FAQ Category: Pain

There’s an expression: knowledge is power. Taking charge of your health is a good example of how that can be true. Having pain over a long period of time can be frustrating and depressing. This can go in circles, causing even more pain in the long run. Once the vicious cycle begins, it can be hard to break out of it. You and your doctor need to work together as a team. Your doctor is there to help you, but you need to understand what is happening to your body and to take control.

If you don’t understand what is actually causing your pain, make an appointment with your doctor to talk about your injury from the beginning, and how the injury is affecting you now. Go over what treatments you have tried and why they might not have worked. If you’re afraid of forgetting your questions once you get to the office, write them down as you think of them and bring them with you. You might want to bring someone with you to act as another pair of ears.

Document your pain. Keep a diary where you can track the good days and not-so-good days. By doing this, you might be able to learn of patterns or triggers that make your pain worse.

Be proactive and research your condition. There are support groups that might be able to help you, and you can use the Internet, but be sure to use only reliable sources. Good places to start are sites run by national organizations or universities; stay away from those that offer instant relief or magic cures. Your doctor may also be able to point you in the right direction.

Try to change your way of thinking from I can’t do anything about it to this is my body and I can take control. The more you learn about your situation and the better you understand it, the better chance you have of taking charge and learning how to live your life with the pain.

Trying to decide if a patient is a good candidate for self-care isn’t an exact science, but there are certain signs that will tell a doctor if someone might be more successful than someone else.

For example, he’ll assess how bad the pain is and how it affects your life. People with severe pain that keeps them from doing things, will likely have a lower chance of self-management. Are you depressed or does the pain make you very anxious? If you answer yes to either of those questions, it might be harder for you to take control. Of course, if the depression or the anxiety is addressed, you could increase your chances of being successful.

Do you feel in charge of your life in other aspects, not just in pain? If you’re a take-charge kind of person, again, you probably have a better chance of succeeding than someone who often allows others to make decisions or who believes that things just happen, good or bad.

Are you willing to try new things, to experiment with different treatments or programs? If you are, then you might be the right person for self-management.

The cycle of anxiety and pain can be frustrating. As you become more anxious, you may tense up, feel more aware and hyper alert, and then feel more pain. Then, as the pain gets worse, the cycle continues.

The best thing to keep pain from getting worse may sound too simplistic, but it’s to stop the pain before it gets bad. If you have a prescription for pain relievers, don’t wait until the pain is really bad before you take them. Pain relievers work best before your pain hits its peak. Take your medication as prescribed too; this will help control your pain.

If your pain is not being controlled with pain relievers, there are other options you can explore. Some people learn to use imagery or biofeedback to relieve their anxiety and thus relieve their pain. There are many techniques are available, and you may need to try more than one before finding the one that helps you. Also, many of the techniques take practice, so it’s important to be consistent with using them.

There are different levels of independence, and like all things, there can be too much of a good thing. Some people are extremely independent, sometimes to the point that they don’t realize that this independence is causing more harm than good. Some by avoiding the issue, pretending it’s not there, and then they don’t have to deal with it. However, that’s not realistic if pain is affecting their life.

There are people who see asking for help as being weak, showing that they are not able to care for themselves. Others feel that taking medications is a sign of weakness too. These types of things are what works against you if they are causing you to experience more pain. If accepting help, be it a ride to physiotherapy, or a helping hand to do the chores around the house, is difficult for you, then this could be affecting your pain, making it worse.

Laws about acupuncture practice vary from state to state and right now, only about 40 states have standards for certification.

Speak with your doctor or ask at your local clinic if they have any recommendations. Word of mouth is a good way to find someone that is trustworthy. Once you’ve found an acupuncturist, visit the office and ask questions about hygiene and safety. All the disposable needles should be one-use only and come from single sterilized packages opened just for you, and your skin should be cleaned with an disinfectant before treatment begins.

