FAQ Category: Pain

The idea that psychological issues and psychosocial issues affect how we feel and interpret pain has been researched for quite some time now. Unfortunately, although the idea is there and some research definitely points in the direction of psychology affecting some aspects of pain, there isn’t any hard evidence on many ways that doctors can use this knowledge to treat pain.

The medical community is moving forward on the psychology and pain connection. For example, often patients who are living with chronic pain may be referred to support groups or counselors, in order to find ways to cope better with the pain. Many people catastrophize the pain, making things worse than they may really be. Since this is a reaction that they may not realize they are doing, getting help to notice this and reverse the thought process can help reduce the pain.

Research is continuing and as it continues, doctors will have new ideas to try until the find the right approach for each patient.

Your aunt may be engaging in an experience called pain catastrophizing. The is the tendency to think about pain, mull it over and over in her mind, and magnify her symptoms. Pain catastrophizing is made worse when the patient feels helpless about his or her pain.

Pain catastrophizing gets started when there is chronic pain, psychologic distress, and physical disability. These factors can lead someone to feel fearful about movements that could possibly bring the pain on or increase the pain.

Patients who hold back from communicating their pain often have higher levels of negative effects from the pain. In cases like your aunt (who doesn’t hold back), she may actually feel better and function better for having expressed her fears, concerns, and upsets. It’s the patients who sit and stew silently who have worse outcomes.

Experts think it’s possible that listening to patients in a way that makes them feel heard may be the key to reducing pain catastrophizing. It’s possible that she feels underappreciated or that her pain is underestimated. Complaining loudly is just a way to gain others’ understading of their pain and pain-related problems. Without a steam valve to express her fears, worries, or frustrations, her pain behaviors may only increase.

You may be referring to capsaicin cream. This is a topical agent that acts as a counterirritant. The nervous system pays attention to the new messages of skin irritation. This may override messages to the nervous system from the primary (main) lesion or problem.

People with pain, numbness or tingling, or burning from shingles, amputations, and chronic pain may find a benefit from this treatment. Studies of patients using capsaicin compared to a control group (no treatment) or a placebo group (cream without capsaicin) show positive results for the capsaicin.

Some people may have an allergic skin reaction to capsaicin. Before spreading it over a large area, apply it to a small test site. You may want to put a dime-size amount of cream somewhere near your painful knee. If there is no problem after 24 hours, you can try it on a larger area around the knee.

There may be other more effective medical treatments available for your problem. If you have not had a physician examine you to diagnose the cause of your knee pain, this may be a good time to seek medical help first. Ask your doctor if capsaicin might be a good treatment method for your particular knee problem.

Complementary and alternative medicine (CAM) offers the patient alternative therapies that complement (go along with) traditional approaches offered by medical doctors and other health care professionals. Sometimes CAM medicine is referred to as unconventional or nontraditional therapy.

CAM is a more holistic way to view the whole patient including mind, body, emotions, and spirit. Holistic reflects the idea that these parts can’t be separated. It is believed that they are held together by a vital force sometimes referred to as ch’i or qi (pronounced chee) that flows throughout the body.

Anything that disrupts this energy force alters the balance of health and can result in disease and other unnatural conditions. By rebalancing the mind-body vital life force, the body can heal itself and restore natural health and an inner balance for you.

Alternative and complementary therapies are based on a different cultural attitude and different beliefs about health and healing than those offered by the traditional health care system. They offer an alternative to medications, surgery, or injections for chronic back pain.

Other benefits of CAM include relaxation, stress reduction, release of toxins from the body, and improved blood circulation. Many patients experience reduced anxiety and nervousness with increased mental and spiritual awareness. Even if CAM doesn’t eliminate chronic pain, these techniques often help improve function so that you can do more each day despite the pain.

There are many different types of CAMs available to patients. These can include (but are not limited to) acupuncture/acupressure, Shiatsu massage, chiropractic care, myofascial release, bioenergetics, homeopathy/naturopathic, herbal therapy, and hypnotherapy.

Physical and occupational therapists, nurses, and massage therapists are often the people performing many of these techniques as a complement to their practice. Some approaches such as Reiki, reflexology, yoga, and T’ai Chi are offered by practitioners who do not have a traditional medical background.

Some physicians are now providing traditional and alternative care under one roof. This is referred to as integrative medicine. In other communities, patients must seek out the individual services of one or more alternative practitioners on a private basis.

There are a few high quality review studies of complementary and alternative medicine with patients who have diabetic neuropathies. These studies support the use of electrical stimulation, Geranium oil, and shoe magnets. There is also some positive evidence that capsaicin topical cream can help alleviate nerve pain. The trials done so far were not specifically with patients who had diabetes.

