Chronic Pain: A Disease in its Own Right

[UglyGreed]

Melanie Thernstrom has written a superb book based on a historical, philosophical, and scientific review of pain: The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering. Herself a victim of chronic pain, she brings a personal perspective to the subject and also includes informative vignettes of doctors and patients she encountered at the many pain clinics she visited in her investigations. She shows that medical treatment of pain is suboptimal because most doctors have not yet incorporated recent scientific discoveries into their thinking, discoveries indicating that chronic pain is a disease in its own right, a state of pathological pain sensitivity.

Chronic pain often outlives its original causes, worsens over time, and takes on a puzzling life of its own… there is increasing evidence that over time, untreated pain eventually rewrites the central nervous system, causing pathological changes to the brain and spinal cord, and that these in turn cause greater pain. Even more disturbingly, recent evidence suggests that prolonged pain actually damages parts of the brain, including those involved in cognition.

Sometimes the original problem creates new ones as the patient distorts posture and avoids exercise in an attempt to reduce the pain. In chronic pain, the protective mechanism of avoidance becomes maladaptive. Muscles atrophy from disuse and new sources of pain develop. Jerome Groopman, MD, in The Anatomy of Hope, told how he conquered years of chronic back pain by realizing that his pain was not a warning to avoid further damage but a false message that he could refuse to listen to; with exercise and physical therapy he rebuilt his muscles and became pain-free.

Dr. John Sarno believes that chronic musculoskeletal pain is a manifestation of “tension myositis syndrome” due to repressed negative emotions. He recommends renouncing all treatments, accepting that pain is only in the mind, and resuming normal activities. I don’t accept his psychosomatic premise, but there is a grain of truth in his method. If patients can re-frame their thinking and resume normal activities despite the pain, they are more likely to improve than if they maintain the self-image of a sick, disabled victim.


https://www.sciencebasedmedicine.org/chronic-pain-a-disease-in-its-own-right/

[shraby]

1. He should try to tell that to someone with thalamic pain due to a stroke.

Google it. It's a horrid pain that never quits, never lets up.

[UglyGreed]

2. That is the problem

people that don't go through the pain will never understand and we are at the mercy of these people and society it's self.

[UglyGreed]

3. For those who are interested

Dejerine–Roussy syndrome or thalamic pain syndrome is a condition developed after a thalamic stroke, a stroke causing damage to the thalamus.[1][2] Ischemic strokes and hemorrhagic strokes can cause lesioning in the thalamus. The lesions, usually present in one hemisphere of the brain, most often cause an initial lack of sensation and tingling in the opposite side of the body. Weeks to months later, numbness can develop into severe and chronic pain that is not proportional to an environmental stimulus, called dysaesthesia or allodynia.[1] As initial stroke symptoms, numbness and tingling, dissipate, an imbalance in sensation causes these later syndromes, characterizing Dejerine–Roussy syndrome. Although some treatments exist, they are often expensive, chemically based, invasive, and only treat patients for some time before they need more treatment, called "refractory treatment."[2]

http://en.wikipedia.org/wiki/Dejerine%E2%80%93Roussy_syndrome

[dixiegrrrrl]

5. TY so much for that info.

bookmarking for ( hopefully not) future reference.

[UglyGreed]

7. You are welcome

thank you for the reply and the rec

[shraby]

8. My son has it and he said it feels like most of his body has no skin.

[UglyGreed]

9. I am so sorry to hear that

I can only imagine the pain. All I can say is that I hope he is receiving adequate care.

[shraby]

17. He is, but still is in bad pain but it's manageable.

[cali]

4. I have a specific condition. one of it's symptoms is chronic pain.

[UglyGreed]

6. Yes I remember

I believe it is this one. Correct me if I am wrong.

http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome

Complex regional pain syndrome (CRPS) formerly reflex sympathetic dystrophy (RSD), "causalgia", or reflex neurovascular dystrophy (RND) is an amplified musculoskeletal pain syndrome (AMPS). It is a chronic systemic disease characterized by severe pain, swelling, and changes in the skin. CRPS often worsens over time. It may initially affect an arm or leg and spread throughout the body; 35% of people report symptoms throughout their whole body.[1] Other potential effects include: systemic autonomic dysregulation; neurogenic edema; musculoskeletal, endocrine, or dermatological manifestations; and changes in urological or gastrointestinal function.[2]

CRPS is associated with dysregulation of the central nervous system[3] and autonomic nervous system resulting in multiple functional loss, impairment, and disability. The International Association for the Study of Pain has proposed dividing CRPS into two types based on the presence of nerve lesion following the injury.

