FAQ Category: Pain

Pain and the mechanisms of pain are still a large mystery to experts. Even low intensity stimulation like a massage can be interpreted by the nervous system as painful instead of pleasurable.

If it seems okay at the time but causes painful symptoms later, then there may be some hyperexcitability on the part of the spinal cord. The nerves in the skin and muscles send messages to the brain via the spinal cord. If for some reason, the nervous system is over reacting, then normal, soothing touch can be interpreted as painful or noxious.

Studies of chronic whiplash patients show that this concept of nervous system hyperexcitability may very well explain some of their long-term symptoms. Even after the soft tissues in the neck are healed and there is no tissue damage observed, changes in the nervous system can persist.

Be sure and let your massage therapist know of this reaction. He may have some ways to influence or moderate the nervous system’s response to the treatment.

In today’s health care culture, evidence-based medicine (EBM) is a key byword. EBM refers to the idea that as much as possible, only treatments known to have a positive effect are used. Some treatments make a patient feel better but it’s only temporary. There aren’t any real lasting changes in motion or function.

In order to measure change in a patient’s status, certain tests must be performed each time. There are many such tests that can be used depending on the problem the patient is being treated for. This helps the doctor or therapist judge the status of the patient.

It also helps determine whether a meaningful change has taken place. For example, say you rate your pain as a six on a scale from zero to 10. After your first treatment, it goes down to a five. But you still can’t dress yourself or comb your hair without help. Your pain is improved but a meaningful change in your status hasn’t occurred yet.

If every patient who is treated this way gets slight pain relief but no functional improvement, then the treatment method should be abandoned for something more effective. Testing the patient before and after is the best way to see what makes a difference.

You may be misinterpreting the actions and concerns of your physician’s staff. Oxycodone is an opioid (narcotic) drug with the potential to become addictive. Close monitoring during the first three months of use is highly recommended for two reasons.

First, your doctor wants you to get the pain relief you need. Inadequate treatment is one way patients fail to get the help they need. And to go along with this first reason is the second reason for close contact. Opioids are dose titrated over time.

This means the amount of drug is increased slowly until you reach the right level for your symptoms. With this approach, you get the right amount of drug for relief of your particular symptoms. Some people have more pain at night and need dosing instructions that are different from other patients who need stable pain control around the clock.

There is always the concern about giving patients too much opioid and causing a drug dependence or addiction. Talk to your doctor at your next follow-up visit or call him/her if you are still in doubt about the need for weekly phone calls. Sometimes just understanding the reason behind the supervision can help patients feel cared for rather than assaulted.

A high daily dose of an opioid such as oxycodone is not enough to label a patient an addict. Addiction is defined by craving, uncontrolled or compulsive use. The person continues to use the drug despite harm. It’s rare to develop the disease of addiction if a person has no risk factors.

It’s more likely your father has a physical dependence. Dependence occurs in everyone on opioids. This happens when you take them regularly for more than two to three weeks. Physical dependence does not mean the person is addicted. It just means that the body has become used to the drug. If the person stops taking the drug suddenly, then symptoms of withdrawal may occur.

There is another concept you should understand about oxycodone. Patients can develop tolerance to the drug. Tolerance means the person needs more drug to get the same amount of pain relief. Tolerance is not the same as addiction.

Not everyone develops tolerance to pain relief. If your father is starting to develop tolerance, there are ways to deal with it. His doctor may want to switch to a different drug. Or sometimes treating other conditions such as depression and anxiety helps.

Adding a non-opioid drug can offer some extra pain relief without increasing the addictive effects. The best approach depends on each patient’s situation. Talk with your father about your concerns. He may have the same worry about becoming an addict. His physician should be able to give you an idea of what to look for and how to avoid addiction.

There is no clear answer to your question. Some doctors try to limit the use of opioid (narcotic) drugs like Oxycodone to a three-month period of time. Others see no reason not to use the medications for as long as the patient needs help controlling or managing their pain.

There have been a few studies done to try and determine the best long-term use of opioids. But so far, there haven’t been enough studies done for a long enough time period to help answer the question.

The problem of addiction always comes up when discussing opioids. Yet studies show only a small number of patients actually ever become addicted. Because there is such a great concern, patients are usually monitored carefully. If anything, many patients are probably under medicated and don’t get the full benefit of these pain relievers.

If you find yourself taking more pills than are prescribed each day, you may need to talk to your doctor about a change in dosage or drug. If you are tempted to see another doctor to get an extra prescription, you may be in danger of drug addiction.

