FAQ Category: Pain

More and more studies are finding a link between pain and depression. In fact there’s a name for this condition: the depression-pain syndrome. It appears there’s a connection both ways. Pain appears to make depression worse. And depression makes pain worse.

Scientists think pain and depression have a common pathway. In both conditions, regulation of neurotransmitters is altered. Neurotransmitters are messengers in the body taking chemical messages from the body to the brain and back.

Antidepressants seem to decrease pain and improve mood. Antidepressants and cognitive behavioral therapy can help patients with depression. This approach is not as successful for pain. Not all patients see any improvement in pain. More study is needed to identify who may be helped with antidepressants for relief from chronic low back pain.

OxyContin (also known as Oxycodone) is a schedule II opioid pain reliever. That means it’s a drug that can only be obtained from a doctor by prescription. It was first brought onto the market in 1996 so it is a relatively new drug.

OxyContin is a highly effective pain reliever used by millions of chronic pain patients. Unfortunately it does have a down side with long-term use because it is morphine-based and can be addictive. Morphine-based drugs bring pain relief but also a sense of euphoria and pleasure that can lead to abuse and addiction.

Long-term use of OxyContin leads first to tolerance. This means you must take larger amounts over time to get the same pain relieving (or euphoric) effects. Tolerance is not the same thing as addiction.

The next step is physical or psychologic dependence. Dependence means that without this drug, the body starts to go into withdrawal symptoms. The person is considered addicted when the drug is needed for the person to function normally and when withdrawal symptoms occur if the drug is stopped.

Talk to your doctor about your concerns. Find out how to manage your dosage to get the maximum benefit with the minimum amount of risk.

Probably neither one. Pain patterns after neurosurgery have been studied by a group of scientists in Germany and the Netherlands. It seems that pain is less likely for patients having operations on the skull (cranium) compared with spinal surgery. Headache is possible but not common.

Spinal or back surgery, on the other hand, tends to be more painful. These patients have more pain before the operation and less pain relief than expected afterwards.

Whether cranial or spinal surgery, gender (male or female) doesn’t seem to matter. Both sexes reported about the same pain patterns when comparing pain level, location, or duration.

Age may make a slight difference. Younger patients tend to have more pain after the operation. Older patients (greater than 60 years of age) report more pain before the surgery. Anyone of any age or gender has more pain when there are complications after surgery.

It’s possible that your daughter had good pain management before and after surgery. When the right combination of drug relievers is used, pain can be reduced and even eliminated for many patients.

Processing capacity of patients with chronic pain was the focus of a recent study in the Netherlands. Patients with pain levels similar to yours were compared to healthy adults with no pain (control group). Both groups did easy and hard tasks during the experiment.

The researchers report that the chronic pain patients were faster but also made more mistakes than the control group. Analyzing the data from the study they came up with the following conclusions:

Maybe both. It’s been shown that people in pain are distracted by the pain. The mind and body have a limited number of resources to complete each daily task. Pain is a stressor that automatically takes a certain amount of your energy and concentration.

A recent study of chronic pain patients showed that pain does have an effect on your ability to process mental tasks. With some part of your focus on the pain (even if it’s subconscious), there’s less attention available for tasks you must do at the same time.

Chronic pain patients tend to react quicker during tasks. This is true whether the task is easy or hard. It could account for the number of mistakes you are making even though you are doing a simple, but repetitive task.

It’s not clear if slowing down and concentrating more would make a difference. Knowing there’s a link between your pain levels and the number of errors you make may help remind you to slow down. See if it makes a difference. If you haven’t explored all options for pain relief, further treatment may be helpful for you.

Strong emotion of any kind has been shown to be linked with strong memories of that moment. The exact physiologic mechanism by which this happens isn’t clear. Neuropeptides or biologic messengers that travel around the body may have something to do with it.

