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Chronic Pain: Won’t it just go away?

Chronic Pain: Won’t it just go away?

Chronic pain is believed to affect 50 million Americans. Over time, chronic pain may cause a destructive physiologic response characterized by fatigue, mood disorders, brain hormone abnormalities, muscle pain, and other physical as well as mental impairments. Chronic pain may set off a vicious cycle of stress and disability that eventually raises a person’s sensitivity to pain. Uncontrolled, chronic pain can disrupt an individual’s family life, work life and income, it may lead to depression, isolation and anxiety. The key to breaking this damaging cycle is to treat chronic pain early and effectively.

Types of pain: Acute and chronic pain

In order to effectively treat chronic pain you must first distinguish it from acute pain. Acute pain is caused by tissue damage, and its source is usually obvious such as a burn or even possibly a bee sting. Although acute pain may be intense it usually is very short lived. Acute pain is usually repaired through the natural healing powers of the body and the pain eventually fades away. Sometimes individuals will take some type of pain killer for interpreting time until the body has a chance to repair the tissue damage.

In contrast to acute pain, chronic pain is persistent and the nervous system continues to transmit pain impulses for months or even years. Musculoskeletal injury and inflammation usually lie at the root of some forms of chronic pain. Other forms of chronic pain may include rheumatoid arthritis, cancer, or coronary artery disease. In many cases the original cause, such as a herniated disc or tumor may be successfully treated, yet the pain will remain and sometimes even get worse. This type of chronic pain, which is often out of proportion to the original injury, arises from nerve damage and is term neuropathic pain.

Neuropathic pain can occur whenever nerves have been damaged. Until recently, neuropathic pain has usually referred to specific pain syndromes such as postherpetic neuralgia, the intense pain that frequently follows shingles; tic douloureux (trigeminal neuralgia), a condition marked by searing jolts of facial pain; and diabetic peripheral neuropathy, a form of nerve damage that leads to numbness and pain in the hands, feet and legs. It is becoming increasingly clear that a larger array of conditions may fall under the category of neuropathic pain. Pain syndromes that are associated with amputations, spinal cord injury, migraines, multiple sclerosis, mastectomy, and Parkinson’s disease are now also believed to be examples of neuropathic pain. Also, doctors are now starting to believe that some forms of lower back pain may have a neuropathic component.

Regardless of the source of the chronic pain, it is believed that cortisol is triggered and other hormones that can have a significant effect on an individual’s immune system and mental health. Also, research has continued to identify some of the changes underlying chronic neuropathic pain. It is believed that our nervous systems are very flexible; the nerve circuits that transmit pain impulses can become “rewired” after nerve injury and consequently lead to persistent pain. If the pain remains untreated, these wiring changes can then become permanent, resulting in progressive as well as more severe and widespread chronic pain.

Some Information adapted from The Johns Hopkins Medical Guide to Health After 50

Additional Information and webpage by Paul Susic Ph.D. Licensed Psychologist

Chronic Pain: What are the treatments of choice?

Chronic pain treatment overview: 

Chronic pain treatment comes in many forms.  If the pain is of an inflammatory or musculoskeletal origin, it can often be treated successfully with analgesics such as nonsteroidal anti-inflammatory drugs (NSAID’s), or opiates, possibly in combination with physical therapy or corrective surgery.  Some specific chronic pain treatment regimens have been developed to relieve the pain of rheumatoid arthritis for example, an autoimmune inflammatory disorder, and severe osteoarthritis, a musculoskeletal disorder, which also results in some inflammation.  Neuropathic pain usually requires its own unique chronic pain treatment regimen. The following medications are primarily used to treat neuropathic pain:

Tricyclic antidepressants such as desipramine (Norpramin) and nortriptyline (Pamelor) can relieve neuropathic pain such as that caused by trigeminal neuralgia and postherpetic neuralgia.  These antidepressants have been found to be effective even in the absence of any depression.  It is believed that the neurotransmitters norepinephrine and serotonin may have an important role in the control of pain pathways in that the antidepressants evidently relieve pain by boosting the levels of both serotonin and norepinephrine.  Also, contemporary research indicates that antidepressants can also enhance the pain relieving effects of opiates which then allows lower dosages to be used. 

Antiseizure drugs are believed to reduce the pain signals which are discharged from injured sensory nerves in patients with neuropathic pain. Gabapentin (Neurontin) and lamotrigine (Lamictal) have proven effective in alleviating the pain associated with diabetic neuropathy, postherpetic neuralgia and trigeminal neuralgia. 

Opioids such as oxycodone (OxyContin), fentanyl (Duragesic), or morphine (MS Contin) are also frequently used for neuropathic pain, often in combination with antidepressants or antiseizure drugs. Opioids have significant side effects and may cause drowsiness, respiratory depression, nausea and constipation. When they are given in combination with antidepressants or antiseizure drugs, their dosage can be lowered and the potential side effects may be minimized. 

Many people are very aware of the potential for the abuse of opioid medications.  Despite the potential for abuse, drug addiction is relatively rare among patients receiving chronic pain treatment. It is believed that the addiction rate is less than 1% in people without a previous history of addiction.  This addiction potential is probably relatively limited in such chronic pain treatment patients; because the opiates provide relief from pain in a form that supplies a steady release of medication throughout the day and does not really produce the euphoric effect that addicted individuals prefer.

Some information from The Johns Hopkins Medical Guide to Health After 50 

Additional Information and webpage by Paul Susic Ph.D. Licensed Psychologist