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Rescuing Patients From Pain

Rescuing Patients From PainWhile millions of Americans suffer from chronic pain, most physicians don't understand their suffering -- but pioneering doctors like Tufts' Daniel Carr are trying to change that.

Boston [12.21.01] Even though 30-50 million Americans suffer from chronic pain every year, the medical field has been slow to understand or address the issue. But research and work by pioneering doctors like Tufts' Daniel Carr has transformed the field of pain management from an overlooked area of study into one of medicine's hottest fields.

"It's a field on the verge of explosion," Carr told the New York Times Magazine. "There's no area of medicine with more growth and more public interest. We've come far enough scientifically to see how far we have to go."

Carr and a small group of other doctors and researchers are largely responsible for the tremendous growth of the field.

"Daniel Carr's interest in pain began as an intellectual one," reported the Times. "After training as an internist and endocrinologist, he published a landmark study in 1981 of runners, which showed that exercise stimulates beta-endorphin production, leading to a 'runner's high' that temporarily anesthetizes the runner. He began to wonder: if the runner's high is an example of how a healthy body successfully modulates pain, what abnormality leads to chronic pain?"

Over the 20 years that followed, Carr focused on the subject of pain management. He founded two pain clinics (one at Tufts), became director of the American Pain Society and helped create the country's first and only master's degree in pain research, education and policy at Tufts' School of Medicine.

What he's learned about chronic pain would astonish anyone unfamiliar with the condition.

"Some of my patients are on the border of human life," Carr told the Times. "Chronic pain is like water damage to a house -- if it goes on long enough, the house collapses. By the time most patients make their way to a pain clinic, it's very late."

Lee Burke is one of those patients.

According to the New York Times, the 56-year-old woman had a tumor removed from behind her ear while in her late 40s. The recovery was supposed to take less than two months, but Burke has been suffering with severe headaches and shooting pain for years.

"It's like being slammed into a wall and totally destroyed," she told the Times. "It makes you want to pull every hair out of your head. There's nothing I can do to defend myself."

Burke turned to Carr for help.

The Tufts doctor approached her case like he does many others, looking for the hidden cause of the chronic -- and often devastating pain.

"It's Carr's job to rescue the crushed person within, to locate the original source of pain -- the leak, the structural instability -- and begin to rebuild; psychically, psychologically, socially," reported the newspaper.

While many of his patients break down during their sessions with Carr, the New York Times reporter who shadowed him noted: "He is neither indifferent to emotion nor distracted by it; you sense at all times that his focus is on the culprit -- the shape-shifter, the pain."

In Burke's case, her pain appears to be linked to a nerve accidentally severed during her surgery.

"Doctors used to be so confident that severed nerves could not transmit pain -- they're severed! -- that nerve cutting was commonly prescribed as a treatment for pain," reported the Times. "But while cut motor nerves can be counted on to cause paralysis, sensory nerves are tricky. Sometimes they stay dead, causing only numbness. But sometimes they grow back irregularly or begin firing spontaneously and produce stabbing, electrical or shooting sensations."

Doctors like Carr say the research and treatment of chronic pain still has a long way to go.

But for the patients who have finally found doctors who understand their suffering, the progress to date has provided them with much needed relief.

"Dr. Carr is my savior," Burke told the Times, as she left his office with new hope that she'll eventually free herself from the pain.

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