FAQ Category: Pain

When a patient with chronic pain is referred for counseling or participates in group sessions, this is in no way a sign that the pain is not real. In fact, the sessions are helping people learn how to cope with their pain and perhaps find ways to lessen the pain.

For example, someone who is very stressed and under a lot of pressure may feel more pain than someone who has learned to manage the stress so that it doesn’t affect the body physically. If your back is painful and lack of exercise is contributing to the pain, counseling may help you learn how to overcome the fear of exercising.

More and more, counseling is becoming an integral part of pain management.

When a human feels pain, it is the result of damage, inflammation or some disturbance to body tissues. In some cases, the pain is easily detected and treated. For example, a broken arm can be x-rayed, diagnosed, and treated, the same for a cut that needs stitching.

It gets more complicated with pain that is inside the body, such as problems with the stomach or appendix. However, these can still be tested and treated by surgery or medications. Nerves, however, are a different thing altogether. Nerve pain can be more difficult to diagnose and even more difficult to treat.

Nerve pain is caused by damaged nerves that cause tingling, burning, or severe pain. What makes it even more difficult to pinpoint is the original problem that caused the neuropathic, nerve, pain may seem completely unrelated. FOr example, someone with diabetes can develop a very painful disorder called diabetic neuropathy, which causes pain along the nerve endings often in the feet. Or, you could have a spinal cord injury that causes nerve pain elsewhere in the body.

Finally, another reason that makes nerve pain hard to diagnose is that it can be felt differently by different people. Some may feel an intense burning, while others may feel electrical shock-like sensations.

Right now, there are not too many medications on the market that can adequately help relieve nerve pain. Those that are available can be very helpful for some, but for others, they may not help at all.

Nerve pain, also called neuropathic pain, can vary from person to person. Some may feel the nerve pain constantly, some may feel it occasionally or at certain intervals. Some symptoms of nerve pain are:

– Pins and needles

– An electric shock-like feeling

– A stabbing pain, like a spike being driven into your hand or foot

– Walking on broken glass

– Burning pain

– Tingling

– Numbness

Pain is a very subjective sensation – people don’t all feel pain the same way. We also have a tendency to want to be able to see what is causing the pain. How many times have you heard someone looking at a bad wound say, “oh, that’s got to hurt”? If people don’t see the injury happen or see the results, it’s often not something that they consider as being very painful.

Another reason why it’s difficult to get some people to understand the chronic pain is that many people who do have chronic pain have good days and bad days. On good days, they can accomplish a lot, on bad days, not so much. If people see them running around on good days, they may question how bad the bad days actually are.

The only way you can help people understand is through education. If you can help people understand the problem that is causing your pain, they may be more understanding of the pain itself.

Research shows that pain experience has physical, cognitive, motivational, and emotional factors. Research also demonstrates that persons with depression and catastrophizing will often display more pain behavior in response to pain. They are also more likely to avoid activity for fear of increased pain, which then leads to more disability.

Pain is an experience that is influenced by many factors. It is not only a physical experience, but is influenced by emotional states such as depression, anxiety, fear, motivation, and previous experience with pain.

Scientists aren’t sure what is the exact mechanism behind musculoskeletal pain associated with fibromyalgia. It appears that there is a wide range of differences between patients. Pain intensity and duration varies from person to person.

What we do know is that the cramplike, diffuse muscle aching of fibromyalgia occurs when muscle receptors called nociceptors get turned on or turned up. Group III and group IV muscle receptors (nociceptors) are affected.

These nociceptors respond to mechanical or chemical stimulation. Substances released by the nerve endings sensitize the nociceptors. Once the nociceptors get fired up, neurons in the dorsal horn of the spinal cord also get turned on.

The messages between the muscles, spinal cord, and brain prolong the muscle pain. This creates a state of chronic muscle pain called hyperalgesia. Pretty soon, there are more receptors responding to normal stimulation as if it were noxious or painful.

The result is even more pain that can be great enough to travel to other areas of the body. This phenomenon is called referred pain. Motor control can get disrupted so that pain occurs at rest and becomes chronic (present all the time).

