Chronic Pain Management

The Epidemic of Chronic Pain

Chronic pain is becoming a HUGE problem in our society.  About 11% of Americans (25.3 million people) at any one time have experienced daily pain for 3 months or longer.  Furthermore, there has been a 4-fold increase in the amount of opiods sold from 1999 to 2015 resulting in a public health epidemic of nearly 500,000 opiod-related deaths without a decrease in the number of people experiencing chronic pain.  Fibromyaliga is one type of chronic pain characterized by widespread pain and tenderness to touch.  Fibromyalgia has its own specific characteristics such as poor sleep and fatigue, but the treatment is similar to that of other types of chronic pain.  The first step in chronic pain management is understanding about pain in general, the differences between acute and chronic pain, and what can be done to prevent pain from progressing to chronicity or to minimize its impact if it has already become chronic.

The biopsychosocial model of pain

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”  Note the sensory (the signals our body sends to our brain) and emotional (how our brain interprets those signals) components of the pain are both always present.  Our current  understanding of pain is that pain is associated with threat.  It is protective for our survival.  When the brain has more credible evidence of danger than of safety, it produces an unpleasant response (pain) that calls us to take action in order to get out of danger, which we understand as pain.  So in summary: danger = pain, safety = no pain.  Seems pretty simple…right?

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The difficult part though is that there are many different things that can give us evidence of danger or safety. The sensory messages we get from or our body are one part, but things like amount and quality of sleep, thoughts and feelings (i.e. stress, anxiety, depression, anger, fear), activity level, diet, culture, values, and past experiences also play a role.  Our brain’s job is to process all of this evidence and come up with a response that is the most beneficial to our well-being.  Most of the time this process works pretty well and produces appropriate responses.  However, sometimes the system malfunctions and pain lasts longer than it should, even after tissues have completed their healing process.  Keep reading to learn the difference between acute pain and chronic pain.
 

Acute Pain

Acute pain is mostly driven by the sensory signals that come from our body.  Imagine for example, if you twisted your ankle.  Your brain would send an immediate response to your ankle telling it to get out of that position.  You may have some residual signals coming from the tissues due to inflammation, and your brain may tell you to avoid putting weight on the ankle or wear an ankle brace for a few days.  The key is that your tissues are sending signals to your brain, your brain is receiving them in proportion to what they should be, and your brain is making appropriate decisions based on that information.  This type of pain is adaptive, or beneficial to our well-being.

Chronic or Persistent Pain

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Chronic or persistent pain is pain that lasts longer than the normal expected recovery time.  Unlike acute pain, the signal from the tissues is a much smaller (but still important) part of the pain experience.  Your tissues send signals along your nerves to the spinal cord which acts as a relay center to the brain.  Based on how much danger the brain perceives though, it can “turn up” or “turn down” how much information is allowed to pass through the spinal cord to the brain.  If something seems important, the brain will want a lot more information whereas if something is not important (i.e. the feeling of clothes on our body), the brain will not want as much information about it.  Thus, if there is more credible evidence of danger than safety the spinal cord will magnify how much signal is allowed to pass from the tissues to the brain.  The brain receives the out-of-proportion signals and makes appropriate decisions based on incorrect information.
One worry that patients who live with chronic pain have is that other people may think they are crazy or think “its all in your head”.  Notice though that your brain is making good decisions based on the information it receives…it just so happens that that information does not accurately reflect the reality of what is going on at the tissue level. This type of pain is maladaptive, meaning it is of no benefit to us.  The protective responses that our brain produces may tell us not to do things such as being physically active, returning to work, or doing normal household chores for fear that doing so will cause further harm.  In reality though, doing these things has been shown to result in better improvements in pain and function than does resting.
Understanding how pain works is important in order to feel better!  First of all, just having a better understanding of what’s going on with your body, knowing that it’s common, and that you’re not crazy helps calm some of the fear and anxiety over your pain which actually changes the pain itself!  Secondly by understanding that ongoing pain is not reflective of tissue damage, you can resume your normal activities and gradually increase your physical activity level with the peace of mind of knowing that you will not cause further damage.  Since physical activity level and being able to fill our roles in society (i.e. parenting, housekeeping, returning to work or sports) affect the amount of perceived threat, this also helps decrease pain.  Finally, knowing that pain is a multi-factorial problem, it allows you to choose treatments that address all aspects of the pain.  Physical factors such as posture, body mechanics, and muscle strength are still important, but they only address the “bio” part of the “biopsychosocial” experience of pain.  The chronic pain experts at More 4 Life  can teach you strategies to improve sleep, manage stress, increase activity level, and modify the way that you do certain activities in order to allow you to perform them with less pain.

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