Perspectives in Intractable Pain Management
An analysis of current diverging viewpoints

Definitions and Background Information

What is intractable pain?

Intractable pain is a pain state in which the cause of the pain cannot be removed or otherwise treated and which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts including, but not limited to, evaluation by the attending physicians and surgeon and one or more physicians and surgeons specializing in the treatment of the area, system, or organ of the body perceived as the source of pain

What are the ailments often associated with intractable pain?

The following is a list of ailments that may result in intractable pain:

• Lower back pain
• Cancer
• Severe burns
• Tension and migraine headaches
• Arthritis
• Myocardial ischemia
• Renal colic
• Gout

What is the recommended treatment for severe intractable pain?

The recommended treatment for severe intractable pain is opioid therapy. Opioids are classified as drugs that are either natural derivatives or synthetic forms of opium.

Examples of opioids are:

• Morphine
• Hydromorphone
• Oxycodone
• Codeine
• Meperidine
• Methadone
• Levorphanol
• Fentanyl
• Propoxyphene

Who is effected by intractable pain?

Thirty-four million Americans suffer from intractable pain every year. What’s even sadder is that there are medications available that can relieve their pain, but certain barriers created by societal stigmas and taboos continue to block pain patients from receiving the relief they need.

What’s the problem?

Although opioids have been recommended for moderate to severe pain by pain researchers over the past three decades, five audiences—governments, state medical boards, physicians, patients, and insurance companies—have perpetuated the old paradigm in thinking that opioids taken for intractable pain treatment are unsuitable at high dosage levels and for an extended period of time.

The new paradigm in thought advocates for the use of opioids for intractable pain by gearing dosage levels and treatment durations specific to the levels of pain experienced by each individual patient. By allowing physicians to work with their patients to determine the appropriate pain treatment for each case, more patients will be adequately treated. Once adequately treated, most patients regain a healthy quality of life.

Review each audiences’ perspective of pain management and the updates in pain management to understand why the old paradigm continues to persist and to discover what measures are being taken to advance into the new paradigm of accepted opioid treatment for intractable pain.

©1999 The National Foundation for the Treatment of Pain.

Last update: 02/18/06