The Most Misdiagnosed, Misunderstood Medical Condition In The United States

It’s the focus of a new movie: Cake, starring Jennifer Anniston as a woman struggling with chronic pain, and is scheduled for release Jan. 23.

And it’s much more common that you could ever dream of, unless you are one of the millions that suffer from the nightmarish condition of chronic pain. Commonly misunderstood and mistreated, sufferers are often labelled as the problem “being in their head,” malingerers, or drug-seekers. Many become extremely isolated and depressed as a result of their chronic pain and the intense personal and social ramifications.

Chronic pain affects more people than cancer, diabetes, heart attack, and stroke combined. The Institute of Medicine estimates there are more than 100 million sufferers in the United States, costing the nation as much as $635 billion a year in medical treatment and lost productivity, meaning people are unable to attend work due to the condition or must seek disability.

Pain sufferers often are misdiagnosed, misunderstood, and miserable. Their friends and family can become worn out from listening to complaints, and may stop interacting with their loved one. Their identities may be significantly altered because they cannot engage in activities they once enjoyed — they no longer can take part in sports or everyday activities. Parenting and spousal relations may be significantly altered. Doctors get frustrated by the inability to provide a cure, and may not adequately medicate the patient, fearing the patient will become addicted to narcotics, or worse, fear they don’t really have pain and just are looking for narcotics. The stigma can be embarrassing and paralyzing to the patient, transforming formerly happy lives into a living hell.

There are many diseases that cause chronic pain, such as rheumatoid arthritis and fibromyalgia. But many cases of chronic pain don’t have an official diagnosis. Usually, people feel acute pain after an illness, injury, or surgery. If pain lasts beyond the time it takes to heal, or longer than 12 weeks, it’s considered chronic. Michael Clark, a psychiatrist and director of the pain treatment program at Johns Hopkins Hospital, explains the underlying pathophysiology.

“The disease of chronic pain is more than just acute pain that lasts longer. It has greater intensity, causes impaired function and can migrate beyond the original pain site. The nervous system becomes distorted. Pain receptors get amplified and internal pain blockers minimized, which can make even the lightest touch be perceived as painful. Chronic pain is not simply a single symptom or a straightforward experience like acute pain.”

Clark said depression, and the risk of suicide, is a significant danger to the millions suffering from this silent illness that most people can’t understand. While physical therapy, antidepressants, pain medications, cognitive therapy, support groups, and neurofeedback are all therapies that may help, being recognized and understood by the public may help the most in eliminating isolation.

“Approximately one-third to three-quarters of people with chronic pain experience moderate to severe depression. Patients with depression experience increased pain because of overlap in the two affected systems: pain reception and mood regulation. Both depression and chronic pain share some of the same neurotransmitters and nerve pathways. So pain is worse, function is poor, response to pain treatment is diminished and their prognosis is worse until they can get their depression under better control.”

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