It’s always a good idea to check with your physician first before trying new or alternative treatments. Depending on your age, condition, and medications you are taking, there may be a reason why you should not use some alternative types of care.

You may be someone who is very accurate in reading other people’s body language. Many people who are in pain exhibit pain behaviors that are subtle but visible to the sensitive or extremely observant person. For example, facial expressions such as wincing or even tension around the eyes or mouth can communicate discomfort and/or pain.

Some people also demonstrate protective pain behaviors that are not always evident unless you are looking for them. This may include increased muscle tension to guard against sudden movements. Holding, touching, or rubbing an injured or painful area may be gestures that you are picking up on.

The person in pain may give some audible signs of distress. Grunts, sighs, and even little moans direct our attention to their situation. Avoiding certain movements or activities is another way people in pain express their discomfort. Sometimes observing the absence of movement is a telltale sign of pain behavior that communicates a message.

Accurate perception of another person’s experience is called empathic accuracy. Empathy refers to ability to recognize or understand another person’s state of mind or emotion. It is often referred to as the ability to put yourself in someone else’s shoes. Empathic accuracy is the degree to which you are able to accurately identify another person’s feelings or thoughts.

Studies show that strangers may actually be more accurate in gauging someone else’s pain. Partners living with chronic pain patients may start to ignore pain behaviors. This helps reduce frustration or even anger on the part of the healthy spouse in order to protect the relationship.

Anyone in pain appreciates someone who recognizes their suffering. Your sensitivities may be a wonderful way to support such individuals — especially when family members’ patience has worn thin.

For certain types of injuries, it does seem that women are affected more with pain than men. While years ago it was thought that it was because women were the “weaker” sex, research is beginning to show that women do actually have more pain and experience in a different way from men in some instances. How and why this occurs, doctors don’t know yet.

It is known that women also tend to have more disabilities that involve pain, such as fibromyalgia and migraines.

Complex regional pain syndrome (CRPS) is a syndrome that doctors don’t fully understand yet. For unknown reasons, after a seemingly minor injury, someone can develop the extremely painful syndrome. In many cases, it does go away – but that seems to be a case of if it will go away on its own, it does so before you’ve had it for too long.

Whether your mother will see relief from her pain may depend on what her doctor has ordered and what she has tried. Because doctors don’t understand CRPS, many times, finding the right treatment is a case of trial-and-error until the right one is found for the right person.

There are many options to try if someone is living with the extremely painful complex regional pain syndrome (CRPS). What might work for one person may not work for another, so there may have to be a period of trying different methods before one may help relieve the pain.

Treatment isn’t aimed at the syndrome, because their no cure for it yet, so treatment is aimed at relieving pain. Usually, the first thing tried are medications – either in pill form or topical, creams and ointment. As with many types of chronic pain, some people find relief with certain types of antidepressants – there is something in the make up of the antidepressants that works on the pain transmitters. Other medications are cortiocosteroids or stronger narcotic (controlled) medications. Your doctor may suggest physiotherapy to help keep the limb moving. If the pain is severe, the doctor may suggest a treatment called a sympathetic nerve block, which involves injecting and anesthetic (numbing) medication into the nerve that feeds the painful area or even a special catheter or tube that is inserted into your spine to inject pain reliever.

You are actually much more of a typical case than not. Very few people with musculoskeletal pain really have just one pinpoint area of pain. When asked, most have widespread pain and symptoms. That’s why a drawing of this type is helpful.

Instead of focusing on one problem area, you can let your physician know the whole picture. This can be helpful when evaluating a problem or prescribing treatment. Diagnosing and treating local pain only addresses a small part of the problem.

In fact, there’s some recent research from Norway that shows localize pain may not really even exist. It’s much more likely that patients are like you — they come in with a specific problematic area (e.g., head, neck, shoulder, back), but when asked, they report many other areas of similar painful symptoms.

Putting the whole picture together shows how function is affected by increasing areas of pain. A local area of pain isn’t as likely to reduce daily physical or social activities like widespread pain does. So be sure and indicate every painful area on the chart.

If you can’t isolate it to a single pinpoint, then use the pencil to shade in the region affected. You’ll get a much more accurate diagnosis when you provide the complete information about yourself and your condition.

It’s easy for both the patient and the practitioner to get focused on one site of pain. But, in fact, studies show that most patients have multiple sites of pain and symptoms. This information can be very important when evaluating a patient’s condition.

A single site of localized pain can be a very different medical problem than one of widespread involvement. Joint pain or musculoskeletal pain and symptoms from more than one area suggests a systemic problem.

