Intractable pain, also known as Intractable Pain Disease or IPD, is a severe, constant, relentless and debilitating pain that is not curable by any known means and which causes a house-bound or bed-bound state... and early death... if not adequately treated, usually with opioids and/or interventional procedures. It is not relieved by ordinary medical, surgical, nursing, or pharmaceutical measures. Unlike the more common chronic pain, it causes adverse biologic effects on the body's cardiovascular, hormone, and neurologic systems. Patients experience changes in testosterone, estrogen, cortisol, thyroid hormones, and/or pituitary hormones. Both men and women require testosterone, however many doctors neglect to test women for low testosterone. Untreated Intractable Pain can cause death.
Legal Definitions
The exact definition of intractable pain varies based on the source and is not generally agreed upon. Several states have passed intractable pain laws or guidelines. Texas, under their Intractable Pain Treatment Act, defines Intractable Pain as a state of pain for which the cause of the pain cannot be removed or otherwise treated and in the generally accepted course of medical practice, relief or cure of the cause of the pain is not possible or has not been found after reasonable efforts. Florida's Intractable Pain statute defines “intractable pain” as pain for which, in the generally accepted course of medical practice, the cause cannot be removed and otherwise treated.
Treatments
Although Intractable Pain is not curable, there are treatments. The aim of IP treatment is to appreciate the pain caused by the root condition in order to minimize or reverse the neurological, endocrine, and cardiac changes. The specific treatments depend on the cause of the pain, the physician's preference, and the patient's health and preferences. These treatments can be used on their own, but are commonly combined with one another. Not every patient will respond to every treatment, but some more common treatments include:
Surgical repair, such as spinal fusion for scoliosis
mu-Opioids - Depending on the specific drug, opioids can be oral, transdermal, IV, intramuscular, subcutaneous, transmucosal, sublingual, intranasal, epidural, or intrathecal. Examples include morphine, hydromorphone, oxymorphone, hydrocodone, oxycodone, codeine, buprenorphine
Some medications can be used to potentiate the primary treatment, this is most commonly done to boost the efficacy of opioids and minimize the dose of the opioid needed to alleviate the pain. Some of these treatments are also used on their own, examples include:
There are many painful conditions that can cause intractable pain disease. Not every patient with these conditions will develop intractable pain, but the following conditions are known to cause Intractable Pain in some patients:
