FAQ Category: Pain

Prescribing opioids (narcotics) for cancer pain was not considered to pose significant risk for abuse of the medication, diversion which is the selling or trading of a drug, or addiction given their short-term use.

However, since providers have been prescribing opioids for chronic, non-cancer pain, the abuse of prescriptions opioids has greatly increased. In recent years, there has been a seven fold increase in Emergency Department visits and overdose deaths related to oxycodone alone. Other studies have shown that the rate of prescription opioid abuse has surpassed the rate of heroin use.

The companies that make opioids are try to help by making abuse-deterrent pills. The pills make it difficult or impossible to remove the opioid by crushing, biting, snorting, or injecting it. The hope is that this will reduce the risk of abuse, addiction, as well as diversion as the street value will be decreased.

Qigong, pronounced chee gung, is an ancient Chinese practice of treating and healing, and preventative medicine. There are several categories of qigong, only one of which is to help heal chronic pain. Someone who practices qigong learns how to use breathing techniques and body movements, as well as meditation, to help the body become stronger and heal itself.

It is believed that if you practice qigong, you will be able to help relieve your pain.

There may be a biomechanical explanation for your painful symptoms. For example, if the sacrum and pelvis aren’t centered and stable, then back, leg, knee, and even neck and shoulder pain can develop.

Chiropractic and osteopathic physicians base much of their treatment on this notion. They believe that restoring normal balance to the pelvis will reduce or eliminate these other painful problems.

But it’s also been observed that few people ever experience pain in just one area. Most people report multiple sites of pain and/or symptoms. This is especially true in adults who have chronic pain of any kind. In fact, studies show that the risk of pain in multiple areas increases with each instance of regional pain.

The reasons for these pain patterns remains a mystery. Scientists are trying to unravel specific links and risk factors for multiple sites of pain. The hope is that by identifying who’s at risk, it may be possible to prevent pain from progressing from an acute state to a chronic pain syndrome.

You make some good observations and ask a question that has been raised by many doctors and patients. Oxycodone is an opioid (narcotic) drug that is one of several used to control chronic pain.

Trauma, surgery, and cancer treatment can lead to chronic pain. Sometimes the most effective way to control that pain is through the use of potentially addictive agents. This is an appropriate use of narcotics. But it must be managed carefully.

The real problem in our society is the large number of people who do not have a legitimate medical need. They use and abuse alcohol and other drugs for the effects these drugs provide. The risk of addiction is much greater in these individuals compared with medical patients who do not have a lifetime history of problems with substance abuse.

There is an effort underway to develop opioid abuse-deterrent products. Such a drug would allow for the management of chronic pain but patients would remain abuse resistant. The challenges facing drug companies in this research effort are wide-ranging.

According to experts in the field, opioid abuse-deterrent formulations will eventually be made available. Research and development using human subjects in trials with narcotic agents takes time. Finding a product that deters one type of abuse may not work for others. It’s likely that more than one drug will have to be developed.

The Food and Drug Administration will play a key role in deciding how these products can be marketed and advertised. Guidelines will have to be developed for monitoring the use of such products. We may be several years away from a workable solution to this problem.

It is an irony in this country that people are buying and selling prescription drugs on the streets. At the same time, patients with real medical problems can’t get the same drug for a legitimate purpose.

There are actually many methods used to obtain prescription medications illicitly. Some people steal prescription pads while in the doctor’s office and forge their own. Others change the way the drug is administered. For example, instead of swallowing the pill, they crush it up and snort, smoke, or inject it.

Stealing or borrowing from others, such as family and friends is not uncommon. Pretending to lose a prescription or demanding more drug works for some patients.

People with a long history of drug and other alcohol use and abuse are really the ones at greatest risk for addiction. Casual users of narcotic medications without a medical need can also lead to addiction.

Doctors are rightly concerned about avoiding drug addiction for their patients. But with careful management and close follow-up, chronic pain patients can benefit from narcotics without concern about misuse and abuse.

With the increasing costs of all aspects of medical treatment, patient referral to physical therapy (PT) and other health services must be based on evidence of positive results. Predicting which patients can benefit from PT is the focus of numerous studies.

