About Pain

Accidentally cutting yourself with a knife, slamming your hand in a car door, falling on your knee, all of these encounters can potentially cause harm to your body. In response, nociceptors (pain receptors) send a message to your brain via your spinal cord to warn you that you are in danger, so you can react protectively. This is the most common and therefore the most familiar kind of pain we experience. It is called nociceptive pain.

The sensations caused by nociceptive pain are familiar to us: they are usually sharp, dull, gnawing or aching. It is the kind of pain that accompanies surgery, infections, bone fractures, muscle injuries and many types of cancer pain. It can last for a short time (acute pain) or for long time (chronic pain). If a person has acute pain, when the injury resolves, so does the pain, in most cases. If a chronic disease process is responsible for the pain, for example, arthritis, the pain may not resolve. Chronic pain needs to be managed over time.

Neuropathic pain, unlike nociceptive pain, results from a disturbance in a nerve or in the nervous system. It can be caused by injury or disease. Unlike nociceptive pain, in which there is actual tissue damage, neuropathic pain persists without actual on-going tissue damage. A pain signal is sent from the nerve to the spinal cord and brain but is not a broken bone, an infection, cancer or arthritis to explain why the pain is there.

Examples of neuropathic pain include peripheral neuropathy (which can result from diabetes), complex regional pain syndrome (RSD), trigeminal neuralgia, post-herpetic neuralgia and phantom limb pain. In a sense, the pain itself is the “disease”. The pain sensations generated by neuropathic pain are usually described as burning, electrical, tingling or shooting.

Some pain conditions do not seem to have a cause; we call this kind of pain idiopathic pain. Idiopathic simply means that we do not know the cause of the pain, even though we believe the patient is experiencing it.

Pain cannot be measured by any external device; it is highly subjective as no can know how much pain another person is in. Our experience of pain is influenced and effected by many things, including our past experience with pain, genetics, coping mechanisms, what pain means to us, how anxious or depressed we are and what kind of social or emotional support we have available to us. Pain can and should be treated.

Treating Chronic Pain

Unrelieved pain can cause depression, which can result in:

• loss of appetite and sleep

• withdrawal from usual enjoyable and productive activities

• feelings of hopelessness

Pain can be treated, often quite quickly, with a number of different approaches. The first step is finding a doctor with whom you can work to manage your pain. Because each person is unique, you will need an individualized pain program. Your pain doctor will explain treatment options to you:

• Medications such as over the counter remedies, NSAIDs, opioids, anti-depressants, anti-convulsants, steroids, local anesthetics, topical agents and many others.

• Mind-Body approaches which include guided imagery, relaxation exercises, biofeedback, learned optimism.

• Physical rehabilitation such as occupational therapy, physical therapy, ultrasound, electrical stimulation and other maneuvers.

• Interventional Pain management techniques which include various injections like nerve blocks and epidural steroid injections; spinal cord stimulation; and drug infusions.

• Behavioral therapies to help you take the emphasis off your pain and on to the positive aspects of your life.

About addiction

If a patient does not have a history of substance abuse, their risk of developing an addiction to pain medication is very low. Some people are afraid to seek help because of this fear. Don’t let any fear stop you from seeking treatment. With the help of a pain management doctor, you will become informed about all the options available to you, what the risks and benefits are and what you can do to help yourself.

Get help

While information about medical problems can be helpful, resist spending hours at your computer researching your condition.

Untreated, chronic pain can truly be disabling. It limits both your social and physical activities, makes you feel older than you are and takes the joy out of life. Fortunately, chronic pain can be managed and the best outcomes occur when you take an active role in your care.

Get some help. Find a pain management doctor to work with you to help you manage your pain and get back into your life.

What research is being done to help chronic pain patients?

Clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of natural pain-killing molecules in their spinal fluid.

• Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture), which some researchers have found to activate the natural pain killing systems in the body.

• Other experiments with acupuncture have shown that there are higher levels of the natural pain killing molecules patients’ cerebrospinal fluid following acupuncture.

• Investigators are studying the effect of stress on the experience of chronic pain.

• Chemists are creating new analgesic (pain-killing) medications and discovering pain-killing virtues in drugs not normally prescribed for pain.