After injury or surgery, patients are often asked to rank their pain on a scale of 0-10, a way of evaluating a mostly subjective phenomenon. But what if a patient’s pain never fully dissipates? That’s the case for as many as 50 million Americans, who live with chronic pain. Carrying a cost of more than $125 billion each year to the health care system, chronic pain can impact mood, social interactions, and physical functioning. In short, pain can devastate people’s lives.

These patients are the primary concern of Zacharia Isaac, MD, a physical medicine and rehabilitation spine and pain care specialist at Brigham and Women’s Hospital (BWH). With a measured approach emphasizing communication and education, Dr. Isaac seeks to uncover the source of patients’ chronic pain, which in the case of back pain alone can have a myriad of root causes. Many of his patients have spent years trying to unlock the mystery of their pain.

“Patients in chronic pain who don’t have significant structural issues are often extremely frustrated—they go from doctor to doctor, receive study after study, and get no firm answers or treatment solutions,” says Dr. Isaac, who is also the medical director of the Comprehensive Spine Center at BWH, and chief of the division of spine care and pain management at Spaulding Rehabilitation Hospital. “These patients feel more invalidated when their doctors can’t find an identifiable source of their pain, and their friends or family can’t understand their plight.”

Though structural abnormalities are at times to blame, chronic pain lasting more than three months is often due to neuropathic pain, in which the brain becomes hypersensitive to even slight pain signals. Caused by a combination of factors such as brain chemistry and posture, neuropathic pain leads the brain to fixate on pain. Though this fixation can take time to reverse, Dr. Isaac works with patients to implement a multi-pronged approach that includes education, inflammation reduction, healthy sleep, and exercise, which paradoxically is key to recovery.

By engaging the brain’s ability to change, Dr. Isaac often witnesses patients’ hope return as their pain fades over weeks and months.

“Make no mistake, breaking the cycle of chronic pain is difficult. It takes commitment and determination, but I’ve seen patients break free of chronic pain and get their lives back,” he says.

More on Dr. Isaac’s approach to these complex cases here.

Topics: Integrated Care, Patient Experience, Academic Medical Centers

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