There are several factors that have been consistently identified by many researchers as predictors of results. Patients with one or more of these predictive factors are at increased risk for treatment failure. These include manual labor, severe pain intensity, and neck pain lasting more than three months.

A new study from England has added two more factors that may be even more reliable than these items already listed. Low expectations of treatment and catastrophizing most of the time have now been placed at the top of the list of predictive factors for poor outcome.

Patients who catastrophize describe their pain in emotional terms. They use words like torturing, dreadful, or terrible to describe their symptoms. They are more likely to report that the pain is killing me. Or they declare they will never get better–ever.

We are a long way from understanding and explaining pain. How pain gets started and why it doesn’t go away for some people is a key area of research.

Studies clearly show that most people report pain in more than one area at a time. Some pain patterns are almost predictable. For example, back pain is more likely to occur in people who also have facial pain. Back and knee pain together are common.

Is this because back and knee pain are the most likely places to have pain in the first place? Is it just by chance that they happen at the same time? Or is there some pain mechanism that turns pain on in paired locations?

None of these questions have answers just yet. Risk factors (including heredity) are being studied. Since the occurrence of pain at multiple sites affects so many people in the general public, heredity isn’t strongly suspected.

Other risk factors such as occupational activity may be a more likely cause. Repetitive motions involving the entire body may lead to pain in multiple sites. Certain conditions such as fibromyalgia or osteoarthritis tend to affect more than one area at a time.

Social, cultural, and economic risk factors may have a distinct role in type, location, and severity of painful symptoms. Since family members tend to share these characteristics, they may be the reason why you see similar pain patterns among your relatives.

Many studies have been done about the perception of pain and catastrophizing of pain, meaning that people will think the worst will happen if the pain is aggravated. It is known that our perception of pain does affect the physical aspects. This is why some people receive good relief from methods such as biofeedback and cognitive therapy. The issue isn’t so much of the pain is mental or physical, because both types of pain are real and can affect your quality of life. The issue is how to deal with it.

If you feel that your reaction to pain may be making it worse, it would likely be helpful for you to looking into getting an appointment at a pain clinic or investigating emotional and psychological ways of working with your pain.

Without knowing your mother’s history, what is causing the pain, and what she is taking, we can’t say why the pills aren’t helping. However, different pain medications act differently on the body’s systems and they way they relieve pain. For example, if you’re taking an anti-inflammatory medication, your body works on reducing the inflammation or swelling that is causing pain. If you are taking an opioid, like codeine or morphine, the medication works by blocking the pain sensation and perception before it reaches the brain. Some medications combine the two types of drugs together.

There are also medications that were discovered to treat other problems, but doctors found that they were effective in treating certain types of pain. One well-known group is the antidepressants. Many people are prescribed antidepressants for pain relief.

Morphine-like painkillers are referred to as opioid analgesics. Use of these drugs has been on the rise since the early 1980s. It used to be that opioids were reserved for chronic pain patients. Terminal cancer patients were the main users.

But as the drugs have improved with fewer side effects, their use has also expanded. Doctors are more likely now to presribe opioids for patients with pain from an acute injury such as yourself. The idea is to gain pain control early and prevent a chronic pain-spasm cycle from occurring.

But there’s some new evidence that the use of opioids to treat painful, acute symptoms may not be the best idea in the long-run. Over time, it appears that patients who take opioids early (within the first 15 days of injury), are more likely to have problems later.

They are six times more likely to still be taking opioids much later. They are three times more likely to have back surgery. And the number of days with disability off work is much longer for patients who took early opioids.

Limited use of opioids may be appropriate for your situation. Some experts still advise the safest medication for the pain and disabling symptoms from an acute injury is still acetaminophen (Tylenol). Nonsteroidal antiinflammatories are also a good option.

If you have any doubts or concerns, give your doctor’s office a call. The nurse is usually able to answer these kinds of questions.

Complex regional pain syndrome (CRPS) is not yet really understood by doctors and researchers. They do know that CRPS causes pain, but they have yet to figure out what is actually causing the pain. The also don’t know who will recover and who will not.

