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The standard approach to the use of muscle relaxants is to use them for the treatment of acute, i.e. short-term, injuries. The idea is to reinforce the need for a complete rest by relying on the sedative qualities of muscle relaxants. This gives the body a chance to begin healing. Then, with physical therapy, you can slowly restore strength and mobility. Because it’s not safe to use these drugs over any significant period of time, their use has been overlooked in the treatment of chronic diseases and disorders. Indeed, there’s been poor coordination between the specialists and the generalists who want to establish pain management as a specialism in its own right. Those who have built their empires on the back of particular injuries or diseases, are reluctant to give up control of patients to a new department that might challenge their authority. The result is long waiting times for people with chronic pain to get effective treatment for the pain.

Speaking at a recent European conference, Professor Varrassi reported the results of a long-running study. About 25% of adults in Europe are affected by some degree of chronic pain. Lower back pain is actually the second most common reason for people to visit their doctor in search of treatment. Yet the average delay between the first consultation and a reference to a specialist pain center is about twelve years. The main reason for this long period is that doctors prefer to continue dealing with their patients even though this may mean nothing more than increasing the potency of the painkillers used. This leads to a constant battle to balance the reality of the pain against the side effects of the opiate drugs most often used. Professor Varrassi strongly argues for a complete reeducation of doctors. The evidence clearly shows there is a strong neuropathic element to chronic pain, and continuing treatment for a physical condition is not going to work.

The Europeans are therefore arguing for a multidisciplinary approach to managing chronic pain. They believe the main focus should be on physical therapy, cognitive behavioral therapy and the selective use of muscle relaxants over short periods of time. The strategy is to relax and calm the body both through a drug like Carisoprodol and, say, deep muscle massage. With physical relaxation induced through Carisoprodol, the therapist can apply corrective therapy to the muscles, tendons, ligaments and the associated soft tissue. What is damaged can be encouraged to regain mobility with less pain. Once the combination of drug and physical therapy has established a new baseline for mobility, the cognitive behavioral therapist can move in to suggest how movement can be optimized within the new physical limits. The idea is to find ways of improving the quality of life. This lifts the mood and allows the patient the opportunity to view pain in a slightly different light. The main problem with chronic pain is that, the longer it goes on, the more depressed the person can become. But if the use of, first Carisoprodol, and then therapies can demonstrate the practical possibility of less pain and increased mobility, optimism can return. Mood is everything in the management of long-term pain. So long as traditional doctors focus on the body, treatment will always fall short. The individual patient should become the focus of attention. With a holistic approach, everything becomes possible.

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