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Why do I ache? Why can’t I sleep? Why am I depressed? Why
don’t I have any money? Why doesn’t anybody understand me? Why won’t my health care provider listen to
do I hurt so much?
Unfortunately, this is a question I hear nearly every day. The
answer to this question is chronic pain, and it tends to tamper with your
quality of life.
At the present time, there is no known cure for chronic pain.
No test to diagnose it. No pill to cure it. No procedure to fix it. No surgery
to remove it.
This blog is merely a commentary on chronic pain and for a better
understanding of your particular situation; you may need to have several
conversations with several healthcare providers.
The negative consequences of chronic pain are certainly
astounding, to say the least. HOWEVER—patient advocacy groups and patients
themselves have demanded better care. Better care starts with a better
understanding of the problem. And a better understanding begins with research.
Chronic pain often co-exists with other conditions. That is to say, that
fibromyalgia, painful bladder syndrome, chronic fatigue syndrome, chronic
pelvic pain, TMJ pain, irritable bowel syndrome, dysautonomia, depression and
anxiety: many of these problems go together! Although this is not good news, it
is an important finding, especially if the health care team is going to manage
patients effectively. First, let’s take a look at what we know about pain and
How did it start?
Both biology and environment are usually in the background
of the diagnosis of chronic pain.
One common factor in regards to all chronic pain syndromes
is that the central nervous system (brain and spinal cord) is altered in the
way it processes pain. So, the way that chronic pain is felt, is much different
than the way acute, or new pain, is felt. Acute pain is usually very intense,
localized to a certain area, and definable.
For example, a stabbing, sharp pain
in a certain spot tends to stay that way until it’s gone. It’s
also typically accompanied by swelling, redness, or heat; there is evidence of
actual damage to the body. Chronic pain is much different; there is no new tissue
damage and no observable sign that there is a problem in the body. Chronic pain
is generally achy and widespread, and hard to define. Pain is present, but
there is no new injury.
So, if the biology of the two types of pain is different,
there must be different ways to approach management.
In acute pain situations, because heat and swelling are in
the area of injury, ice and compression are very effective ways to combat those
problems. Medication is effective in blocking the pain from the spinal cord to
the brain, and the patient will perceive a reduction in pain, while the body
does its part in healing.
Chronic pain changes the way in which the brain PERCEIVES
information. What might normally be a little bump on the knee, now becomes a
painful experience lasting much longer than what would be considered normal. So
the body has lost sight of what a normal reaction to pain is. The phenomenon of
central sensitization becomes one of
the complex issues in chronic pain. Central sensitization is the altered
processing of incoming information by the nervous system. What was once normal
is no longer normal. It is as confusing as it sounds! Furthermore, things that
are normally effective for the tissue damage that occurs with acute injury, no
longer become relevant with chronic pain. Ice, compression, medications are not
helpful in the same way that they were before.
Environment also plays a role in chronic pain. And what
about environment? Consciously or unconsciously, our previous life experience
plays a powerful role on the situations we put ourselves into. We have amazing
bodies, and our bodies – every scar, every illness, every experience we have,
is ultimately a road map to HOW we might react to the events of each day. These things (previous injuries, surgeries,
illnesses) also impact how we CHOOSE to live.
This is a mind-boggling concept, but it is a very important one if you
are to fully understand the mechanics of chronic pain.
Having pain has an effect on how we think, feel, and
behave. These models of pain behavior are:
biologic (the process actually going on inside our cells), cognitive (thinking),
emotional (how we feel about it) and behavioral (how we act because of pain). Interventions
need to address all these components of pain including: proper medicines,
psychotherapy, exercise, relaxation techniques, and education. Furthermore, the
delivery of proper care in order to fully address the scope of the problem is
There is no cure for chronic pain, but education, lifestyle
changes that incorporate a healthy diet and activity levels, and proper
medications can help patients regain control over their lives and their pain.
The possibility of a fully engaged, enriching daily life, is certainly
attainable. It does take work, and a little discipline, but once you experience
freedom from the pain, the shackles will fall off for good.