Although pain and depression are two completely different things, they can be connected very closely. When someone experiences chronic pain, they can find themselves not doing many of the activities they enjoy doing, or they may not do them as well as they used to. Chronic pain can keep them from going out to social activities, or spending time with family and friends. Just moving around the home or concentrating on a favorite television show may become difficult.

When someone is used to being active, but the pain keeps them from participating, they can become frustrated or angry at themselves. This can lead to sadness, or depression. We then begin to see a cycle. As someone gets more depressed, they are less likely to try harder to do things, and the cycle continues.

People who have chronic pain often develop pain behaviors. The idea is that people communicate their pain by changes in the way they act. They may start to rub the painful part or walk with a limp.

Facial grimacing, moaning, and other actual reports and complaints of pain all fall into this category of pain behavior. Guarding such as bracing the body and muscle tension is a key feature of pain behaviors. Studies show that higher levels of guarding are linked with more days lost at work and less chance of getting back to work.

There have been many explanations for pain behaviors. Some experts think this is a way of coping. It could be that people develop pain behaviors as a way to avoid pain. This is called avoidance behavior.

Your neighbor’s doctor may have just been describing his or her observation of your neighbor. The significance of pain behaviors isn’t entirely clear. There is some evidence that certain behaviors (such as guarding) predict the development of chronic pain.

Mental defeat is a common problem among combat veterans. It may be part of a chronic problem called post-traumatic stress disorder (PTSD). PTSD is a chronic anxiety disorder. The term shell shock was first used during World War I to describe this anxiety disorder.

PTSD is now recognized as a stress disorder that can occur at any age, including childhood. During our more modern history, wars overseas, military combat, and acts of terrorism have been linked with PTSD. Natural disasters, sexual and criminal assaults, and domestic violence can also lead to PTSD.

Studies show that people who suffer mental defeat are more likely to develop severe and chronic PTSD. Treatment may be less effective and take longer for patients with high levels of mental defeat.

Your family member may have better results with early intervention. These kinds of mental disorders can be treated successfully. It may be helpful to contact your mental health center or veterans administration office for more information. They may have a list local resources available for combat veterans.

Your brother may be experiencing mental defeat. This is a common response to chronic pain. The person starts to see pain as an enemy out to get me. They start to feel less than human. They may even say the pain is taking over.

Chronic pain and loss can trigger negative beliefs about self in relation to pain. The person may experience a loss of control leading to a sense of helplessness.

But when they lose their sense of identity, then helplessness turns into hopelessness. Repeated episodes of uncontrollable pain can wear away at a person’s ability to cope. Mental defeat starts to creep in and may become full blown.

Referral to a licensed counselor, psychologist, or psychiatrist may be appropriate. If your brother has anxiety, depression, or other mood disorders, then medication can help. Cognitive behavioral therapy (CBT) is a method of counseling that can also help patients redirect negative thoughts.

A group of researchers at McGill University in Canada developed a widely used pain assessment tool. It’s called the McGill Pain Questionnaire. There are several parts to the questionnaire. One is a survey of descriptive words used for pain.

By adding up the type and number of pain descriptors, it is possible to identify some general categories for the source of pain. For example, nerve pain is often described as hot, piercing, or shooting.

Muscle pain is more likely to be described as sore, dull aching, hurting, or a heavy sensation. Vascular pain is most often described as throbbing.

When there is a strong emotional component to a person’s pain, certain words are used more than others. For example, torturing, killing, cruel, or vicious are words used when the person is responding to their pain on an emotional level.

Opioids are substances that act like morphine in the body. They improve mood while reducing pain. When used over time, they can become addictive. Everyone has a slightly different tolerance level for medications of this type.

You are in the danger zone if you find yourself needing more and more of the drug to get the same amount of pain relief. Or you may notice the effects wear off sooner and sooner after taking a pill. These are signs of drug dependence.

You may not be addicted but you may need to taper off the drug and try some other ways to manage the pain. If you have withdrawal symptoms, then you may have developed an addiction to the drug.