The fact that you are concerned about addiction is a good first step. Opioids can be very effective in the management of chronic pain. Combined with exercise, psychologic, and behavioral programs, they can be a very useful tool to help patients get control of their lives and avoid the decline into disability.

Statistics vary, but most show that it’s really on a very small percentage (around 1 to 2 percent) of people with chronic pain who do become addicted to pain killers. However, people can – and do – develop a dependence on certain drugs.

According to the FDA website, someone who is addicted is someone craves and uses the drugs compulsively, has to have them, has to use them. Someone who has become physically dependent on a drug is someone whose body has adapted to the drug and it’s not as effective any longer. People who are dependent on opioids do go through withdrawal symptoms when they stop taking the drug, but this doesn’t mean that they were addicted. It’s just that their body needs to get the medication out of their system. In this case, the symptoms are physical, rather than psychological, as with addicted people.

Many people who have chronic pain are afraid of becoming addicted to stronger medications. Although it’s always a possibility, researchers have found that, in general, people who do become addicted do have some predisposing factors. They can include a family history or prior history of addiction, an abusive childhood, or an unusual stress response, to name a few.

If there’s concern about addiction, speak with your doctor about it and discuss why you’re worried. You may want to visit a pain clinic that specializes in managing patients with chronic pain. When working with patients who have chronic pain, doctors have to balance relieving the pain with the potential for addiction. However, although we don’t have accurate numbers, studies are showing that the people who do become addicted to opioids while taking them for pain relief are few in number.

When someone is experiencing pain, to them it doesn’t matter what it’s called. However, for treatment purposes, doctors do need to know what type of pain they’re dealing with. If someone with cancer is experiencing a lot of pain, their pain may be treated differently than the pain of someone whose pain is constant, but not life threatening. That’s mainly why there is this classification.

The sciatic nerve runs from your lower back, down through the buttock to the leg, on both the left and right sides. Sciatica isn’t really a disorder itself, but a symptom of a problem, like the back pain you describe. If you have a slipped disk that is pressing down on a sciatic nerve root, this can cause the pain that you are feeling lower down.

There are several treatments that may help relieve sciatic pain, but since the pain is a symptom, before doing anything you should see your doctor. It’s not safe to assume that it’s your old back injury that is causing this problem because it could be something new. Some of the stretching exercises that work wonderfully well for some people can actually make it worse for others, depending on the cause.

Once your doctor has confirmed the reason for the pain, you might be treated through medications for pain and/or inflammation, physical therapy, back bracing, or even surgery.

Controlling chronic pain with medications is a complex and challenging job. This is especially true if the doctor is using opioids as part of the treatment. Opioids are narcotics such as morphine (MS Contin or OxyContin) or fentanyl (Duragesic). You may recognize one of these names from your mother’s bottles of pills.

Opioids reduce pain by binding to opioid receptors in the brain. Most pain responds well to opioid medications. Some types of pain respond better than others. For example, nociceptive (skeletal or muscular pain) is usually more responsive than neuropathic (nerve) pain.

Patients often get good relief from opioids at first. But they develop tolerance to the drug and may need a higher dose to get the same amount of pain relief. Many people can’t really tolerate taking a higher dose. One way to handle this is to start at a low dose and gradually increase the amount taken as needed. When the maximum safe dose is reached, the doctor may switch the patient to a different drug.

Or sometimes combining a narcotic with an antidepressant and/or a regular analgesic works well. This is called multimodal drug therapy. Multimodal therapy and drug rotation may be the best way to treat chronic nerve pain.

If you have any doubts or questions, go with your mother to her next appointment. Educating the patient and the family is an important part of pain control. Find out what she’s on and how it works. Ask what to expect for short-term and long-term pain control.

Spinal stenosis is a narrowing of the spinal canal where the spinal cord and spinal nerves pass through the spine. Changes in the space (decreased space) can lead to back and leg pain. The pain is especially noticeable when standing and walking.

Treatment for this problem consists of antiinflammatory drugs, exercises, and sometimes, surgery. The use of gabapentin (also known as Neurontin) is being studied. The first study published was recently reported.

Patients all got the same treatment with a corset and exercises. One group also received the Neurontin. They found much greater and faster improvement in the Neurontin group. Pain relief was greater and they could walk faster and farther.

Neurontin is an anti-seizure drug that seems to work well for certain types of nerve pain. The use of a drug for a condition other than it was originally developed for is called off label use.