The actual process by which pain associated with fibromyalgia develops is very complex. Altered pain thresholds, involvement of neurotransmitters, and exaggerated responses of the nervous system may be part of the process. There remains much we don’t know about this painful condition.

Pain that is felt at a place other than the site of origin (where it started) is called referred pain. Referred pain isn’t just pain that has spread a little farther from where it started. It is actually at a distance from the source. It is a very common occurrence in the body.

Muscles, bones, and organs can cause referred pain. Many of the referred pain patterns are well-known. Doctors and therapists are trained to recognize these pain patterns so they won’t be fooled into treating the wrong area.

The exact mechanism for referred pain is unknown. Scientists are actively looking for a neurophysiologic explanation. The brain does receive multiple messages at the same time from areas innervated or supplied by the same nerves. It’s possible that the central nervous system misinterprets the incoming messages and assumes the problem is coming from the wrong place.

Animal studies have led researchers to wonder if pain messages to the brain cause new pain receptors located in other areas (but still supplied by the affected nerve) to form or turn on. The pattern and size of referral varies from one musculoskeletal pain condition to another. Comparing referred pain patterns from a wide range of causes may shed some light on this phenomenon.

In the case of hip pain caused by a problem in the low back. It could be something as simple as pressure on a spinal nerve that supplies sensation to both places. The central processing functions of the nervous system just misunderstand the messages being sent.

Patients with chronic pain really don’t fit in one category together. The only thing they have in common is their pain. Comparing one to another is difficult because they are very different from one another. Some chronic pain patients can be classified into smaller subgroups and treated based on this grouping.

The groups may be defined based on specific characteristics. These may include physical signs and symptoms, physical activity level, or behavioral factors. For example, behavioral factors are known to influence how people deal with their pain.

Fear, fear-avoidance, and anxiety are behavioral factors that can predict and explain disability associated with chronic pain. Pain perception can lead to impaired levels of functioning. Treatment can be geared toward decreasing the impact of these behavioral components. Sometimes the goal isn’t to decrease pain but rather, increase activity despite the pain.

One thing that should be standard from patient to patient is the clinical assessment. A complete evaluation of medical, physical, and psychosocial status is important. Finding the right treatment for each person with chronic pain requires an inventory of all possible factors that could affect the patient’s disability level.

Experts suggest that treatment must be tailored for each patient based on the results of this assessment. The real goal is to find the right treatment at the right time for each individual. So far, there isn’t a cookie cutter approach or recipe that can be applied just because they share a common label.

Scientists are beginning to examine virtual reality (VR) as a way to address chronic pain. VR allows a user to interact with a computer-simulated environment. It could be real or imagined.

Most VR programs offer visual experiences. They are shown either on a computer screen or through special TV displays. Some simulations include sound heard through speakers or headphones. More advanced systems also include tactile input (touch). This feature is referred to as force feedback in medical and gaming applications.

Altering the focus through VR is a way to influence (and maybe even change) a person’s focus. By doing so, it may be possible to decrease the person’s perception of pain. Some studies have already shown that using VR to distract young children can bring pain relief (or pain prevention) for children having painful medical procedures.

MRIs show that brain waves associated with pain are less active when children are distracted by VR gaming. VR as an analgesic (pain reliever) is a novel and new approach that has unlimited potential. More studies in this area are definitely needed.

Healthcare professionals tend to use terms like chronic pain and acute pain without realizing that the patients may not understand what we mean and this is a good question.

Acute pain is a pain that is usually of sudden onset and something that you can pinpoint and treat. Examples of acute pain are:

– tooth ache

– surgery

– broken ankle

– burn

– stubbed toe

Chronic pain, on the other hand, may have come on suddenly, like a broken ankle, or it may come on gradually without being noticed as to when it started, like migraines. Some examples of chronic pain are:

– arthritis

– lower back pain that lasts several months

– endometriosis

– migraines

Chronic pain is not as definable is usually more difficult to treat than acute pain because it can’t be pinpointed. Some doctors feel that pain lasting for three months or more should be considered chronic, while others say it should be six months or more.

TENS, transcutaneous electrical nerve stimulation can be done in a doctor’s office, physiotherapy clinic or even at home if you have been instructed how to use it correctly.