Newer studies show that opioids may be helpful in the short-run but aren’t effective for long-term use. They define short-term use as being up to 16 weeks. If you decide to try this form of treatment, work closely with your doctor to avoid problems of this type.

Sciatica or pain in the low back, buttock, and down the leg is caused by irritation of the sciatic nerve in the lower extremity. It usually only affects one side.

Steroid injection into the epidural space around the spinal nerve can give pain relief. There is some debate about whether or not the results are short-term or long-lasting.

Routine use of epidural steroid injections is not advised. Usually only one to three injections are given. The patient should be informed that these injections may not improve function. They may end up having surgery anyway.

Epidural steroid injections are considered safe. There are a few possible complications. Headache is the most common but doesn’t last more than a few days.

Pain specialists advise patients to keep a pain log. Frequency, intensity, location, and duration of pain are recorded before and after the injection. The pain can be rated each day on a scale from zero (no pain) to 10 (most pain).

Even though this is a subjective measure, it can help you decide if you are getting pain relief, how much, and how long it’s lasting. With repeated injections, you should see continued improvement that lasts and pain doesn’t come back.

Fibromyalgia syndrome (FMS) is a noninflammatory condition with generalized musculoskeletal pain. Experts say this condition is systemic meaning many systems in the body are affected or involved. There is tenderness to touch in a large number of specific areas of the body. Most patients also report many other symptoms as well.

Myofascial pain syndrome (MPS) is pain in individual muscles. There may be a few or many areas with trigger points (TrPs) that are painful. TrPs are hyperirritable points of pain in the muscle or fascia over the muscle. TrPs can refer pain to other areas when pressure is applied.

The main finding in myofascial pain syndrome is the TrP, as opposed to tender points in FMS. Both disorders cause muscle pain and aching. Painful symptoms in both conditions are increased with activity. With fibromyalgia there is more generalized aching. Myofascial pain is more direct and localized.

The person with myofascial pain syndrome does not have other symptoms like the individual with FMS. But it is possible to have both FMS and MPS. Treatment is different for each problem.

Myofascial pain syndrome (MPS) is a term used to describe a condition of chronic muscle pain. The painful symptoms are caused by trigger points (TrPs). TrPs are sensitive points in the muscle or fascia covering the muscle. They form as a result of repetitive motions or immobility such as when your arm or leg is in a cast.

When pressed, TrPs cause immediate pain. Often the pain occurs where the pressure is being applied and in other areas of the body at the same time. This type of local pain response with distant pain is called referred pain.

At the present time, there isn’t a gold standard diagnostic test for TrPs and MPS. The patient’s report of symptoms and local testing for TrPs are the main diagnostic tools used. No lab tests have been found effective. EMG studies have wide ranging responses from patient to patient and can’t be relied upon.

Most times the diagnosis is confirmed by the patient’s response to treatment. If your painful symptoms are improved with TrP therapy, then it’s likely you had MPS. If after seeing a physical therapist for TrP therapy, you aren’t any better, then it may be time to see a medical doctor.

Disrupted sleep is a common problem for people with chronic low back pain. Depression or mood disorders are commonly observed in people with chronic pain from any cause. Some experts say it’s natural to feel depressed when pain is constant and disrupts our lives.

Some studies have shown that poor sleep patterns affect mood more than mood affects sleep. So getting a good night’s sleep every night may be the key to improving pain, mood, and function.

Ways to improve sleep are called sleep hygiene. Sleeping aids such as a sleeping pill may be needed, but most sleep experts suggest other measures first. Daily exercise is a key factor to improving sleep. Likewise, a healthy diet is advised. Caffeine should be avoided before bed.

Some chronic pain patients benefit from cognitive behavioral therapy (CBT). Improved mood, sleep, and function have been reported with this type of counseling and behavioral changes. Pain management should include medications, CBT, exercise, and good sleep hygiene.

Studies show you can see results with CBT after just a few sessions. Your own openness and willingness to work the program may make a difference.