More studies are needed before Neurontin can be routinely recommended for patients with stenosis. But it can’t hurt to tell your mother’s doctor about her sister’s success with it. Just keep in mind that every patient is different, has different body types and needs. What works for one patient doesn’t always work for others. Your mother’s sister may have other problems for which the Neurontin was prescribed.

Right now, there is no one specific test that can tell if you have CRPS so your doctor has to rely on a few things to make the diagnosis. First, your doctor will take a thorough history, including any reports of injuries or traumas, like fractures or surgeries. He or she will make note of any signs or symptoms of CRPS and may do some tests to rule out other disorders that may have similar signs and symptoms.

Your doctor may apply a pinprick, heat or cold to the area to see your reaction and if this causes pain. You may be sent for X-rays or a magnetic resonance image (MRI), which is a more advanced radiology examination. This will allow your doctor to have a look at the condition of the bone or bones in the affected area.

You could also be sent for a triple-phase or three-phase bone scan. Doctors aren’t in agreement as to whether the test is helpful because statistics show that it may diagnose only half of people who have CRPS and even still, it is in the later stages of the disorder.

Other exams that test nerve and muscle function may be done but, as with the triple-phase bone scan, whether the tests are helpful is under debate.

There are two types of CRPS, Type I and Type II. Type I affects the body tissue and Type II affects the nerves.

There are many theories about what causes both types of CRPS but nothing has yet been proven. For Type I, the new school of thought is that pain receptors are somehow affected and respond to a family of nervous system messengers called catecholamines. What doctors do know is that 90 percent of people with CRPS had suffered some sort of trauma that could have been minor, like a sprained ankle, or major, like surgery.

Doctors are just as mystified over the causes of CRPS Type II. New theories aim towards that there is some sort of immune response and the body is reacting by causing swelling and pain.

There may be several reasons for your mother’s behavior. It’s possible she is forgetting that she took her medications and repeats the dose unnecessarily. If she is taking other drugs, she may be confusing one for another. It may be helpful to use a pill dispenser to make sure she gets all her medications in the right dose and with the correct timing.

It’s also possible that she is having breakthrough pain. Sometimes patients really do need a higher dose of a narcotic but they don’t get it because of fears that they may become addicted.

Are you aware of any other drug seeking behaviors? Has your mother told the pharmacist she lost her pills and needs a new prescription? Is she going to more than one doctor with the same complaints of pain seeking extra pills?

If your mother will allow it, make an appointment with her doctor and go together. Perhaps a phone call before the appointment to alert the doctor of the pharmacist’s report and your concerns would be helpful.

It may be she just needs a medication or dosage adjustment. There may be a simple solution if she is having breakthrough pain or she’s being inadequately treated. If she has become dependent or even addicted to the drug, then another plan of care may be needed. The first step is to have her situation re-evaluated by her prescribing physician.

As you have experienced, epidural spinal injections (ESIs) can reduce your pain. The steroid used in the injection cortisone is an extremely powerful anti-inflammatory drug.

When injected around an inflamed and swollen nerve, it can reduce the inflammation and swelling, which in turn, reduces pain. Reducing swelling can allow the nerves to function better, which then decreases the numbness and weakness that some patients have with this condition.

The effects of these injections are temporary. The results may last from a couple weeks to a couple months. The idea is to reduce your symptoms so that you can move more easily and begin a physical therapy program with less pain.

They also help the body repair the underlying condition. For example, most disc herniations cause a great deal of pain when they first occur. This is due to the chemicals that leak from the torn disc and inflame the nerves.

Over several weeks to months, the disc heals enough to stop leaking these chemicals. If the cortisone can reduce the symptoms at the beginning, then when the cortisone injection wears off, the chemical irritation may be gone and the pain may not return. The cortisone itself does not heal the disc herniation.

In other conditions, the cortisone injection is repeated 1 to 3 times per year to help control the symptoms. This is usually done when surgery is too risky or you don’t want to have surgery. Older adults with spinal stenosis, often choose this option.

Spinal stenosis occurs when the spinal canal where the nerves travel is too tight. This results in inflammation and swelling of the nerves and soft tissues. The swelling makes the spinal canal even tighter. The nerves do not have enough room to function correctly and begin to cause pain, numbness and weakness.

An ESI once every six months may reduce the swelling enough to take the pressure off the nerves. You get relief from the symptoms of pain, numbness and weakness but the narrowed spinal canal doesn’t get any bigger from this treatment.

Your surgeon is the best one to advise you on the frequency and safety of this treatment for your particular problem. Your age, general health, and length of time the treatment is effective are just a few of the things considered when deciding how many and how often to use ESIs.

