is for people without chronic pain. Over the course of her interviews, Foreman met a patient in Salt Lake City who had unrelenting headaches, but everywhere he went he was considered to be a “drug seeker.” His doctors had him so convinced he was a drug abuser that he wound up in the psychiatric ward of a hospital.

“No one took his pain seriously,” said Foreman. “Finally, he went to the emergency room where they diagnosed two brain aneurysms. But nobody worked him up, and everyone assumed he was a drug seeker, and that is more common than not.”

Foreman went on to explain a basic schematic of pain, showing a slide of a peripheral stimulus traveling through various types of nerve fibers, up through the spinal cord where it gets transferred to other nerve fibers, and then heading off onto multiple areas of the brain.

“Pain is not just a sensory input to the brain,” Foreman explained. “It also hits emotional centers of the brain. There’s no way to have severe pain and not have an emotional reaction to it.”

Many doctors offered insight on chronic pain in Foreman’s book, and she shared some of their thoughts in her talk. She cited Dr. Clifford Woolf, a major geneticist based out of Boston Children’s Hospital, and his thoughts in regard to how his field thinks about chronic pain.

“There’s been a shift in our thinking away from pain as only a sensory experience,” he said. “Chronic pain is not just a symptom; it is a disease of the nervous system.”

Dr. Elliot Krane, a pediatric anesthesiologist at Lucile Packard Children’s Hospital of Stanford University, gave a TEDTalk on the mystery of chronic pain. Krane stated that “pain is a disease.” He used an example of one of his patients, a 16-year-old girl who fell during a dance practice and sprained her wrist. Three months after she came to his clinic with the sprain, her arm was discolored and her muscles were frozen and paralyzed. The pain had spread from her wrist down to her fingertips and all the way up to her shoulders. She was suffering from “allodynia,” the act of feeling more pain than is actually there—through something as simple as mere touch.

“How can the nervous system misinterpret an innocent sensation, like the touch of a hand, and turn it into a malevolent sensation, like the touch of a flame?” asked Krane.

Foreman spoke to this issue, stating that what scientists have found is that chronic pain comes from the contribution of nerve cells, which come from the nervous system, and glial cells, which come from the immune system. This is important, as she points out, because the current chronic pain drugs are targeted toward the nerves. However, there are currently new drugs being tested to target the immune system.

Lastly, Foreman highlighted that there is not enough time in medical schools devoted to the understanding and learning of chronic pain. She stated that only four medical schools require students to take a course on the subject, and professors of various medical schools have admitted to her that when they do teach students about chronic pain it is “limited, variable and often fragmentary.”

Foreman believes that pain management is fundamental human right, and in order to see change, there needs to be a growing amount of activism.

“The failure to treat pain better, not to cure it, is tantamount to torture by omission,” she said.