Type I, formerly known as reflex sympathetic dystrophy, Sudeck's atrophy, reflex neurovascular dystrophy (RND), or algoneurodystrophy, does not exhibit demonstrable nerve lesions. As the vast majority of patients diagnosed with CRPS have this type, it is most commonly referred to in medical literature as Type I.
Type II, formerly known as causalgia, has evidence of obvious nerve damage. Type II CRPS tends to feature the more painful and difficult-to-control symptomes of CRPS; The Type II disease scores 47 out of 50 on the McGill pain scale[4] (however there is seemingly little or no data pertaining to Type I specifically here). In Type II the "cause" of the syndrome is a known or obvious nerve injury, although the cause of the mechanisms of CRPS Type II are as unknown as the mechanisms of Type I.
The cause of CRPS is unknown. Precipitating factors include injury and surgery, although there are documented cases where no injury had occurred at the original site.[citation needed] CRPS is not caused by psychological factors, yet the constant pain and reduced quality of life has been known to cause psychological problems (such as increased depression and anxiety).[5] Evidence suggests that CRPS has both physical and psychological factors. Although "research does not reveal support for specific personality or psychopathology predictors of the condition," CRPS is associated with psychosocial effects, including impaired social and occupational function. In addition, the poor quality of life, for some, has led to high rates of depression and suicide, which has motivated appeals for greater understanding.

Treatment is complicated, involving drugs, physical therapy, psychological treatments, and neuromodulation and is usually unsatisfactory, especially if begun late.[6]

[closeupready]

10. Like many, I have found as I've aged that my knees

are starting to give me pain, stiffness and swelling. The best remedy for it has been exercise and vigorous jogging. As my lower body muscle mass strengthens, my circulation has improved and the swelling has subsided, as has the stiffness.

[UglyGreed]

11. The problem I come across is that more

exercise at this point in time just causes more pain which takes longer to recover from. Twenty five years of deterioration has taken a great toll on my neck and lower lumbar regions in my spine which in turn affects my whole body. Also at weakened state the Hydrocephalus which popped up when my neck decided to give out has just made things worse.

[closeupready]

13. Wow, sorry to hear that. Obviously, our bodies do

eventually wear out, but in exercising, I try to do low impact activities (as opposed to high impact ones, like running), so as to minimize the wear and tear while getting the benefits from strengthening my body.

What about doing more things like biking or swimming? Or doesn't it matter what kinds of exercise you do?

[UglyGreed]

15. I have tried many times these last few

years but it has not been helpful. I understand what you are saying because in the past I always tried to stay active and felt the difference when I could not do so. That saying use it or lose it is spot on.

[Ghost in the Machine]

12. As a chronic pain sufferer I call BS on that last paragraph. MY chronic pain is from injurie to my

neck and back in a construction accident, which resulted in syringomyelia ( http://en.wikipedia.org/wiki/Syringomyelia ). Mine is in the "Acquired" category due to trauma. I also have severe nerve damage from 2 major neck surgeries for it.

This past March, I re-injured my back in a slip and almost fall that has kept me pretty much down since. The first few days, I thought I had just pulled a muscle, but the pain kept getting worse, so bad to the point that I was passing out from the pain. I went to an orthopedic doctor. He took an x-ray and said "well, you didn't break anything" and put me on Prednisone for 12 days. That didn't help a bit. I ended up calling my Neurosurgeon to schedule an MRI, then, as per orders from the ER, I went back to a pain clinic. I had been in pain management for close to 5 years, but had dropped out back in Sept. because I was on the highest doses of opioids they could give me, and I had built up a tolerance to them to where they were hardly working any more. This new pain clinic put me in physical therapy. I went to physical therapy and it made the pain 10 times worse. The physical therapist called my Neurosurgeon, and he told them to stop therapy for now until we get a scan of my lumbar spine. I'm going for that in a couple of weeks..

I have tried exercise in the past and it only makes me worse. I can't sit, stand or walk for long periods of time without having to lay down for a while, and driving is pure hell on my back and neck.

The problem with a lot of us chronic pain sufferers is that we look perfectly healthy and fine. People can't *see* our disability. You can't see mine unless I pull up my hair and show you the scar down my neck and tell you how they cut me open, took out my vertebrae, shaved the insides of them so my spinal cord wasn't pressing against them anymore from being so swollen, then put it all back together... with no rods, pins, screws, etc., hoping that my neck muscles were strong enough to hold it all together.

Oh... and I still have tethered cord syndrome at the C-4 level...

Peace,

Ghost

[UglyGreed]

14. Seems like we suffer

from same type of problems. Plates, screws and pieces of vertebrates surgical removed are not seen from the outside.

[Ghost in the Machine]

16. It sucks, but I still try to get the best out of life. It took me a couple of years to accept the

fact that I could never work again. I went through a phase of situational depression, but finally got over it once I accepted it. I was a workaholic and lived to work. As a single father, I used to tell people that my REASON for living was my kids, and my PURPOSE in life was to work and make money. My therapist told me that I was just going to have to find a different 'purpose' then, so I decided that it would be to see how many people that I could make laugh, smile or otherwise feel good about themselves, or life, every day. 10 years later and I'm still doing that

Here's wishing you as many pain-free days as possible. We used to have a group of us here who we referred to as our "Brother or Sister in pain", but many have left us now. Take care, my Brother in pain...

Peace,

Ghost

[GusBob]

18. I'm down with the last paragraph

I live with my chronic pain, my constant friend. I call it my pet monkey. It reminds me I am still alive.