Like all medical treatments, there are a few disadvantages to TENS as a pain therapy. First, it isn’t known if TENS should be used on pregnant women. There hasn’t been any definitive research into if it can cause damage to the fetus. Some people develop skin irritation to the area where the TENS is applied and, if you have a pacemaker, you should check with your doctor first before trying this type of treatment.

Not all back injuries will or can respond to epidural injections – injections directly into the spine.

If an epidural injection is the recommended treatment, it can help by injecting the medication directly to the area causing the pain. The medication could be an anti-inflammatory and/or an anesthetic to numb the pain.

Some types of injections are meant to damage the pain pathways, so the pain sensation can’t be transmitted.

As difficult as it is to quantify pain, there have been many attempts at different types of questionnaires to do just that. Doctors are aware that what might be annoying for one person may be excruciating for another. The important issue is to remember that neither person is right or wrong in his or her interpretation of pain.

After doing the regular physical tests to ensure that anything that can be treated is, doctors can do different evaluations of how pain is affecting the patient.

If a patient’s pain is affecting the quality of life, keeping him or her from working or participating in daily activities, this needs to be addressed, regardless if other people may not experience the same level of pain with the same injury or illness.

Using questionnaires that assess pain intensity, frequency, location, and its effect on a patient’s life is the first step to better understanding how to help the patient.

You’re right, there are many different types of questionnaires at the doctors’ disposal. Which one the doctor chooses depends on what he or she is looking for, the type of pain involved, and often the part of the body involved.

For example, there are questionnaires that focus on the pain of migraines, while others focus on the effect of hip pain on mobility and every day life. Therefore, it would be impossible to say which questionnaires are the most reliable.

Scientists – and others – are curious about human nature, what makes us tick and why. Of many emotions and experiences that aren’t understood, the feeling and perception of pain is one of the most curious.

The drive to understand human reactions to pain, for many researchers, is aimed to help us better control pain. The idea is if the researchers can understand what causes the pain and what makes it worse, they can find ways to ease the pain, if not prevent it completely.

So far, many connections have been found between how people perceive pain and how they feel it. With this knowledge, researchers can work on ways to help ease pain by helping people see it or perceive it differently.

Pain is pain, whether we can see its cause or not. If someone is experiencing pain, the intensity of it is personal. Some people can break a bone in their foot and keep walking while others would be unable to do so. It’s not that one has pain and one doesn’t – it’s the perception of pain and the pain thresholds that are different.

Researchers are have been studying pain and its effect on people for decades. They are trying to find what factors increase and what factors decrease the sensation and perception of pain. What many researchers have found is that pain, although definitely present, can be affected by certain psychological issues.

If someone can relax and visualize themself without pain, that person may have significantly less pain than someone who can’t do that. Or, someone who believes that they have some control over their pain may feel pain not as intensely or for as long a period as someone else. On the other hand, this may not work for some people at all.

So the challenge is, if these psychological approaches to pain work in some people, why do they not work in all? And, how exactly do they work in some people? If researchers can discover this, it’s possible that they can find ways to help everyone who has pain.

Yes, because a drug may be beneficial to a small proportion of people who are responders, present study designs may dilute results due to the non-responders. The authors of a recent study suggest the use of a study design called enriched enrolment with randomised withdrawal, EERW. In this study design, subjects are tried on a drug first, and only those who have a positive response are then randomised to study it further.

Illness behavior is a part of human illness. However, it can be out of proportion to the physical problem and then becomes counter productive. Illness behavior can be an expression of emotional or psychological distress that some conclude can be important in the development and maintenance of chronic pain.

Phantom pain is a pain that is felt in a limb that has been amputated. The person who is feeling the pain actually feels a burning, stinging, cutting, or even itching sensation, even though the limb is not physically there.

Doctors don’t understand how and why the pain is caused, but the reality is that the pain is there and needs to be managed. Some patients have had success using medications that are meant to deal with neuropathic pain, or nerve pain, although it is not effective for everyone.

There are new treatments being studied as well. For example, recently a study was published showing positive results when people with amputations used mirrors to put their body into perspective. This seemed to have some effect on the perception of pain.

Phantom pain does tend to decrease for many people eventually.