In a recent study at the University of Washington School of Medicine in Seattle, Washington, patients in a CBT program had positive benefits after four sessions spread out over eight weeks. The positive results were still measurable six and 12 months later.

Patients were able to stop focusing on their pain, improve their function, and decrease their levels of disability. They showed improved healthy ways of coping with their pain and less maladaptive pain coping. Most importantly, their belief in their own ability to control and manage pain themselves was much improved.

You ask a question that 100s of researchers are actively seeking an answer to. Studies have been able to identify some risk factors (RFs) that can predict who might develop chronic pain. If we can change any of those RFs, maybe we can prevent acute pain from turning into chronic pain.

Some of the known RFs include: female sex, older age, and lower social class. People who are unhappy at home or at work tend to have more pain. Psychologic distress can be turned into physical symptoms. This is called somatization.

Some people tend to have more somatic symptoms than others. Depression is linked with somatization but it’s not clear which came first: the depression or the somatization. New findings suggest there may be chemical, genetic, or hormonal factors contributing to chronic pain.

And researchers report that trauma or adverse life events may alter the stress response. This means that some individuals at more vulnerable than others to future adverse events.

Finding ways to prevent chronic pain from developing is the goal of many scientists right now. Unlocking the mystery of the biologic and chemical basis of pain may help the development of drugs to prevent or later treat the symptoms.

Scientists studying pain and especially chronic pain are learning more and more all the time. It appears that people in chronic pain do have lower pain thresholds and higher pain sensitivities. But whether this was present before the injury or occurs as a result of trauma remains unknown.

New studies of brain patterns are helping us understand pain mechanisms. It seems that there is an actual brain network in charge of acute pain perception. Functional magnetic resonance imaging studies (fMRIs) are helping map out brain activity in people with acute and chronic pain. The results are compared to responses from normal, healthy adults without pain.

The role of chemicals and hormones in pain perception is showing a clear biologic basis for some aspects of pain. Some experts think that personality is a combination of biologic, chemical, and genetic traits. If this is true, then you are right in guessing both play a major role in how pain is perceived and handled.

It’s true that quality of life does suffer when a person is faced with chronic pain. Depression can be a natural response to the downward spiral of pain, deconditioning, loss of function, and more pain. But studies show over and over that certain personality types are more likely to become depressed after an injury or problem with back pain.

Some researchers have linked this response to patients who are more likely to catastrophize an event in their lives. This means they blow it out of proportion. Pain and other symptoms escalate and don’t respond to treatment with medications, injections, exercise, or rest. Results don’t improve with physical therapy or even surgery.

A recent study from the University of Texas (Arlington) used a personality inventory called the MMPI to test almost 1,500 patients with chronic occupational spinal disorders (COSDs). Almost two-thirds had some type of personality disorder. Half had a significant depressive or anxiety disorder. Only seven per cent were in the normal profile (NP) category.

If you tested positive for depression, you may benefit from medical treatment for this condition. Ignoring depression won’t make it go away and will almost certainly keep you in the downward spiral mentioned. Starting a course of anti-depressants along with an exercise program could be the start to restored function and improved quality of life.

Functional restoration rehab (FRR) has been around since the 1970s. It was first started to help chronic pain patients who failed to improve with medications, injections, physical therapy, or surgery.

Patients with chronic pain found themselves in a downward spiral of pain, disability, depression, and more pain.

FRR has been proven effective in helping patients break out of this vicious and never-ending cycle. The focus of the program isn’t on a cure from the pain. Instead, patients are taught how to cope better with the pain so they can do more and enjoy what they can do. It is possible to improve a person’s quality of life even without eliminating the pain. That’s the final outcome of FRR.

Each patient is placed on a physical reconditioning program that is best for him or her. Training is provided by physical therapists to increase tolerance of activities. Psychologic support is given to help with stress, depression, anger, and sleep disturbances.

Training is provided to help improve coping skills. Group support is essential in the process because although the program works, it’s not easy.