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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Pains and Their Medical Names


Brachial plexus can manifest as shoulder pain, numbness of the shoulder, arm, or hand, tingling, burning, pain, abnormal sensations, with the location varying with the part of the plexus injured. This problem also causes weakness or decreased muscle strength of the arm, hand, or wrist so that a patient is unable to extend or lift the wrist. If caused by a lung tumor compressing the plexus, there may be associated Horner’s syndrome (eye drooping and decreased sweating in the face and small pupil).

Brachial neuralgia is a painful nerve disorder where pain radiates to the arm.
This pain may be constant, sharp, stabbing, burning, shooting, radiating, annoying, debilitating and sometimes it comes and goes just like flashes.

Carpal Tunnel Syndrome manifests as numbness, tingling and burning in the hand and fingers. Sometimes there is pain in the forearm and as far as the shoulder and neck. Usually patients only suffer pain in the thumb, index and middle fingers, and the side of ring finger nearest the thumb. Carpal tunnel syndrome tends to be worse at night or first thing in the morning. Shaking the hand can relieve the sensation. In the morning it can feel better after using the hand for a while, but symptoms often come back during the day. Initially the symptoms may be mild or only occur from time to time, but if it gets worse they may become continuous. The hand muscles may become weakened, making it difficult to grip objects or perform other manual tasks. In severe, long-lasting cases the thumb muscles may start to waste away or the median nerve may be permanently damaged.

Causalgia is a rare pain syndrome related to partial peripheral nerve injuries. The peripheral nervous system encompasses nerves that extend from the central nervous system of the brain and spinal cord to serve limbs and organs. Causalgia is usually caused by brachial plexus injuries, involving nerves that run from the neck to the arm.
Severe cases are called major causalgia. Minor causalgia describes less severe forms, similar to reflex sympathetic dystrophy (RSD). RSD includes muscular and joint pain symptoms, and changes in bone density.

Symptoms usually involve burning pain prominent in the hand or foot. Almost any sensory stimulation worsens the pain. Vascular changes include either increased or decreased blood flood due to dilation or constriction of blood vessels. Other symptoms include dry, scaly skin; still joints; tapering fingers; ridged nails; long, coarse hair or hair loss; and changes in sweating.

Complex regional pain syndrome (CRPS) is a chronic pain condition.  The key symptom of CRPS is continuous, intense pain which gets worse over time. CRPS most often affects one of the arms, legs, hands, or feet.  Often the pain spreads to include the entire arm or leg.  Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating and swelling.

Cubital Tunnel Syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow. There is a bump of bone on the inner portion of the elbow under which the ulnar nerve passes. This site is commonly called the “funny bone”.  At this site, the ulnar nerve lies directly next to the bone and is susceptible to pressure. When the pressure on the nerve becomes great enough to disturb the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers.

Neuralgia is caused by motor nerve damage. It manifests as pain or muscle weakness, increased sensitivity of the skin or numbness of the affected skin area.  The pain can occur along the path of a specific nerve or anywhere, usually on or near the surface of the body. It can be sharp, stabbing pain that comes and goes (intermittent) or constant, burning pain. Sometimes any touch or pressure is felt as pain. Movement may also be painful.

Parsonage-Turner syndrome (PTS) is a rare syndrome of unknown cause, affecting mainly the lower motor neurons of the brachial plexus, a group of nerves that conduct signals from the spine to the shoulder, arm, and hand. PTS is usually characterized by the sudden onset of severe one-sided shoulder pain, followed by paralysis of the shoulder and lack of muscle control in the arm, wrist, or hand several days later. Local pain around the shoulder girdle is the prevalent symptom of Parsonage-Turner syndrome. It is usually sudden and often severe, often awakening persons during the night. The pain worsens progressively for up to two days. The pain is commonly distributed across the back of the shoulder blade and the tip of the shoulder. Pain often radiates down the outer side of the arm and up along the neck, and seldom spreads down as far as the outer side of the forearm, below the elbow.

Pelvic adhesions refer to scarring or tissue repair that occurs anywhere in the pelvis.
In a normal healthy pelvis (or the whole abdominal cavity is lined with a tissue called peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In an non-injured or irritated state, the peritoneum can be likened to slippery cellophane wrap. The organs and structures lying immediately adjacent to each other just slip off each other and do not become bonded together. Given a tissue injury, the healing process initiates a sequence of events that can result in a certain tissue becoming “stuck” to its neighbor, and when this happens certain undesirable results occur. This sticking together is a result of the healing process after any surgery, trauma, infection, or inflammation. Women are subject to numerous pelvic infections, inflammations or traumas, also resulting in pelvic adhesions.

Whatever the cause, pelvic adhesions remain in the body for life, after a healing event. They can bind the delicate reproductive, digestive, or urogenital organs like glue or a straight-jacket, decreasing their function or causing pain.

Trigeminal neuralgia causes facial pain. It develops in mid to late life most frequently affects women older than 50 years. The disease occurs rarely in those younger than 30 years. The condition is the most frequently occurring of all the nerve pain disorders. The pain, which comes and goes, feels like bursts of sharp, stabbing, electric-shocks. This pain can last from a few seconds to a few minutes. The pain comes from one or more branches of the trigeminal nerve-the major carrier of sensory information from the face to the brain.
There are three branches of the trigeminal nerve: the ophthalmic, maxillary, and mandibular. The pain of trigeminal neuralgia occurs almost exclusively in the maxillary and mandibular divisions. The maxillary nerve runs along the cheekbone, most of the nose, upper lip, and upper teeth. The mandibular nerve affects the lower cheek, lower lip, and jaw. In almost all cases (97%), pain will be restricted to one side of your face.