The same effect is associated with stressful medical tests. Studies show that the level of pain reported and remembered for stressful or negative medical tests is higher than when the test was originally done. This phenomenon is called post-exposure modulation.

It means that memory pain of acutely painful experiences is remembered inaccurately because it is exaggerated over time. This is especially true when the delay between experience and recall is six months or more.

Discography is a painful test. It is designed to confirm which disc is damaged. An injection of contrast dye puts pressure on the disc reproducing painful symptoms. It makes sense that a painful discography test done on a patient who is fearful or anxious would result in a heightened memory of the pain.

Discuss this problem with your mother-in-law and if possible, with her physician. Patients who ask for more medication may seem like they are becoming addicted. It may be that she has just isn’t getting adequate pain control.

Lortab is a short-acting pain reliever. It starts working quickly but doesn’t last as long as some other drugs. She may need a different dose or a different drug. The doctor who prescribed the drug can help her with this.

Another key factor is activity level. Patients who have had a total knee replacement must be encouraged to keep active and do their exercises. Inactivity causes the muscles to stiffen with loss of motion. Motion is lotion and without it pain levels can increase.

OxyContin is considered an opioid analgesic. In other words, it is a morphine-based painkiller. For most patients with chronic pain, opioid analgesics can be used with very few problems. They are not recommended for anyone with a previous history of drug or alcohol addiction.

OxyContin is a sustained-release drug. It lasts 8 to 12 hours. Most patients take one or two a day to get the pain relief needed. If you find you need more pills than the number given, then make an appointment with your doctor. It’s probably time to review the type of drug or the dosage.

Be aware that drugs of this type create physical dependency, which is not the same as addiction. Dependency means the body becomes accustomed to the chemicals in the drug. If you stop taking them all of a sudden instead of slowly tapering the dose, the body goes through withdrawal. To avoid this problem stop taking the drug only with your doctor’s instructions and supervision.

The biggest problem patients have with this type of medication is constipation. Stay hydrated and physically active to avoid this problem. Use a stool softener if needed.

Research on low back pain (LBP) patients does suggest a “keep active” guideline as the first approach to LBP. The concern is that acute LBP will transition into chronic pain and disability. Bed rest hasn’t been proven effective, whereas patients who stay active seem to do the best.

You may need a slightly more comprehensive program of pain management. For some patients, a combination of activity, pain relievers, and behavioral changes works best. Medications to control pain and muscle spasm may be needed so that you can stay active. Ask your doctor which pain meds might work best in your case.

Fear of movement and fear of reinjury are common themes for many back pain patients. It hurts to move so you stop moving. Pretty soon you’re afraid to move because it might hurt. This cycle can tip the scales against you in terms of a quick and easy recovery.

If this is the case for you, a short course of behavioral counseling may be helpful. A physical therapist will analyze your movements and ask a series of questions. The exam is used to identify a pattern of fear avoidance behaviors (FABs). A program to reduce FABs can be very successful.

Researchers are looking for ways to predict risk factors for a positive (or negative) return-to-work result. Identifying patients at risk for poor results is one way to approach this problem.

In one recent study over 3,000 patients with work-related injuries were studied. Pain levels before and after rehab were used as one significant measure. It turns out that increasing pain levels is a predictor of several things.

First higher pain levels before rehab are linked with drop out rates from rehab. And patients with poor rehab results are less likely to get back to work. So there’s some evidence that improving rehab outcomes is a good way to go.

Rehab that lasts longer with longer patient follow-up is one idea. A multimodal approach to rehab is another way to improve return-to-work results. Rehab that includes counseling, fitness, and patient education gives better results. Close supervision for longer periods of time seems to help, too.

Patients with extreme pain after rehab are much less likely to return to work. Efforts to control or manage pain early on seem to be an important key to success. This approach takes a united effort of everyone on the health care team to accomplish.

Your life circumstances may not be stressful but pain is always a stressor to the body. Using methods of relaxation can help reduce muscle tension and improve circulation for healing. Some people are able to use these techniques to reduce (or get rid of) the pain.