Instead of assuming there’s been a local injury from overuse or trauma, the clinician who knows there are other areas of pain is more likely to investigate arthritis, fibromyalgia, or other systemic origins of symptoms.

It wouldn’t hurt to make a phone call and let your nurse practitioner know you have other information about your case that might be helpful.

Managing disabling back pain is a major challenge for health care specialists. The use of opioids for pain control is very controversial. There’s no doubt these drugs are effective. But they do come with their own set of problems. Drug dependence and addiction are the biggest concerns.

Is it possible your brother’s physician doesn’t know about the history of alcohol use? Many physicians rely on patients’ self-report to recognize a problem. But this isn’t always accurate and can’t be relied upon.

Studies show the best predictors of a prescription drug abuse problem include a previous history of alcohol and/or other drug abuse, previous drug convictions, and a history of driving under the influence (DUI). Unless the patient tells the doctor about these behaviors, he or she will not have the information needed to prescribe or withhold narcotics.

In such cases, the physician must monitor the patient closely. This type of monitoring will help the doctor see signs of problems early on. Treatment can be modified at that point.

When used as prescribed, narcotic medications can be very effective without creating dependence and/or addiction. Signs that there may be a problem with misuse and/or abuse include:

The regulation of narcotics such as opioid therapy for cancer pain has been softened since the late 1990s. There just wasn’t enough evidence to support the idea that opioid treatment always led to severe addictions. And there were many chronic pain patients (including cancer patients) who really needed to benefit of these medications.

Studies showed that opioid use was helpful in controlling pain in the short-term. We still don’t know for sure about the effectiveness of opioids for long-term use. More studies are clearly needed in this area.

For cancer patients with a limited life expectancy, pain control and comfort become central issues. The concern for dependence and addiction take a back seat to quality of life. The goal is to provide helpful pain relief without adding unpleasant side effects.

There is still much argument and debate among health care professionals about the use of potentially addictive medications such as opioids. When these drugs are prescribed for chronic pain problems, there is concern that more and more drug will be needed to maintain the same level of pain control.

Becoming dependent on a narcotic makes it more difficult to withdraw from opioid therapy. This is true even when pain control is so poor there seems no point in taking the drug.

But new studies done in the 1990s and early 2000s have shown that opioids can be very helpful for various chronic pain conditions. For example, patients with arthritis, nerve-related pain, and cancer get good relief from pain. Sleep, anxiety, and function are improved. Quality of life measures are also improved.

Long-term use of these drugs still remains in question. Who is at risk for addiction? What exactly defines addiction? Is it the same from one person to the next? Does pain relief always mean improved function, less disability, or better quality of life?

All these questions have been raised about the use of opioid therapy for chronic pain. More studies are needed before we will have answers to guide us. Much more research must be done before opioids are routinely prescribed for every ache and pain that doesn’t go away as expected.

But for now, there has been a softening of some of the rigid policies regarding the use of these medications. You are probably seeing the result of this change based on current evidence available. As more information becomes available, we may see this policy change in the coming years.

Darvocet is an analgesic (pain reliever) used to treat mild-to-moderate pain. It is a weak opioid like codeine. Codeine is more commonly used but some people aren’t able to metabolize it.

It is not advised to change the dose of any medication without checking with your doctor first. Adverse effects of using this drug inappropriately can cause depression, heart problems, or even permanent harm such as liver toxicity.

Pain management can be tricky, requiring several trips back to the doctor to get everything just right. Physicians prefer to err on the side of under medicating patients rather than over medicating them.

It’s possible that a change in dosage or timing of the drug is all that’s needed. But it’s also possible that a different drug would work better altogether. The goal of treatment with opioids is to relieve pain, increase function, and improve quality of life. If you are not getting maximum benefit from your current medication, it’s definitely time for a recheck.

It’s a natural concern to be worried about the possibility of drug misuse, abuse, dependence, and ultimately, addiction. But, in fact, these medications can be used quite effectively to reduce pain and get patients up on their feet and moving and functioning.

Your father is probably fairly safe taking a narcotic for pain control if he doesn’t have any of the major risk factors for drug abuse. The strongest risk factor for drug misuse is a previous history of alcohol or other drug abuse. Previous episodes of driving under the influence (DUI), a criminal history, and young age are three other likely predictors of drug misuse.

Other treatment options for acute and chronic pain may include other, weaker pain medications, acupuncture, and physical therapy. Many pain management experts advise a combination of all three. Since pain is often a multidimensional condition, a multidisciplinary approach may combat it best. Psychologic therapy can be helpful. In some cases, surgical intervention may be needed.

