Pain Recovery. Robert Hunter

1 Chronic Pain: An Overview

       Pain is an intriguing phenomenon, the source of consternation, irritation, and suffering for millions since the beginning of time. It alerts us that something is wrong—that there is damage or threat of damage to our tissues. Pain is usually produced at the site of an injury and is processed in our complex, computer-like nervous system, causing a vast array of physical and emotional responses. The simplest response is to withdraw from the source of pain and then to protect the area that hurts.

       Pain occurs in the body as a result of the interaction of nerve cells, the spinal cord, and the brain (together known as the nervous system). Interactions of a multitude of chemicals, including endorphins, prostaglandins, and neurotransmitters, with electrical impulses coming from the nerve cells create the pain experience, and also pain relief. The brain is exquisitely complex. The part of the brain that processes pain impulses, mainly the thalamus, interacts with other areas of the brain that govern memory, emotions, alertness, movement, blood pressure, hormone levels, and hundreds of other functions. The net effect, in a split second—a composite result of many inputs and outputs—is the experience of pain. Needless to say, this system is efficient beyond that of the most sophisticated computer; however, in the case of chronic pain, the system has gone awry.

       Acute and Chronic Pain

      There are two types of pain, acute and chronic. In acute pain, the computer functions properly, as it was meant to. With chronic pain, on the other hand, it is as if the computer has been affected by a nasty virus, turning previously healthy and needed mechanisms into overactive and inefficient impulses that disrupt normal function.

      Acute pain is time-limited—usually gone within a few hours to days. It may last weeks to a few months, but it eventually goes away. Acute pain can be associated with fractured bones, sore teeth, bruises, cuts, surgeries and their aftermath, infections, and a variety of other injuries and conditions. It exists when there has been damage, and as the damage heals, the pain subsides and eventually resolves, and life returns to the way it was before. Acute pain is part of your body’s “response-to-injury” system, which causes you to try to put an end to the offending, pain-causing experience. You also learn from painful experiences and are less likely to do something that causes pain (although later as we explain addiction, you will that this is not true in all cases).

      Chronic pain continues beyond three to six months and has outlived any useful function. It should have gone away, but persists. It is the exaggerated response of the nervous system to damage, but also to other conditions and situations that occur in the brain. It is often pain out of proportion to the prior injury or damage. Sometimes a condition will develop for no apparent reason, and there is not even a clear physical basis for the protracted pain. This is not to say that the pain is in any way unreal or imagined. Some people’s bodies simply respond differently over time to certain conditions, damage, or injury. The result is pain that won’t quit.

       Chronic pain is pain that continues beyond three to six months, has outlived any useful function, and may or may not have a clear physical basis.

      That’s the worst news about chronic pain—though it may wax and wane, in most cases it doesn’t go away. Twenty-five percent of the US population is affected by chronic pain, according to estimates from the National Center for Health Statistics. It is one of the major reasons people go to doctors. As we age, there is a greater chance we will hurt as a result of damaging events, wear-and-tear, and deteriorating conditions.

      { exercise 1.1 }

       Types of Chronic Pain ________________________

      Here is just a partial list of the many potential causes of chronic pain. Find the cause(s) of your pain and check it/them off or write them in the space provided if the causes are not listed.

      ____ Back, neck, and joint pain, which can result from tension, muscle injury, nerve damage, disc disease, or arthritis.

      ____ Burn pain, which can continue long after a burn wound has healed.

      ____ Chronic pelvic pain, which refers to any pain in your pelvic region (the area between your belly button and your hips) from tumors, infections, or scar tissue.

      ____ Cancer pain, which can result from the growth of a tumor with pressure on nerves, from treatment of the disease (chemotherapy or radiation treatments), or from other effects on the body.

      ____ Infections that didn’t respond to treatment, which can occur almost anywhere in the body.

      ____ Chronic abdominal pain (with or without physical explanation or findings), ulcers, gallbladder disease, pancreatitis, or gastroesophageal reflux disease (GERD).

      ____ Inflammatory bowel disease, irritable bowel syndrome, or other intestinal problems.

      ____ Bursitis, which can affect any joint, most commonly knees, shoulders, hips, elbows, or wrists.

      ____ Head and facial pain, which can be caused by dental problems, temporomandibular joint (TMJ) disorders, trigeminal neuralgia, or conditions affecting the nerves in the face.

      ____ Chronic headaches, such as migraines, cluster headaches, and tension headaches.

      ____ Multiple sclerosis, which can include numbness, aching, or pain.

      ____ Angina or chest pain from heart disease.

      ____ Uterine fibroid tumors (growths in the womb that can be associated with bleeding).

      ____ Chronic obstructive pulmonary disease (COPD) or emphysema.

      ____ Peripheral vascular disease (inadequate blood circulation to arms and legs).

      ____ Ankylosing spondylitis (severe arthritis with restriction of spinal movement) .

      ____ Myofascial pain syndromes (heightened experience of pain coming from the brain, which impacts soft tissue and muscles). This includes fibromyalgia, which is characterized by tenderness in multiple trigger points, widespread muscle pain, fatigue, and stiffness.

      ____ Whiplash that doesn’t go away after an accident.

      ____ Broken bones that healed incompletely or in the wrong position.

      ____ Arthritis (rheumatoid, osteo-, or other forms), which can affect any joint, including hips, knees, neck, back, fingers, wrists, and feet.

      ____ Neuropathy from a variety of conditions, including HIV/AIDS, injury, and cancer.

      ____ Other: _____________________ ____________________________ ____________________________ ____________________________

      ALL PAIN IS REAL