Why Do Pain Patients Seek

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Pain management is an excellent example of where the biomedical model falls short. First, pain management is, by definition, an experience that is subjective1 and cannot be measured directly. Second, the pathophysiologic processes that produce clinical pain problems are still incompletely understood. We can only infer what the pathology is in broad generalities - for example, inflammatory, neuropathic, or mechanical. Complex social and psychological factors play such an important role in chronic pain problems that attempts to treat chronic pain exclusively using scientific principles are doomed to fail under our current state of scientific knowledge. Pain has a motivational component, i.e. it is accompanied by a drive to eliminate it. The result is that patients continually seek alternative treatments to eliminate their pain.

All of these conditions lead patients to seek CAM for pain: incomplete pathophysiologic characterization, lack of scientifically derived treatments, inability of allopathic treatments to control the social and psychological components of complex chronic pain, high motivation for symptom elimination, and lack of physician enthusiasm for treatment. In fact, chronic pain may be the affliction physicians are most loath to treat. Many physicians shun the chronic pain patient because they feel powerless to help these individuals who often have unrealistic expectations and require large amounts of time during and after office hours. It is no wonder that these patients look elsewhere for help.

Astin2 identified chronic pain as a predictor of CAM use. Other predictors included poorer health status, more education, anxiety, back problems, urinary tract problems, interest in spirituality and personal growth psychology, and having had a change in philosophy of life. Interestingly, dissatisfaction with conventional medicine did not predict the use of CAM. In fact, only about 4 percent of individuals report relying exclusively on CAM.2,3

The discomfort of allopathic treatments is often a deterrent for patients. Surgical treatments carry inevitable discomfort and recovery periods of varying degrees. Pharmaceuticals' side effects frequently interfere with normal functioning. The public's perception of these agents as foreign substances can even result in avoidance of medicines that are usually well tolerated. These "costs" of allopathic treatment also fuel the flight to "natural" alternatives.

Patients seeking treatment for pain want physicians to listen to them and to believe them. These elements of the physician-patient relationship are as important as successful pain reduction.4 Yet, time constraints and productivity expectations on physicians by disinterested third parties may reduce the listening time to ten minutes or less. The solo practitioner of a complementary or alternative therapy may offer 30 to 60 minutes of unhurried time to listen to their patients and satisfy that essential ingredient of success.

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