Intractable Pain
by Forest Tennant, MD, DrPH; John Liu, MD; and Laura Hermann, RN, FNP
 The current thrust to humanely identify and treat pain
is uncovering a group of patients with severe, chronic intractable pain (IP). While
epidemiologic surveys indicate that over 40% of the adult population has chronic,
recurrent pain, mainly due to musculo-skeletal degenerative conditions, there is a
sub-group of tragic individuals who suffer constant, excruciating, unrelenting pain.1,2
To separate these patients from the more prevalent chronic pain patients, these patients
are commonly referred to as IP patients.2 Most states in this country have
recently passed IP laws or established guidelines and standards to allow physicians to
prescribe opioids and other end-stage treatments to these individuals without legal
repercussions. Since IP patients always have an underlying, incurable disease or condition
causing IP, their clinical management is complex and may require a specialized clinical
setting. Just as renal failure or insulin-dependent diabetes require lifetime care by a
cadre of specialized medical personnel, IP likewise requires similar lifetime care due to
its incurable nature.
Who Is the IP Patient?
The authors define IP as “pain that is excruciating, constant, incurable, and of such
severity that it dominates virtually every conscious moment, produces mental and physical
debilitation and may produce a desire to commit suicide for the sole purpose of stopping
the pain.” In the authors’ clinical experience, bonafide IP patients suffer
profusely and are fundamentally bed- or house-bound in the absence of intense medical
management.3 Table 1 presents some common characteristics of the IP patient.
A variety of traumatic and medical conditions may be the underlying cause of IP (see
Table 2). Note that over half of them involve spine degeneration.
Please refer to the May/Jun 2002 issue for the complete text. In the event you need to order a back issue, please click here.
— May/Jun 2002
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