Oxymorphone is an opioid (narcotic) that has been around since the late 1950s. An extended release form was recently approved for use by the FDA. It is recommended for use by patients with moderate-to-severe pain who need constant, long-term pain control. It works best for muscular or skeletal pain and is not as effective with nerve pain.

Studies show that extended-release Oxymorphone does work. When compared to a placebo (sugar pill), patients on the oxymorphone had better pain control over a longer period of time. And unlike other opioids, they didn’t need higher and higher doses to get the same effect over time. In fact, patients can remain on a stable dose of this drug for up to three months and longer.

Switching to extended-release Oxymorphone if you’ve been taking other opioids should be fairly easy. Your doctor may combine it with a short-acting opioid to get you started. By gradually increasing the dose, you’ll have a smooth transition to this drug.

It’s understandable that you could be confused about why an antidepressant medication would be prescribed to treat pain, but it’s not an unusual treatment for chronic pain, especially if it’s nerve pain. Some antidepressants have an analgesic or pain killing effect. Some of these medications are amitriptaline, imipramine (Tofranil), nortriptyline (Pamelor), desipramine (Norpramine), venlefaxine (Effexor), and duloxetine (Cymbalta). Duloxetine has been approved by the FDA for use in both depression and pain caused by nerve injury.

That being said, sometimes doctors do use antidepressants to treat an underlying depression that can occur with chronic pain. They may feel that the depression is worsening the pain, then the pain worsens the depression and we have a cycle that needs to be broken.

Studies are being conducted on whether counseling can help people manage their chronic pain. A recent study reviewed previously done trials that investigated people with arthritis and how psychosocial interventions helped or didn’t help them cope. The researchers found that patients who participated in the programs for cognitive-behavioral therapy, pain-coping skills, biofeedback, or stress management, among others, did report higher levels of coping with their pain and, in turn, their complaints of pain decreased.

There are two types of CRPS, complex regional pain syndrome. Type I is most often triggered after someone has broken or sprained a bone or joint. The tissue injury seems to bring it on. Type II has injured a nerve, rather than body tissue.

The symptoms can include a searing, burning pain in or along the part of the body that was injured, stiff joints, skin that is sensitive to touch, changes in skin color and/or texture, hair and nail changes, and perhaps difficulty moving the part of the body that was injured. This is usually referred to as Stage 1 and can last up to three months.

As the symptoms intensify or get worse, the CRPS can develop into Stage 2, which can last from three to six months. Stage 3, which can follow, is severe.

Doctors don’t yet know a lot about CRPS and there are no tests for it, so the diagnosis is made by listening to your history and complaints, and by watching for signs and symptoms. Since there isn’t a cure for the disorder, doctors concentrate on helping to ease the symptoms. The treatment will depend on what stage you are in and how you have responded to therapy.

No medication has been found to help everyone with CRPS nor to treat all the symptoms. Doctors may try different medications, alone or in combination with others, to see what is best for you. You may be given analgesics, or painkillers, to take by mouth such as NSAIDs (non-steroidal anti-inflammatory drugs) like Aspirin or ibuprofen, which are just two of many. You could be given narcotics or opioids like morphine or codeine. There are many types of analgesics that your doctor can try. You may also be given a topical medication, a cream or ointment that you spread on the skin. Some doctors have seen patients do well on anti-depressants, muscle relaxants, anti-anxiety medications, steroids and even medications for seizures.

Some patients have had success with alternative therapies such as acupuncture, biofeedback and visual imagery. A psychotherapist can often help with the anxiety or depression that can be associated with a chronic pain disorder.

Physical therapists can play a role in helping to relieve the pain. By exercising your injured limb, you may keep the joints from getting too stiff and painful. As well, many physiotherapists use electrical stimulation called TENS, or transcutaneous electrical stimulation, to help reduce pain.

Finally, your doctor may suggest a nerve block, spinal cord stimulation or a drug pump. With a nerve block, your doctor injects an anesthetic directly into the nerve that is causing the pain. With spinal stimulation, a surgeon places electrodes alongside your spinal cord and the electrodes give off impulses that block the pain. A drug pump provides you with a constant flow of analgesic directly into your spinal cord, providing pain relief.

Surgery, called a surgical sympathectomy, is controversial and not all doctors recommend it. A surgeon destroys the nerves that are causing the pain.

Not everyone responds to treatment in the same way and not all patients get full relief. Some may get partial relief and some may even go into remission, or have periods where they have no pain or symptoms.