The pain, when it comes, is blinding.

It stabs like a knife into one eye. It’s not a migraine, and lying down only makes it worse. So you pace—carefully, not jarring your head—back and forth across the room, or outside, if it’s dark and cold; the colder the better. Slow tears leak out of the eye on the headache side and your nose drips. You don’t care. It goes on and time stops until suddenly, the headache is over. Until tomorrow, same time same channel, when it starts up again. Until the cycle is done and all you can do is wait and wonder when it’s going to come back.

That’s a cluster headache—just one example of chronic pain.

Clusters aren’t treated with opioids, often, they don’t work, but other types of chronic pain, just as agonizing, are. Think pain post-surgery. Cancer pain. Severe burns.

Articles about pain-relieving drugs tend to lead with stories of addiction, and the toll the opioid epidemic is taking is horrifying. But the whole reason for these drugs in the first place is that they get rid of pain; the focus on its addictive qualities are causing those hurting to suffer even more.

But not here, says Director of Patient Care at Wayne Memorial Hospital James Pettinato. “Everyone works together,” he said, to make sure the suffering aren’t left behind.

Nationwide, there are a lot of people in pain.

The U.S. Department of Health and Human Services (HHS) notes in a 2019 report on pain management, “50 million adults in the United States have chronic daily pain, with 19.6 million adults experiencing high-impact chronic pain that interferes with daily life or work activities. The cost of pain to our nation is estimated at between $560 billion and $635 billion annually.”

Access to some sort of pain management has been considered a human right since the Single Convention on Narcotic Drugs in 1961, but the challenge lies in balancing the needs of suffering people and “containing the rising toll of the harms that can result from the use of opioid medications,” the report says.

 From a medical standpoint, “trying to decrease the dose [of opioids] or not get them started are the goals,” Pettinato said.

So something happened to you, an accident, arthritis, or you got sick. You’re in pain. What happens?

For the new pain patient, there are many ways to treat it, to be used depending on what’s causing it; one size does not fit all. The HHS report has a list that includes other medications, physical therapy, multiple types of “interventional procedures” like nerve blocks, cognitive-behavioral therapy and complementary techniques from acupuncture to yoga to tai chi.

Opioids, in other words, don’t have to be the answer.

Pain after surgery is another significant problem, but now it can be managed, Pettinato said, in such a way that patients only need anti-inflammatories afterward, not opioids.

Who treats pain? It starts with the primary care doctor, he said. “Primary care is the first step. It’s a multidimensional process.” The primary care physician (PCP) coordinates other forms of care, including sending the patient to a pain-management specialist if necessary.

 Wayne County has one, but Pettinato stresses the importance of the PCP. That’s the doctor who knows you best. If you need a pain management appointment fast, there are pain clinics in Scranton/Wilkes-Barre and Allentown too.

What if you’re on opioids already?

For that person, it’s more complicated. The American Society of Anesthesiologists says that while pain may be managed by opioids, side effects can range from nausea and constipation to dependence and tolerance to a slow heart rate and shallow breathing.

So for doctors, there’s good reason, aside from addiction, to be careful with opioids. “Limit the prescription amount,” Pettinato said. “Limit the opioid-naive [people who do not use opioids chronically]... Limit quantities, limit the dose.”

And of course there is another disease process going on, he said: addiction and dependency.

Switching to another pain reliever is the answer for some patients. Unfortunately, it’s easier said than done. “The one constant,” Pettinato said, “has to be the drive to come off it. It’s multidimensional, multiple challenges. You need to deal with the addiction; the brain has to be rewired.” Recent changes in Pennsylvania law have made it easier for people to get medication assisted treatment, he added.

Others will need to stay on the meds. Again, the PCP and perhaps a pain management specialist would help here, especially to monitor side effects.

Beyond that, for all pain patients, and others who use or have used opioids, services are critical: sufficient healthcare, behavioral health, sober housing, food. Plus mental health care as needed. When it comes to that, it’s “a challenge we all face. Those resources are very scarce,” Pettinato said.

But, he adds, “We’re pretty blessed compared to other areas.” When faced with the opioid epidemic, people said, “We have a problem in this county; what can everyone bring to bear?”

“It’s not just going to a doctor and getting a treatment,” Pettinato said. “It’s the social determinants.” That’s where we are born, live, and age. And to fix that, it will take all of us, working together.