You know it at once. It may be the fiery sensation of a burn moments after your finger touches the stove. Or it’s a dull ache above your brow after a day of stress and tension. Or you may recognize it as a sharp pierce in your back after you lift something heavy.
It is pain. In its most benign form, it warns us that something isn’t quite right, that we should take medicine or see a doctor. At its worst, however, pain robs us of our productivity, our well-being, and, for many of us suffering from extended illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those who appear to have identical injuries or illnesses.
The Two Faces of Pain: Acute and Chronic
What is pain? The International Association for the Study of Pain defines it as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.
Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.
Chronic pain is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can—and often does—cause severe problems for patients. A person may have two or more co-existing chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.
Chronic pain affects as many as one in 10 adults. It can be caused by a number of things, though the most common conditions associated with chronic pain are back injuries, headaches and joint pain. Chronic pain can also be caused by diseases or disorders such as fibromyalgia and nerve damage. Here are some of the most prevalent chronic pain conditions.
Back Pain
Back pain affects eight out of 10 people at some point in their lives. It can be caused by an injury, or it can develop with age. Back injuries are an epidemic in the workplace, and are one of the leading causes of disability.
Headaches
Headaches are one of the most common types of chronic pain. A headache is considered chronic if it happens for three months in a row, for at least 15 days out of each month.
Joint Pain
Joint pain is one of the leading types of chronic pain reported by Americans. Arthritis is the most common type of joint pain; however joint pain is not only felt by the elderly. Depending on its source, chronic joint pain can begin at any age.
Neuropathic Pain
Nerves that carry pain signals to the brain may be triggered by swelling, compression or damage. Nerves that are healing may also over-fire, causing sensations such as pain to be more intense.
Chronic neuropathic pain can also be present in disorders of the nervous system such as MS, spinal cord injury and stroke.
Other Diseases and Illnesses that Cause Chronic Pain
Fibromyalgia. Though the exact cause of fibromyalgia is unknown, its effects can be devastating. It causes widespread muscle fatigue and pain, and is often accompanied by chronic fatigue, sleep disorders and irritable bowel syndrome.
Cancer. Cancer pain can be caused by tumors or lacerations to tissues or nerves. Pain is also a common side effect of many cancer drugs, such as those used for chemotherapy and radiation.
Depression. While depression is commonly thought of as a psychiatric disorder, it is often accompanied by unrelenting pain. In fact, many drugs used to treat depression today are also effective at treating the physical symptoms of this disease
Tell someone you suffer from chronic pain, and they think they know exactly what you are going though. “Oh, I get headaches all the time.” In reality, chronic pain is very different from acute pain. Acute pain happens at the time of injury, and goes away when the injury heals. Chronic pain sticks around longer than it should, offering little to no relief.
Obviously, the main symptom of chronic pain is pain. The word “pain,” however, does not accurately describe the experience of people who live with it every day. Chronic pain is more than just a physical symptom: it may also cause depression, fatigue, and irritability. It can even interfere with work, relationships and activities of daily living.
Symptoms That Often Accompany Chronic Pain
People who suffer from chronic pain often experience other sensations associated with their illness. If you have chronic pain, in addition to the physical symptom of pain you may notice one or more of the following :
Depression or anxiety
Irritable Bowel Syndrome (IBS)
Decreased coordination
Confusion or difficulty concentrating
Insomnia
Flu-like aches and pains
Headaches
Nausea
Blurry vision
There is no way to tell how much pain a person has. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. Sometimes, as in the case of headaches, physicians find that the best aid to diagnosis is the patient’s own description of the type, duration, and location of pain. Defining pain as sharp or dull, constant or intermittent, burning or aching may give the best clues to the cause of pain. These descriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a patient with pain.
Physicians, however, do have a number of technologies they use to find the cause of pain. Primarily these include :
1. Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. Information from EMG can help physicians tell precisely which muscles or nerves are affected by weakness or pain. Thin needles are inserted in muscles and a physician can see or listen to electrical signals displayed on an EMG machine. With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle. The second set of electrodes is used to make a recording of the nerve’s electrical signals, and from this information the doctor can determine if there is nerve damage. EP tests also involve two sets of electrodes — one set for stimulating a nerve (these electrodes are attached to a limb) and another set on the scalp for recording the speed of nerve signal transmission to the brain.
2. Imaging, especially magnetic resonance imaging or MRI, provides physicians with pictures of the body’s structures and tissues. MRI uses magnetic fields and radio waves to differentiate between healthy and diseased tissue.
3. A neurological examination in which the physician tests movement, reflexes, sensation, balance, and coordination.
4. X-rays produce pictures of the body’s structures, such as bones and joints.
The goal of pain management is to improve function, enabling individuals to work, attend school, or participate in other day-to-day activities. Patients and their physicians have a number of options for the treatment of pain; some are more effective than others. Sometimes, relaxation and the use of imagery as a distraction provide relief. These methods can be powerful and effective, according to those who advocate their use. Whatever the treatment regime, it is important to remember that pain is treatable. The following treatments are among the most common.
The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. Acute pain usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.
The emergence of studies relating chronic pain to neuroplasticity also suggest the utilization of neurofeedback rehabilitation techniques to resolve maladaptive cortical changes and patterns. The proposed goal of neurofeedback intervention is to abolish maladaptive neuroplastic changes made as a result of chronic nociception, as measured by abnormal EEG, and thereby relieve the individual’s pain. However, this field of research lacks randomized control trials, and therefore requires further investigation.
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