Are we doing enough to help chronic pain sufferers?

One in five adults in the U.S. suffers from chronic pain. We see these patients every day—but do we really hear them when they confide in us about their pain?

As health care providers, no matter our discipline, we can do more to truly listen and consider the best referral pathway for pain sufferers. We should never assume they’re making it up, that it’s in their heads, or that nothing can be done about it. The belief that living with pain is acceptable is unacceptable—if someone has pain, something is wrong.

We are often so focused on treating or managing the symptom of pain, that in many cases we are failing to identify and address the root cause. Treatments such as pain medications are only temporary fixes, so we can’t stop there. If the cause can’t be identified through typical means like an X-ray, CT scan, or MRI, consider that the pain could be caused by an injured nerve. If a patient’s pain began after a traumatic injury, previous surgery, or amputation, it’s quite possible nerve damage is to blame.

Nerves are like the body’s wiring system; they send messages to the brain that allow us to feel and move. When they are injured, nerve signals deviate course and can cause pain. Sometimes, the pain is caused by a neuroma, which is a mass of nerve and scar tissue that forms in the nerve; pain can also be caused by surrounding tissues compressing the nerve. Pain, tingling, or numbness that lasts longer than three months after a trauma, surgery, accident, or injury may be a sign of nerve damage.

Neuropathic pain is the most common type of chronic pain, affecting one in 10 people. Yet, not enough health care providers (or patients) know about nerve pain, what causes it, or that there are potentially permanent ways to resolve it surgically. In fact, patients often see more than 20 providers before being evaluated by a surgeon specializing in microsurgical nerve repair.

Patients describe nerve pain in a variety of ways—tingling, sharp spasms, burning, scalding, electric shocks, or extreme sensitivity to touch and temperature. The pain can be intermittent or constant.

Most nerve injuries will not resolve on their own. Referring a patient to providers such as plastic reconstructive surgeons who specialize in nerve function and repair is best done as soon as possible. If a patient’s pain stems from an injured nerve, having nerve repair surgery within the first three to six months is ideal. Therefore, we must refer these patients to providers who specialize in nerve function and repair sooner. That said, even if the six-month window has been exceeded, a patient should still be referred.

Nerves can be surgically repaired, fixing the source of the pain, and in some cases, restoring lost function. Recent advances in microsurgery make it possible to repair nerves, removing the source of the pain, to allow normal signals to the brain to be restored. Many people find immediate pain relief after surgery, such as a patient of mine who experienced agonizing pain in his lower leg due to a suture that was accidentally put through his peroneal nerve during surgery, as well as a patient in her eighties who was unable to use left hand because broken glass sliced her palm and median nerve.

There are millions of people out there suffering with similar nerve injuries who could be helped. It’s time we get them the answers and care they deserve. We may not have received in-depth training in nerve pathology in med school or residency, but we owe it to our patients to learn more—and do more—now.

Adam Strohl is a plastic reconstructive and peripheral nerve surgeon.

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