Once you’ve learned a few relaxation skills you can take them anywhere anytime. It could be a quick and easy way to keep your pain from escalating or getting worse in certain circumstances. A good relaxation method can be used without a complicated series of steps.

Keeping active is an important key to handling back pain. Relaxation is one of several tools used to help patients cope with pain and keep active.

Amputation of a limb is used only on rare occasions for complex regional pain syndrome (CRPS). All other forms of treatment are tried first. Before you consider amputation review the various treatment options. These may include medications, physical therapy, and nerve blocks. A spinal cord stimulator has been tried with some patients. The idea is to stop or rechannel pain signals at the spinal cord level.

There are some reports from patients with CRPS who had an arm or leg cut off. In all cases the patients still had severe pain. With the limb gone this type of pain is called phantom limb pain. For those who had partial pain relief, it only lasted a short time. A few weeks later severe stump pain started.

There’s no easy answer to the intractable chronic pain of CRPS. If at all possible, it’s better to keep the limb for whatever function, balance, and cosmetics it offers to the body. There are no guarantees that cutting it off is the answer to this problem.

Not at all. The new understanding of low back pain looks at the total person — not just the biology and biomechanics of your spine. Back pain whether from an injury or unknown cause is very real. But the stresses and strains of the body as well as the stress on the mind are both part of the picture.

It’s clear now that the broader view of life helps explain why pain becomes chronic lasting more than a few weeks. For example there is the fear of reinjury. This is one very important psychosocial factor in chronic back pain. The person in pain is afraid to move because it will hurt. Or maybe the pain is getting better but the patient is still avoiding certain motions or activities to keep from getting hurt again. This leads to a cycle of pain – no movement – pain.

Sometimes the psychologic or emotional distress of pain leads people to blow it out of proportion. This is called pain catastrophising and is another psychosocial variable.

Doctors realize now it’s best to be aware of all aspects of pain. Keep moving and don’t let pain rule what you do or don’t do. In other words, don’t let fear keep you from getting better.

It’s fairly normal to have some aches and pains along the way especially in midlife and beyond. When one thing after another starts to bother you, it might be time to have a physical exam. There could be some medical condition causing your symptoms.

The doctor may be able to tell you the outcome of this new shoulder pain, too. Doctors use a guideline called Clinical Prediction Rules to help predict what might happen. Based on studies of many patients with shoulder pain, researchers have been able to find a couple factors that predict outcome.

For example, patients with neck and shoulder pain are more likely to still have shoulder pain six weeks later. Patients with back and shoulder pain together are more likely to have continued pain six months later. For the most part, intense pain of long duration at the time of a medical visit suggests a poor prognosis. The client is more likely to have symptoms longer than expected.

Other factors are also taken into consideration such as repetitive movements and psychologic problems.

You may have taken the Fear Avoidance Behavior Questionnaire (FABQ). This survey is a tool to help doctors and physical therapists identify patients who are afraid to move normally. Either fear of pain or fear of reinjury rules how or when they move.

There are really no known cut-off scores for this test. Studies done on back pain patients have given us a range of expected values. Some researchers group FABQ scores into high and low based on the physical activity scale in the test. The total score for that section is 24 points. Getting less than 15 is a low score. It means there’s a low risk for elevated fear-avoidance beliefs. More than 15 is high and signals a high level of fear-avoidance.

As you say the difference of one or two points doesn’t make sense. It may be best to look at the scores as being somewhere on the same line rather than dividing them into low or high.

Actually the wait-and-see approach is part of a protocol called Practice Guidelines for Shoulder Pain used here in the United States and in other countries. The practice guidelines have only been around for the last five years or so. This treatment is useful in the first two to four weeks after the start of symptoms.

Some doctors may prescribe analgesics or even anti-inflammatories during this waiting period. Treatment decisions are based on the physical exam and known factors for a poor outcome. Studies have shown that the longer you’ve had the pain and the more intense the pain is at the time of your first doctor’s visit, the poorer your results will be.

