Chronic Pain

Is Pain Useful?

Yes.  The ability to experience pain is critical for survival. Without pain, we might seriously hurt ourselves yet not knowing it. Or we might not realize that we have a medical problem that needs treatment. So pain is our danger signal that calls for our attention. That being the case, what do we make out of it when we take “pain killers” to cut off this signal? Is that the right thing to do?

However, chronic pain serves no biological purpose. It tends to go on and on and it is no longer a pain that brings any good for us. In fact, it becomes a serious problem to those who suffer from it.

Feeling of Pain

Pain may be sharp or dull. It may come and go, or it may remain constant. We may feel pain in one area of our body, or we may feel pain all over the body. The Chinese is elaborate when describing pain. They say pain can be: aching pain, distending pain, dull pain, empty pain, cold pain, gripping pain, heavy pain, pulling pain, scorching pain, scurrying pain, and  stabbing pain.

Chronic pain may be due to an ongoing cause, such as cancer or arthritis. Sometimes the cause is unknown with no apparent cause.

Process of Pain

Pain is a feeling triggered in the nervous system. There are four basic steps involved:

1. Transduction – when a certain “noxious stimulus” in a particular part of the body causes the release of chemicals that essentially turn on nerve cells.

2. Transmission – the pain signal is sent to the brain through a number of relay stations in which the signal jumps between the nerve cells in the spinal cord and finally reach the thalamus in the brain.

3. Perception – the brain registers and interprets the pain.

4. Modulation – the brain acts to change the body’s response to pain.

Incidence of Pain

 In the US, pain affects more Americans than diabetes, heart disease and cancer combined (1).

Condition

Number of sufferers

Chronic Pain 116 million people
Diabetes 25.8 million people
Coronary Heart Disease (heart attack and chest pain) 16.3 million people
Stroke 7.0 million people
Cancer 11.7 million people

The most commonly-reported pain conditions are lower back pain (27%), followed by severe headache or migraine pain (15%), neck pain (15%) and facial ache or pain (4%). 

An article in the Wall Street Journal of 11 May 2010 said, “Some 76.5 million Americans, or about 26% of all adults, suffer from chronic pain, generally defined as any pain that lasts more than six months … the conditions can be as debilitating as many severe diseases, leaving the patient exhausted and unable to carry on with many everyday activities. Unless you live with chronic pain, you can’t imagine how it feels.

Without adequate treatment, this pain and suffering can be expected to continue throughout life (2).

According to the Norwegian Institute of Public Health, chronic pain affects about 30 per cent of the adult Norwegian population. The most common chronic pain conditions  are back and neck pain and pain of unknown origin. Other chronic pain conditions include headaches, pains from injuries and surgery, pain associated with cardiovascular disease and with neurological disorders (3).

Prevalence of pain increases with age, and women are more susceptible than men.

Treatment of Chronic Pain

Treating chronic pain be challenging. Often the reason for the pain is not clear. And it may take several types or combinations of treatments before relief is found (4).

Dr. Edward Pullen wrote, “Treatment of chronic pain is the scenario that puts me and every practicing primary care physician in a no-win situation regularly (5).

Science Daily of 5 June 2008 (6) reported that while various approaches and combinations of therapies to treat pain have advantages and disadvantages, researchers don’t yet know how to determine which is best for individual patients. Among the approaches to pain management studied were those relying on the prescription of opioids (drugs such as morphine), surgery, and alternative medicine (acupuncture, herbal remedies). Matthew J. Bair, assistant professor of medicine at the Indiana University School of Medicine said, “We have found that there are huge gaps in our knowledge base. For example, none of the opioid research trials lasted longer than four months, a small fraction of the time during which many chronic sufferers typically experience pain and are prescribed this potent class of medication”. Many physicians have not been well trained in pain management.

Dennis C. Turk, MD, and colleagues from the University of Washington in Seattle said, “Treatment of chronic pain today remains strikingly inadequate …for all the treatment modalities surveyed, only about half of treated patients had a response — and the reduction in pain was only about 30%” (7).

In Norway the most common method of managing chronic pain is to use painkillers or analgesic drugs. Both opioids (morphine-like) and paracetamol /acetaminophen (Panadol-like) and NSAIDs (non-steroidal anti-inflammatory drugs) are used. In 2010, around 1 million people are prescribed these drugs (3).

Many analgesics are effective for a short time period only. And they carry a risk of habituation and dependency with prolonged use. Some painkillers can cause side effects when used over time. NSAIDs can cause bleeding / stomach ulcers and medication-induced headache (3).

Multidisciplinary Pain Management

Straightforward “single mode” pain treatment usually results in short-term relief at best (8).

Multidisciplinary Pain Management is the gold standard when it comes to helping people with chronic pain recover their lives (9). Chronic pains management should take into consideration a broad range of physical, social, psychological, and behavioral issues. Medications, acupuncture, local electrical stimulation, brain stimulation, surgery, psychotherapy, relaxation, biofeedback, and behavior modification may need to be employed to treat chronic pain.

References

  1. http://www.painmed.org/patient/facts.html#top)
  2. http://online.wsj.com/article/SB10001424052748704879704575236373207643604.html
  3. http://www.fhi.no/eway/default.aspx?pid=238&trg=Area_5954&MainArea_5811=5895:0:15,4671:1:0:0:::0:0&MainLeft_5895=5954:0:15,4671:1:0:0:::0:0&Area_5954=5825:88781::1:5955:1:::0:0)
  4.  http://www.webmd.com/pain-management/tc/chronic-pain-treatment-overview
  5. http://www.kevinmd.com/blog/2011/04/treatment-chronic-pain-puts-doctors-win-situation.html
  6. http://www.sciencedaily.com/releases/2008/06/080605115703.htm
  7. http://www.medpagetoday.com/PainManagement/PainManagement/27248
  8. http://www.iow.nhs.uk/index.asp?record=690
  9. http://www.painrecoveryonline.com/page27.html

 

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