Q&A: Chronic Pain




Q&A: Chronic Pain
An Interview with Doris K. Cope, M.D.

Doris K. Cope, M.D., is a member of the American Society of Anesthesiologists’ Committee on Pain Medicine and Professor and Vice Chairman for Pain Medicine in the Department of Anesthesiology at the University of Pittsburgh School of Medicine. She is Director of the Interprofessional Program on Pain Research, Education and Health Care, University of Pittsburgh Schools of Health Sciences. She specializes in treating chronic pain patients. The following is an interview with her about chronic pain.

ASA: What is chronic pain?

Dr. Cope: Short-term pain can become a chronic illness when pain persists for three months or more. Nearly 130 million Americans suffer from chronic pain of various types regardless of their age, race or gender. Pain is a subjective experience that impacts each patient in his/her own way. Pain Medicine is a new subspecialty with board certification that deals with not only the treatment but the evaluation of chronic and cancer pain. A physician specifically trained in Pain Medicine is able to diagnose and treat many painful syndromes to improve quality of life and often to avoid the development of a chronic and debilitating pain condition.

ASA: What causes chronic pain?

Dr. Cope: When pain from many sources becomes chronic it can take on a life of its own. The nerves in the body, spinal cord and brain can become hypersensitive to all stimuli resulting in a debilitating state. Common causes of chronic pain syndromes are: arthritis, cancer, AIDS, back and neck injury, migraine headaches, phantom limb pain for amputees, shingles, back, neck and joint pain.

Chronic pain not only affects a patient's health resulting in poor sleep, nutrition and inability to exercise, but can have significant psychological effects on the patient and his/her family. Work-related issues are common and with lack of ability to function, a patient's self-esteem and interest in the outside world deteriorate.

It is a great source of joy when a patient can have his/her pain effectively treated enough to enjoy life and their family. This requires a team effort among the patient, pain physician and outside environment.

ASA: What do pain specialists do?

Dr. Cope: Most pain specialists are anesthesiologists who have completed anesthesiology training and achieved board certification in that specialty. Further board certification in Pain Medicine is then available for this specialty practice. Pain physicians are at the hub of the wheel of medical care, working closely with primary care physicians, physiatrists, neurologists, oncologists, spinal surgeons, orthopedists and general surgeons to diagnose and treat chronic pain conditions. Often their expertise is sought in medical management, as well as newer invasive techniques to alleviate pain. These physicians give each patient a thorough medical evaluation to determine specific treatment based on the individual patient and the clinical experience and expertise of the physician. Certainly with the myriad of pain conditions, a physician is required to diagnose the problem in concert with other physicians and to formulate often a multidisciplinary plan to improve pain control and to restore functionality.

ASA: What are the most common types of chronic pain?

Dr. Cope: Many types of chronic pain exist, but the most common are headaches, back pain and arthritis.

  • Headaches: The majority of headaches fall into three main types: tension, migraines and cluster. Tension headaches are normally caused by a stressful lifestyle or event, while migraines may be caused by hormonal changes, diet or even certain types of medication. Cluster headaches often cause more pain than tension headaches and severe migraines.
  • Back pain: Chronic back pain is often complex based on mechanical issues of posture, weight and gait, as well arthritis. There are several possible sources of bone and joint pain as well as nerve and muscle pain that may be responsible for the patient's symptoms. The patient may describe a deep aching pain that starts in one area of the back and then travels down the legs. It is quite different from the occasional sore back caused by overexertion from an activity such as shoveling.
    The acute pain from exercise or overexertion usually resolves with rest and anti-inflammatory drugs such as Motrin or Aleve and may not turn into a chronic pain syndrome.
  • Joint pain: This is a very common type of chronic pain and includes osteoarthritis and rheumatic diseases. Osteoarthritis is a degenerative joint disease and the most common form of arthritis. Rheumatoid arthritis, a systemic immune system disease, also causes inflammation within the lining of various small and large joints.

ASA: What are the treatments for chronic pain?

Dr. Cope: Chronic pain treatment is like treatment for heart disease or cancer. The patient's specific medical diagnosis directs the course of treatment. One size treatment certainly does not fit all patients and without a proper medical evaluation, therapy may be misguided or even, at worse, harmful.

ASA: Can patients become addicted to chronic pain medication?

Dr. Cope: The milder medications usually used as first-line treatment do not pose this risk. But certain stronger medications used to treat pain may result in a physical dependence on that medication and the patient will experience withdrawal symptoms on sudden stopping of the drug. However, under medical supervision, the medicine can be tapered slowly and carefully without side effects or other problems. Addiction is a psychological as well as physical dependence in which a patient will persist in seeking out substances to make him/her feel “high” or euphoric despite negative consequences to that patient and his/her family. Rarely do patients who take pain medications under medical supervision develop the severe psychological craving that is characteristic of addiction.

Helpful Links

What is Anesthesiology

Total care of the surgical patient before, during and after surgery.


Anesthesia Topics Quick Links

Choose a topic:

Featured Video:

Smoking and Surgery
Learn why stopping smoking before surgery can have an impact on your outcome.

Play Video

In Case of Emergency

Download, print, fill out, and keep this checklist. It just may save your life.


Come Prepared

Ask your anesthesiologist questions about what to expect before, during, and after your procedure.


The ASA does not employ physician anesthesiologists on staff and cannot respond to patient inquiries regarding specific medical conditions or anesthesia administration. Please direct any questions related to anesthetics, procedures or treatment outcomes to the patient’s anesthesiologist or general physician.