Editor's Memo
by Forest A. Tennant, MD, DrPH
 The just-completed annual meetings
of the American Pain Society and American Academy of Pain Medicine were chock-full of new,
scientific data strongly indicating that practitioners need to be more aggressive in
treating pain.
Dr. Russell Portenoy and associates reported on an epidemiologic survey of US
households who had a member with persistent pain. A high percentage of African Americans,
Hispanics and Caucasians reported that pain caused loss of work, disturbed sleep, and
inability to do household work or sports. Hispanic pain patients, more often than other
racial groups, reported that pain ruined their lives, and, at times, wished they would
die.
Research groups for Utah and Florida presented clear evidence that chronic pain
produces cardiovascular and immunologic complications. Even more compelling was a study by
Sora and Associates from Northwestern University that compared brain mass in chronic pain
patients with normal controls. The chronic pain patients’ gray matter had
significantly less density. This study was so significant that its contents rightfully
showed up in Investors Business Daily following its presentation. Although
nervous system-type pain, per se, is in early stages of research, practitioners and
patients need to be keenly aware that there is growing evidence that uncontrolled pain may
produce pathologic, neurologic, immunologic, cardiovascular and endocrine changes.
On the positive side, a number of papers confirm previous studies that aggressive pain
treatment—including opioids—not only controls pain, but also improves social and
economic function, neuropsychological ability, and ensures a better, safer vehicle driver.
All told, practitioners must be practical, shun shibboleths and naysayers, and
aggressively treat pain by whatever method “works” in the mind of the patient.
After all, it is now clear that the patient’s mind (i.e. gray matter) doesn’t
function very well without adequate pain control.
Forest A. Tennant, MD, DrPH
Editor in Chief
— May/Jun 2003
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