Pain relievers that contain opioid substances are called narcotics. An opioid is a chemical substance that has a morphine-like action in the body. Because law enforcement refers to any illegal drug as a narcotic, doctors prefer to use the term opioid for any medication that has opioid-like actions in the body.

Opioids reduce pain and give people a general sense of well-being. They feel high euphoric. Opioids reduce tension, anxiety, and aggression. But they can also cause tolerance, dependence and addiction.

Tolerance refers to the individual’s need for increased amounts of the substance to produce the same effect. Dependence refers to the increasing use of the drug to maintain the same level of pain control.

Dependence is a physiologic dependence on the substance. Withdrawal symptoms emerge when the drug is stopped abruptly. Once a medication is no longer needed, the dosage will have to be tapered down to avoid withdrawal symptoms.

Addiction refers to compulsive use of and craving for a substance or drug. With addiction there is a daily need for the substance in order to function. It also includes an inability to stop use as well as recurrent use when it is harmful physically, socially, and/or psychologically.

Addiction is based on physiologic changes associated with drug use. But there are also psychologic and behavioral components. Individuals who are addicted will use the substance to relieve psychologic symptoms even after physical pain or discomfort is gone.

Oxycodone is an opioid (narcotic) drug with potential for addiction and dependence. The fact that you are even concerned about drug dependence is a good sign. But concern doesn’t always translate into prevention. So, asking the question is a good place to start.

There are some known risk factors for opioid misuse. The first is a personal or family history of alcohol or other drug abuse. Young age and a history of criminal activity or legal problems is another. Any episodes of driving under the influence (DUI) is a yellow warning flag.

People who engage in risk-taking behaviors and thrill-seeking activities are at risk for drug misuse and abuse. Heavy tobacco use, psychologic stressors, and severe depression or anxiety also lend themselves to opioid misuse.

Taking meds in ways other than it was prescribed can be a problem. Talk to your doctor if you find yourself taking double or triple doses or taking the next dose before the recommended time. You may need a change in the overall pain management program.

There are screening tools that can help assess patients for drug problems. Questions are asked related to mood swings and family problems (or friends) with alcohol or other drugs. The use of illegal drugs such as marijuana or cocaine in the recent past (last five years) puts you at increased risk for drug misuse. Your physician or a drug addiction counselor can help you identify your personal risk level.

Many people (and even some health care professionals) are surprised by this simple recommendation. But the research and evidence just don’t support more than that as a first-line treatment approach to nonspecific back pain. Nonspecific refers to the fact that there is no known cause for the pain.

At this point, groups such as the American College of Physicians (ACP) and the American Pain Society (APS) have even suggested holding off on more aggressive treatment or even imaging studies for that matter. They say that a review of the studies done so far show that self-care is the way to go.

When it comes to back pain, simple pain relievers and gentle physical activity work as well as anything else. There’s no evidence that more invasive care is going to help. Steroid injections, invasive diagnostic testing, and surgery are no longer on the front lines of care for patients with low back pain.

There is some concern about this type of minimalist approach. The American Society of Interventional Pain Physicians (ASIPP) have their own set of guidelines. This group supports pain management with intervention early. They say an aggressive approach may prevent chronic pain and disabilty from developing.

Decompressive laminectomy (removal of bone from around spinal nerve roots) and discectomy (removal of damaged or herniated disc material) bring faster pain relief and return to function. But the ACP and the APS counter this argument by saying that long-term studies show no difference in final results several years down the road.

Self-care is probably a good way to get started. Stay in close contact and communication with your physician. Ask for follow-up care if you don’t have a steady return to normal.

Sometimes a second step in pain management is needed. It doesn’t have to be invasive such as surgery. Physical therapy for some specific exercises may be a good intermediate step when analgesics and activity aren’t enough.

Living with chronic pain can be very difficult and many people who have chronic pain, including chronic lower back pain, can end up being depressed. This then can cause a vicious cycle with the pain: the more pain, the more depressed – the more depressed, the more pain.

There is research that is going on to try to find the best approach to break this cycle in patients and – even better – stop the cycle before it starts. Researchers are aware that the patients who have this pain need to know how to handle set backs or turn off negative thinking that can contribute to the increase of pain.

As the cycle goes now, the patient has pain, feels depressed or scared to aggravate the pain. He or she then stops moving too much to avoid bringing the pain on. But, as he or she doesn’t move, stiffness sets in as does weakness, making the back less able to bear the weight and work that it needs to. And then the cycle continues.

As far as your father goes, it’s important to understand why the pain keeps coming back. Is it because he feels he has no control? Is he not keeping up with recommended programs for pain relief? If you can figure out the base, you could help him realize his role in the situation and help him understand how he can help himself.