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.

A good survey is brief but comprehensive. It gets the answers to questions from a variety of viewpoints. In this way it can seem repetitive. Sometimes more than one question asked in a similar way helps to validate the person’s response. In other words, it shows if that’s how the person truly feels. Conflicts of thought are brought out by questions repeated in different ways.

Many pain surveys begin with a description of the pain. Patients try to match words to their experience. The location, frequency, duration, and intensity are all measured. Use of medications is often included. Beliefs about disability, control, and function come out with the right questions.

The person giving you the test may have given you special instructions before starting. Often the patient is told to answer each question as honestly as possible without looking back at previous answers. It’s not meant to trick patients as much as to get a clear picture of the patient’s thoughts about the pain.

The signs and symptoms of CRPS are the same with both Type I and Type II. The only real difference is that with Type II (also known as causalgia), there is a known nerve lesion or nerve damage. Type I has no identifiable nerve trauma. Type I has been called reflex sympathetic dystrophy until this distinction was made several years ago.

You may be able to figure out for yourself which type you have based on your history. If not, ask your doctor to explain which type you have and why. Type I is most common after some type of soft tissue trauma. Type I is also possible after a period of immobilization such as after an accident, injury, or stroke. Something as simple as having blood drawn or a bug bite can also result in Type I CRPS.

Type II occurs when the nerve has been cut, damaged, or injured in some way. This could happen as a result of an accident or surgery.

Avoiding certain activities or movements that might cause pain or reinjury is called fear-avoidance behavior. This may be what you are describing about yourself. And you are right to be concerned. Chronic pain can be disabling.

The Fear-Avoidance Model of Exaggerated Pain Perception (FAMEPP) was first introduced in the early 1980s. The idea is based on studies that show a person’s fear of pain (not physical problem) is the most important factor in how he or she responds to low back pain. Fear of pain commonly leads to avoiding physical or social activities.

Education is the key to injury prevention and fear avoidance behaviors. You’ve already taken the first step to getting over this problem: you’ve seen it! A physical therapist may be able to help you. First you’ll be tested for fear avoidance behaviors. A series of questions are asked to find this out. When a patient shows signs of fear-avoidance beliefs, then the therapist’s management approach will include education.

The therapist can teach you about the difference between pain and tissue injury. Chronic ongoing pain does not mean tissue injury is taking place. This common misconception is another reason why patients use movement avoidance behaviors. Then you’ll be given a graded approach to exercise. The therapist will guide you through the activities and movements that cause you the most fear.

Pain catastrophizing refers to a negative view of the pain experience. It is exaggerated or blown out of proportion. Sometimes it refers to a patient who actually has pain already. In other cases the person isn’t even in pain yet — he or she is still just anticipating it might happen.

The staff at a chronic pain clinic are trained to test for and recognize the signs of pain catastrophizing. Studies show that without intervention these behaviors can lead to chronic pain and disability over time.

Catastrophizing or expecting the worst to happen increases pain. Catastrophizing boosts anxiety and worry. These negative emotions stimulate neural systems that produce increased sensitivity to pain. It can become a vicious cycle.

There’s a known link between pain and worry — even for people who don’t worry normally. Studies don’t support the idea that worrying prevents patients from healing or getting better. In fact, when compared with patients who have been diagnosed with mood disorders such as anxiety or depression, the chronic worrier comes out ahead.

The worrier’s path takes a little different twist if he or she thinks that the only successful outcome is a cure for the pain. Seeing the problem to be solved by cure alone makes a person even more aware of the pain. When every effort to get “better” doesn’t bring about a chance in pain, then the patient becomes frustrated. Frustration can lead to negative thinking about oneself.

There is help available if you think your worrying is a problem. Behavioral counseling has helped many people rein in their worry habits. Even if it doesn’t change your pain, your quality of life may be improved.

Worrying is a problem if it interrupts your thoughts, your sleep, or your relationships with others. Worry that is intense and uncontrollable is too much. This type of worry makes matters worse not better. It adds another problem when you’re already dealing with the problem of chronic pain.

Worry of this type may keep you from finding acceptable solutions to the problem at hand. In fact you may not be able to see answers that are right in front of your face if worry gets in the way.

There are some short-term solutions that can help you break the pain-worry cycle. Sometimes medications are helpful. In other cases distractions work well enough. Various methods can be used such as exercising, calling a friend and talking about anything except your worries, listening to calming music, or reading a book.

If after trying these distractions you still can’t get a thought out of your mind, seek help in finding some effective solutions. Learning to live without obsessive worrying is a good life skill to have.

When patients look for a cure and define it as being ‘pain free’ after years of pain — the result is likely going to be frustration. Repeated attempts to solve the problem with one treatment after another often cause the person to become more and more negative.

Negative thoughts can lead to what’s called catastrophic thinking. Pretty soon the person is thinking about the pain all the time. The general trend of their thoughts is toward the worst case scenario. They play this over and over in their minds.

Your sister may need more than just a few key phrases from her family. If she is open to the idea perhaps an appointment with a behavioral psychologist might help. If nothing else, encourage her to talk with her doctor about coming up with a better plan to manage the pain.

Many times it takes a team of health care professionals to help patients retrain their thoughts and manage their pain. The goal to reduce pain is replaced by goals to increase function. This can help improve the patient’s (and the family’s) quality of life. Time spent together becomes less focused on one person’s health and pain and more enjoyable again.

It appears that there may be a general trend for aging adults to have less pain with the same stimulus compared to younger adults. Scientists are unsure how to explain this. It could be a function of age with pain receptors becoming fewer and less functional.

Or it could be that an increased number of pain experiences over the years helps the older adult tune it out more effectively.

A recent study of attachment styles has shed some light on this subject. Attachment styles describes how secure or insecure someone may be in relationship to others. A more securely attached adult has less anxiety and less pain when compared to someone with an insecure attachment style.

In fact, younger, more fearfully attached adults are more likely to have greater pain and less pain tolerance when exposed to the same amount of pain as a secure or dismissive adult.

With all the other senses declining in old age, the decrease in pain perception may seem like a good thing. But pain is a protective mechanism to help warn and guide us. Only in cases of chronic pain would a reduced pain sensation be to anyone’s advantage.