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Making pain a vital sign and judging the quality of medical care by how often we ask someone to rate their pain, and then treating it aggressively, have paradoxically increased both our fear and our experience of pain. It moves around and spreads.

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They suffer headaches, irritable bowel syndrome, interstitial cystitis, fibromyalgia, insomnia, and sensitivity to light, sound and smells. Their arthritis is more painful. The simplest daily activities hurt, and they become afraid to move. They often take a long list of prescription medications and supplements, and undergo multiple injections and surgeries, all in a futile attempt to feel better.

Their pain is real, and the vast majority of them are not addicts. None of this is predestined, and if we want to reverse the opioid crisis, a new approach to pain is a good place to start. American medical schools do a poor job of teaching the latest in pain science.

They want to get rid of it. Whenever reasonably possible, that is what doctors should do. But it comes at a cost: Our present system overpromises and underdelivers on relief, fostering dependence in the process. One way of reorienting patient thinking along these lines comes from the multidisciplinary pain clinics pioneered by the late John Bonica, a pain specialist at the University of Washington.

Bonica proposed that we look at the whole person. Education is a cornerstone: They teach patients how their nervous system can either calm their pain or amplify it, then give them the skills to direct that system. New approaches hope to teach self-management by educating patients about their bodies and nervous systems, reducing fear of pain, and treating depression and hopelessness — partly by getting them back to exercise and normal activities. Helping patients resume their lives rather than focusing narrowly on eliminating pain changes their outlook. Instead of taking pills and awaiting their next epidural, they calculate the costs and benefits of getting up and engaging in life again.

They invariably fear that the pain will be too great and their ability to tolerate it too limited, and this is where caring professionals can help lead them through a step-by-step management programme. This aboveground transit system is old and loud.

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It roars past homes and businesses. Nearby residents feel the vibrations; it can be so noisy that they pause their conversations while the train goes by. Yet those who think a lower rent is worth the annoyance report that the sound soon ceases to be disruptive. You get used to it. Getting angry every time a train passes is a sure way to obsess over it. The more we learn to calm it down, the less it bothers us; the more we try to be pain free, the more it takes over our lives.

But one fix is for insurers to scrub the rules that make it cheaper for patients to continue failed pain treatments, surgeries, injections and medications. James D. You can manage them any time by clicking on the notification icon. Monday, December 2, Opinion Op-Eds. Editorials Op-Eds Letters Columnists. All Sections. Acute pain can be made more tolerable by a short course of medication. Their pain is real.


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