Contact Dr. Bockoff

8733 West Beverly Blvd.
Suite 400
West Hollywood, CA 90048
Telephone: 310-652-5800
Adjacent to Cedars-Sinai Medical Center Campus

Treating Chronic or Intractable Pain

Chronic pain is usually defined as any persistent or intermittent pain that lasts more than 3 months. When this definition is used, more than 40% of the general population reports having chronic pain, primarily due to arthritis or other musculoskeletal disorder.

Based on our clinical observations, within the chronic pain population, a subgroup has an intractable pain syndrome or disease.

All have incurable, extremely painful conditions, as evidenced by failure of various interventions to control their pain, including surgery, nerve blocks, physical rehabilitation, and weak opioids. Patients describe their pain as constant, debilitating, and potent enough to interfere with sleep and sexual function. Many report suicidal thoughts for the sole purpose of stopping the pain, incessant crying spells, fatigue, depression, social isolation, restriction of mobility, and numerous bed- or couch-bound days.

Objective assessment of these patients invariably reveals intermittently elevated blood pressure and pulse rate and abnormal concentrations of serum cortisol and other adrenal hormones, indicating the presence of a severe and extended stress state. Others have also recently postulated that severe chronic pain may produce an extended, destructive stress state characterized by neuroendocrine dysregulation, fatigue, dysphoria, myalgia, and impaired mental and physical performance.

NIH suggests that this constellation of abnormalities be called intractable pain disease.

About a dozen states, including California, Oregon, and Washington, have passed intractable pain laws, primarily to allow physicians to legally prescribe opioids to patients who suffer from chronic pain. Although the legal and legislative definition of the term intractable in the various state laws may be vague, the legislative intent of all these laws is clearly to identify the subgroup of patients with chronic pain who require opioids.

It, therefore, appears prudent and practical to adopt the term intractable for those patients with severe, chronic pain who demonstrate the extended, severe stress response described above. Although some other name could be adopted for this tragic group of afflicted patients, an intractable pain syndrome clearly needs to be recognized, treated, and researched independently as a separate disease that differs from simple chronic pain whose symptoms may merely be minor, mild, intermittent, or persistent for longer than 3 months.