SAN FRANCISCO (KCBS RADIO) -- Chronic pain affects approximately 1 in 5 Americans, and yet it remains one of the most misunderstood and difficult-to-treat medical conditions. Unlike acute pain, which often arises from an injury or illness and resolves over time, chronic pain persists for months or even years.
Still, defining chronic pain is not as straightforward as it may seem. Causes can vary, ranging from physical injuries and medical conditions to mental health factors and even unknown sources, according to Dr. Chris Abrecht, Medical Director for the Center for Pain Medicine at UCSF Health.
"On the very basic level, chronic pain is essentially pain that is present for a prolonged period of time. And even that is a little bit in debate. Sometimes I hear three months, sometimes six months," Dr. Abrecht told KCBS Radio's Patti Reising on this week's episode of "As Prescribed."
The challenge of treating chronic pain is compounded by the difficulty in measuring it. Unlike other conditions with clear diagnostic tests, pain is something that can only be reported by the patient.
"Pain is something that is essentially impossible currently to accurately measure, and our main measure of pain is what a patient is reporting," said Dr. Abrecht.
The common practice of asking patients to rate their pain on a scale from 1 to 10 is one example of how doctors attempt to measure pain, but it has its limitations.
"I very frequently will see patients that say, 'I have a 10 out of 10.' And when I see them, they appear to be fine, calm, having a conversation, but saying it's the worst pain of their life," said Dr. Abrecht. "And other times I will see someone who has a pain level that they endorse that is a three or four that says, 'You know, this three or four is really interfering with my quality of life. I can't do all the things that I want to normally do.'"
Chronic pain is recognized as a bio-psycho-social condition, influenced by physical injury, psychological factors like stress or depression, and social elements such as cultural beliefs and support systems. Recent research has also highlighted its strong connection to the central nervous system. Dr. Abrecht emphasized that pain, in essence, only exists in the brain.
"If you step on a nail and you experience pain, it's not that your foot hurts, but really you perceive the hurt in your brain. So that signal has to travel from the foot and go all the way to the brain, and then you say, 'Ow,'" he said. "Whether it pierced through your foot and caused pain or whether you perceived that it did, you experienced pain and that experience was in the brain."
This process becomes problematic in chronic pain conditions, where the nervous system may become dysregulated. As a result, the system's response to pain goes awry, leading to ongoing pain that no longer matches any active injury or illness.
Managing chronic pain requires a multifaceted approach that combines traditional and integrative medical practices. Treatment has evolved from an over-reliance on opioids to a more holistic, multidisciplinary strategy that incorporates medications, physical therapy, psychological support, nerve blocks, and lifestyle adjustments for comprehensive pain management.
"I think we are now coming to realize that the best way to address not just chronic pain, but any pain is via a multidisciplinary multifaceted approach. So not just take a pill or get a nerve block, but all of those things together and more, and it's very individualized," said Dr. Abrecht.
As research into chronic pain advances, new treatment possibilities are emerging, including the exploration of psychedelics as a potential solution for managing symptoms. Although not yet widely accepted, research into substances like psilocybin is gaining traction due to their potential to "break this dysfunction of the central nervous system that may have taken hold" and reset the brain's response to pain, Dr. Abrecht explained.
Other areas of interest include the development of new medications that could offer pain relief without the addictive properties of opioids.
"There's always the hope for new medications... different kinds of injections," said Dr. Abrecht. "But I think most of the research is hopefully going to be finding out that pain care needs to be individualized and multidisciplinary. So hopefully there's more on that horizon and we all can get on board with that notion."
Listen to this week's "As Prescribed" to learn more. You can also listen to last week's episode to learn about a new UCSF study that offers hope to people suffering from symptoms of long COVID, here.
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“As Prescribed” is sponsored by UCSF.