Pain is likely comorbid, co-contributory to negative CV outcomes

LAS VEGAS — Determine what type of pain a patient has, what the pain is trying to signal and then consider a multimodal approach as it “may be the best approach to pain,” said a physician who specializes in palliative care here at the Cardiometabolic Risk Summit.

“Chronic pain actually does increase your risk of CHD,” said W. Clay Jackson, MD, clinical assistant professor of psychiatry, University of Tennessee College of Medicine, Tennessee. “Pain is not just an innocent bystander. It is not just a marker. It is not just at the crime scene. Pain is actually Colonel Mustard with the wrench in the library.”

Jackson began his lecture asking the audience: “Does pain simply exist as warning signal? Is it just a car alarm to tell you when things are being broken into or is it an actual driver of disease? Does pain have a pathophysiologic function as well as an alarm function in the body?” And then followed up this question with a discussion about the differences between acute and chronic pain.

Acute and chronic pain have different prognostic factors, respond to different therapies and have different therapeutic ceilings, he said.

“Chronic pain is not acute pain that lasts longer,” Jackson said. “Acute pain is designed to show us something is amiss.” But acute pain, which should disappear when the injury has healed, “doesn’t always take a graceful exit” and can turn into chronic pain.

Chronic pain is a disease process; is longer in duration (months to years); and persists beyond usual course of an acute condition or the expected time for injury to heal, he said.

“Your genetic risk and your environmental exposure can combine to put you at increased risk to developing a chronic pain syndrome,” he warned.

“What you think has a huge effect on how you feel and how you feel has a huge effect on what you think,” he said.

Jackson said there are three choices for pain: it is a symptom of a disease and has no predictive power and “is just a car alarm and that’s it”; it is a marker of disease and has predictive power and is comorbid; or it is a driver of disease, has predictive power and has a pathophysiological mechanism.

“Pain is likely comorbid and co-contributory to negative CV outcomes,” Jackson said and continued to say the type, severity and distribution of pail have important implications for the increased risk of negative CV outcomes.

Jackson said that “some of the things we do for patients might be things that we do to patients.”

Some of the agents that physicians use to treat pain may incur CV risk such as NSAIDs, COX-2 inhibitors (can double the risk of MI); and opioids. Acetaminophen “is not a safe harbor” and physicians should warn patients that just because a product is available OTC that they are still medications, he said.

There are five risk factors for CHD: poor sleep, sedentary lifestyle, stress, smoking and obesity and all of these things are associated with pain, Jackson said. And “the association is bidirectional.” – Joan-Marie Stiglich

Disclosures: Jackson is a consultant for Merck and Sunovion; on the speakers’ bureau for Sunovion; a stock shareholder for Aspire Healthcare; and an American Academy of Pain Management board member.

Reference:

Jackson WC. Pain: Simply a symptom or a driver of disease. Presented at: Cardiometabolic Risk Summit Fall Pre-Conference; Oct. 14, 2016; Las Vegas.