On Itch in an Algiatrist

We physicians call it pruritus, and we prescribe pills, lotions, ointments, and creams. We patients call it itching, and we scratch and scratch and scratch. Chronic itch may have a low profile as a medical problem, but it can totally disrupt the life of a patient. At its mildest, chronic itch is just an irritation, but at its worst, chronic itch can be disabling and all consuming. I wrote this essay based on my personal experience as a patient with chronic itch due to cholestatic liver disease coupled with my professional experience as a physician who has been treating patients with chronic pain for 25 years. I do not mean to suggest generalizing from my specifics, but now that I am feeling well, I felt it worthwhile to share some of my experiences from both sides of the exam table. The neurobiological and clinical similarities between chronic itch and chronic pain are striking, and are just recently being well appreciated. Like chronic pain, in addition to being a symptom of a disease, itch can become the disease itself. Itch-related illness and chronic pain share aspects of anatomy and neurophysiology, have similar bio-psycho-social issues, and require many of the same treatments. The model algiatrists used to treat patients with chronic pain can readily be applied to patients with chronic itch, especially with respect to medication management, rehabilitation, and the need for regular physician and other support. As a physician, I had not thought much about chronic itch and certainly never considered how disabling it can be. As a patient, there …