Chronic Pain

Who Is At Risk For Chronic Pain

Factors that may increase the risk of chronic pain include:

Aging. Older adults are more likely to suffer from chronic conditions such as arthritis, diabetes, shingles, and other causes of nerve problems (neuropathy). However, chronic pain is not a normal part of growing older. Smoking. Nicotine use can increase pain and decrease the effectiveness of medicines.
Health problems. These include:
Existing health conditions, such as fibromyalgia, shingles, arthritis, depression or anxiety disorders, or having a limb amputated (phantom limb pain).
Past health problems, such as joint injuries. Also, previous surgery may cause new pain or may not work to relieve pain (such as back surgery that does not relieve pain).

Overall general health condition. You may have a weakened immune system, which can lead to frequent infections or illness.
Conditions that are difficult to treat, such as nerve pain from shingles (postherpetic neuralgia).
Lifestyle, such as not eating healthy foods, not exercising regularly, smoking, or having a substance abuse or alcohol dependency problem.

Other factors that may increase your risk for developing chronic pain include injury, stress, inactivity, relationship problems, or a history of physical, sexual, or emotional abuse. Daily activities that may contribute to chronic pain include repetitive motions at work or at home, such as lifting, or being in awkward positions for long periods of time.

Alternative Pain Therapies of Chronic Pain 

How the Mind Controls Pain

Science is beginning to investigate and support the role of therapies such as biofeedback and meditation in pain control. The idea that the mind has power over the body may be especially useful to chronic pain patients who often find themselves without satisfactory medical treatments.
The emotional response to pain
Pain travels along two pathways from a source, such as an injury, back to your brain. One is the sensory pathway, which transmits the physical sensation. The other is the emotional pathway, which goes from the injury to the amygdala and the anterior cingulate cortex—areas of the brain that process emotion.

“You may not be aware of it, but you’re having a negative emotional reaction to chronic pain as well as a physical reaction,” says Natalia Morone, MD, assistant professor of general internal medicine at the University of Pittsburgh School of Medicine. Mind-body treatments that involve meditation and relaxation probably affect these emotional pathways. However, Dr. Morone admits that many doctors don’t put much stock in this theory. “Anything to do with mind-body medicine around pain is going to be controversial. This is all very new.”

Research is beginning to show the connection
In a 2005 study, researchers at Stanford University in Palo Alto, Calif., used functional magnetic resonance imaging (fMRI), which measures activity in different areas of the brain, to see whether subjects could learn to control a brain region involved in pain and whether that could be a tool for altering their pain perception.

Laura Tibbitts, 34, an event planner from San Francisco who severely injured her arm, shoulder and back when she was thrown off of a horse, participated in the study.

In describing her pain, she says: “My muscles and nerves feel like a bunch of snakes that are all intertwined, but then I also get a stabbing and shooting pain. So you have that horrible, achy, uncomfortableness, but then you get these jolts of pain.”

In the study, Tibbitts was asked to increase her pain and as she did, an image of a flame on a computer monitor became stronger and more vibrant. Then she was told to decrease her pain, which caused the flame to die-down. “Sometimes I would imagine that the pain was literally being scooped out from me, taken away and carried off. Other times I used water imagery, like it was flowing through me and taking it away,” says Tibbitts. After the test, she learned that she had been able to produce a 30% to 40% reduction in her overall pain.

Giving control to pain patients

For Sean Mackey, MD, director of the pain management division at Stanford University School of Medicine and one of the study’s researchers, the research revealed a striking element of empowerment. “Patients would say, ‘A-ha! For the first time I could see the pain in my brain, and I could control it. And that was a very powerful experience,” he says.

Dr. Mackey believes pain medicine is moving away from the concept of strict mind-body separation toward a more unified—and ancient-sounding—view in which “mind and body are really one.”

The bottom line for pain patients is that they may want to pursue pain-control techniques such as biofeedback, yoga, and meditation. But they also need to be on the alert for scams and beware of claims made by therapists seeking to exploit their desperation. Before turning to one of these therapies, it’s best to thoroughly research the practitioner you choose.

What To Keep In Your Pain Diary

1. Your pain level.

Keep track of: where your pain falls on a scale of 0 to 10. If 0 is no pain at all and 10 is the worst pain you can imagine, decide where your pain falls. Mark down what number you hit during different parts of the day. This will help your doctor look for patterns that might help him or her better target your treatment. For instance, if your pain tends to spike in the evening and you take your medication in the morning, your medication may not be lasting long enough and you may need to take smaller doses more often. 2. What medication you took and its effect.

Keep track of: how much medication you are taking, when you take it, whether it provides you any relief, and if you experience any side effects. This information will give your doctor an understanding of the magnitude of your pain and help him or her decide whether you need to try a new medication or switch from over-the-counter drugs to prescription meds. Finally, your doctor can make sure that you are not combining medications that could have a bad interaction.
3. Other treatments you tried.

Keep track of: any non-drug therapies that you use to control the pain and whether they help.

Did your back feel better or worse after your yoga class? Were you headache-free on a day you visited the acupuncturist? Did taking five minutes at the end of your day to relax and release tension help you sleep with a little less pain? This kind of information will help you see what really lessens your pain and help your doctor get closer to the source of it.

4. Anything else that relieved pain or made it worse.

Keep track of: any big changes that seemed to impact your pain. Did driving for four hours to your in-laws cause your sciatica to flare? When you were in meetings all day and not at your desk, did your lower back feel better than normal? Did those two glasses of red wine precede one of your worst migraines ever? Noticing the small changes in your daily routine that have big impacts on your pain can help you make choices to keep the pain in check.

5. Moments you are grateful for.

Keep track of: pain-free moments too. Keeping a pain diary can help you and your doctor create a plan to reduce pain and make you more comfortable. But focusing too much on your pain can inadvertently worsen it. Try to set aside a specific time a few times a week, so that you don’t spend every day obsessing about it. And remember to mark down a few good moments to remind you to stay in touch with all the other parts of your life too.

 

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