In cases like this, instead of recovering in two to four weeks, it takes six weeks to six months (or more) to get back to normal. Even with a short wait-and-see approach, earlier treatment with drugs or physical therapy can make a difference in the long run. Make sure you go back to the doctor if your symptoms aren’t resolved by the end of a month’s time.

Measures of pain have been reported for many population groups. Researchers often try to include patients with a variety of backgrounds. African-American, American Indian, Alaskan Native, and Hispanic are just a few of the groups used by the U.S. Census. Social researchers tend to use these same groupings.

In the last 25 years it’s become clear that pain is not just a biologic or medical experience. Emotional, cultural, and social factors are equally if not more important. The passion with which your aunties express their pain may be more behavioral than physical. It may or may not be based on their ethnic background.

Some psychologists look for pain with an emotional overlay. This means patients who have pain respond to it in a different way because of their emotional or psychologic make-up. They tend to describe their pain using phrases like “it’s killing me” or “the pain is torturing me”. Other emotionally based words might be “frightening,” “vicious,” or “miserable”.

Whether or not there is a physical or biologic reason for pain doesn’t matter to the person’s experience. Everyone of any ethnicity feels the pain just as if it were very real.

Complex regional pain syndrome or CRPS is a painful condition that affects the arm and hand or leg and foot. It usually occurs after trauma of some sort, including surgery. Most people think the syndrome occurs after healing is complete. But one theory is that there is ongoing inflammation. The inflammation causes nerve endings to become extra sensitive.

Another theory is that changes in brain function occur. Which area(s) of the brain and why remain unknown. It may be possible that CRPS is a psychiatric problem. Psychosomatic or a mind-body response occurs after trauma leading to a stress-induced condition of pain and other symptoms.

Most recently several studies have been published pointing to nerve damage as the primary cause of CRPS. But the studies were small. The authors themselves said they couldn’t be sure the changes measured happened first or after CRPS.

The more we can find out about this condition the sooner effective treatment can be developed. It’s entirely possible that there is more than one mechanism involved. The complex interactions between brain, body, and peripheral nervous system support this theory.

The test results will help you in the long run. Right now the doctors, nurses, and therapists at the clinic need some information to help them put together a plan of care for you. This means understanding your pain experience — where does it hurt? When does it hurt? What makes it better or worse?

Knowing how you think and view your pain will help guide the pain management portion of the program. Often patients will say they think one way but their inner thoughts and “self-talk” suggest something else. Positive self-talk is a fairly new treatment method being studied. Finding which patients each treatment technique will help is the key to success.

Whenever a survey or tool of this type is used there are trade-offs. Too few questions may not give the total picture of the patient. Too many questions can turn the patient off to the process.

For the moment it’s good to know that someone is taking a close and careful look at your experience. The more they know about you and how you function, the more likely you’ll get the help you need.

Complex regional pain syndrome (CRPS) and reflex sympathetic dystrophy (RSD) are the same thing. RSD is the old term used for the problem. It’s been updated now to CRPS based on research in the last 10 years. The change came about in naming this condition when researchers were able to identify the problem a little more clearly.

Dr. S. W. Mitchell first reported CRPS in 1872. Back then it was called causalgia from burning pain in wounded soldiers. Symptoms of intense pain, swelling, and skin changes were common. Less involved injuries got the label reflex sympathetic dystrophy.

A similar problem called shoulder-hand syndrome was identified after heart attacks. Years ago anyone who had a heart attack was treated by six weeks of bed rest. There is a known connection between the heart and shoulder. The enforced immobility fired up those connections resulting in shoulder pain, loss of motion, and symptoms in the arm and hand.

New efforts are being made to understand this complex syndrome. Finding out what causes it will be a big step toward finding better ways to treat it and perhaps even prevent it from happening.