FAQ Category: Pain

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.

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.

Your doctor is following the latest guidelines on the treatment of acute (new) back pain. Research shows most people get better on their own in the first two or three weeks. The best advice is to keep moving and active despite the pain.

Seeking treatment usually means care from a chiropractor, physical therapist, acupuncturist or other conservative practitioner. It doesn’t mean you can’t treat your current symptoms. Many doctors advise the use of over-the-counter pain relievers. Ice in the early days and heat later may also help. Rest for a day or two is okay but overall, it’s clear that activity is the best medicine.

Phobia is a common term to describe fear of something. Kinesio is used to describe movement. So a person with kinesiophobia is afraid to move. That sounds rather extreme and most people with kinesiophobia are not zombies who walk and move like Frankenstein.

They are often people with chronic pain from an injury. Fear of pain or reinjury makes them very cautious in their movements. They start to avoid anything that makes the pain worse. In the end they may even make the pain worse by using this strategy. The body is designed for movement. Motion is lotion.

Loss of motion tends to make us stiff and feeds into the pain cycle. If the problem goes too far a physical therapist may be needed to help the patient break out of this movement phobia.

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.