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.

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.

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.

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.

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.

Not always. Some people catastrophize pain all throughout their lives. This means they focus on their pain and the negative aspects of it. They imagine the worst is going to happen and dwell on those thoughts day and night.

Emotionally secure adults are better able to face suffering and upsets. In fact adults who are secure in their relationship with one another often report less pain intensity than those who have insecure attachments. This is true even when there are high levels of pain involved.

Please understand that nurses can only dispense drugs for pain according to the doctor’s orders. Some pain meds are very addicting. Others can kill a patient if given too often or in too high a dosage. Pain management is often a difficult part of patient care. This is especially true for someone like your wife who already has constant or chronic pain.

Sometimes it’s difficult for the doctor, nurse, or other health care worker to judge a patient’s pain level. Seeing pain and suffering on a daily basis can decrease the observer’s sense of understanding or empathy. The health care worker’s own distress may actually reduce his or her empathy as a way to cope. Studies show this is a common response in critical care and burn units.

Talk with the nurse in charge and/or the doctor. Having a better understanding of the big picture may help both you and your wife cope. On the other hand, your questions may help the medical staff review pain measures being used with your wife. It’s possible there’s a better way to manage her case.

It’s a little too early to jump to any conclusions. Editors from the Pain journal where the new studies were reported advise caution when reading the new studies. The two articles based on original research point to the same conclusion: there is a neuropathic cause of CRPS. This means nerve damage in the arm or leg causes all the symptoms.

They say that the studies were done on patients with type I complex regional pain syndrome (CRPS). The patients had all gone through many medical and treatment procedures. It’s impossible to tell if the findings of the new study apply to the actual CRPS condition or just what happens after treatment. There could be a big difference between the two.

It’s also true that changes in blood supply during the disease could cause the kind of nerve damage seen in these two studies. These changes aren’t what started the CRPS — they occur after the initial trauma.

We’re not close to a cure yet but we’re getting closer. Once scientists can pinpoint the cause then the effects can be prevented or at least minimized. This is good news for anyone suffering the chronic and debilitating pain associated with CRPS.

At first pain has the purpose of warning the person. It protects us from further injury or harm. The body is saying, “Stop whatever you are doing — it hurts.” Escape is the next step: get away from whatever is causing the pain. This is also a protective mechanism.

Expressions of pain (facial or verbal cues) are a way to seek help. They also have the effect of causing empathy on the part of others. Our own distress in seeing someone in pain motivates us to help or assist that person. Pain helps the sufferer get the care he or she needs.

If the pain signals are not turned off early on, they can get stuck. Someone with chronic pain that doesn’t go away may not have anything wrong biologically. The pain system has set up a circuit or loop that can’t get turned off. The natural purpose for pain has been overridden.

In some people there may be a psychologic or emotional need for pain. This type of pain is called a behavioral response. The traditional medical model of treatment may not help this person. Until we learn how to stop chronic pain, treatment has become a management issue. We help the patient do more within the confines of their pain. Pain may be reduced but not eliminated.

There isn’t an easy or simple answer to the question of complex regional pain syndrome (CRPS). Scientists are conducting many studies to sort out all the variables and factors that go into a condition like this. So far there isn’t agreement about the mechanism of cause.

It may be that nerve damage after an accident or injury occurs setting off this extreme response. Some doctors and scientists think the central mechanisms of the nervous system are triggered by the injury. Their signals get mixed up and reorganized in a chaotic way.

For now it seems that there’ isn’t a single one-way to explain what went wrong. Once the underlying pathology is discovered treatment will be able to address the cause instead of just the effects (symptoms).

It’s really possible. Scientists using MRIs have been able to show that when an outside observer is with someone in pain, similar neurons in the brain are activated in both people. This process has been called a mirror neuron/circuit system.

Somehow the mind, body (felt sensations), and emotions are all linked together. As you’ve noticed, the sensations are not exactly the same for both people.

Animals also have a biologic response to the suffering of others. Mammals such as rats and apes seem to mimic and imitate others in pain. Scientists think this may be a way to learn about danger from other members of the species.

Some people seem more empathetic than others. Researchers are trying to find out why this happens and how we may be able to use it to help treat those in pain more effectively.

There are some indications that complex regional pain syndrome (CRPS) has a psychologic or stress-induced component. Most doctors don’t think that’s the only cause behind the problem. As with many illnesses and injuries, emotional or psychologic stress can amplify (make louder) your symptoms.

A vacation that relaxes you also relaxes the nervous system. Since it appears that both the central nervous system (brain and spinal cord) and peripheral (nerves) nervous system are involved in CRPS, it makes sense that anything calming to the nervous system can alter CRPS.

Knowing that you respond well to relaxation is a useful piece of information for treatment. You can make good use of this information to continue reducing your symptoms. Massage, biofeedback, and physiologic quieting™ are tools used by physical therapists to help patients with CRPS. Make sure you report the change in symptoms to your therapist. Ask about a home program of relaxation.