Some patients with CRPS recover spontaneously on their own, while others continue to experience the pain despite any attempts at treating it.

The root of complex regional pain syndrome (CRPS) hasn’t yet been discovered. As researchers work on finding out the exact causes, the only treatments currently available are to treat the symptoms of pain. Some people with CRPS find pain relief from medications (pills, shots, creams), injections of pain relievers to the site or to the spine, or through biofeedback and relaxation.

What may work for one patient may not work for another and, unfortunately, even if a patient does find a method that provides pain relief, that treatment may lose its effectiveness over time.

As a general rule, therapists and specialists working with athletes who sustain major injuries notice that recovery may be faster compared with inactive people (couch potatoes). Nurses in hospitals often comment on the fact that certain highly competitive athletes survive injuries others might not have lived through. Whether or not this is true has never been formally tested.

Researchers studying back pain are trying to determine any predictive factors for chronic pain and disability. Physical fitness and activity level always comes up as a possible predisposing factor.

Disuse or decreased activity level in daily life has been proposed as a key factor in failed recovery among low back pain sufferers. It is proposed that injury leading to a decline in activity will result in chronic low back pain.

A recent study from the Netherlands tested out this theory but couldn’t prove it true. They followed a group of back pain patients for a year. There was no evidence that pain lead to activity decline. The general belief that people with chronic back pain are deconditioned just didn’t stand up in this study.

Depressed mood, negative outlook on life, and fear of re-injury may be more predictive of chronic pain than a decrease in physical fitness. A person’s perception may be far more powerful than their reality. Some people with chronic back pain think they are disabled. Yet their physical activity level is no less than someone without chronic pain.

It’s clear that some people cope with pain using endurance strategies. They increase rather than decrease their exercise and activity. If this describes you, you may not benefit from a rehab program that focuses on increasing your physical fitness. That type of program would just overload your muscles even more.

You may need a specialized program. The therapist will assess you for specific disabling activities or changes in activity pattern that you may not even be aware of. The therapist may be able to help you learn better ways to move that won’t load your spine as much.

And it’s possible there are ways to modulate your pain so that you can continue doing what you want to do activity-wise with less pain and/or discomfort. Chronic pain has a way of changing how your body moves and perceives movement. Based on this fact, you may be at increased risk for future injury.

The therapist can help you regain normal proprioception (sense of joint position) and kinesthesia (awareness of movement). If there is a movement impairment of any kind, the therapist can guide you through specific exercises and patterns of movement to restore full and normal motion.

Complex regional pain syndrome (CRPS) is triggered by a peripheral event such as a traumatic injury, burn, or bone fracture. The patient develops a wide variety of symptoms affecting sensation and movement.

Sometimes, for reasons still unknown to us, the patient also develops a movement disorder. With CRPS, there’s a loss of motion and loss of function. But with the movement disorder, suddenly they can be jerking motions or tremors of the fingers, hand, or arm.

Some people experience a movement disorder called dystonia. The fingers and wrist start to flex into a fist and won’t open up again. If the leg is affected, the foot does the same thing. The toes point downward and get stuck in a claw-like position.

The natural history (what can or will happen) remains unclear. For some patients, the problem may get worse. It can move up the limb to involve more body parts. Or it can even jump to another limb. If the arm and hand are involved, the shoulder and face can start to develop similar symptoms.

There have been isolated reports of spontaneous recovery. Most of the time, a long course of rehab is needed to maintain motion and function. Whatever triggers the CRPS and movement disorder doesn’t seem to have a means of turning off the changes.

Scientists are working very hard to identify these triggers and mechanisms. The hope is to both prevent the problem from occurring in the first place and treat it once it does occur.

No one is really sure yet what the relationship is between complex regional pain syndrome (CRPS) and dystonia (a movement disorder). Both seem to occur after a traumatic injury. They don’t always develop at the same time but dystonia does seem to come after CRPS. Sometimes people with CRPS never have any of the many movement disorders possible.

Other reports of the abnormal postures persisting during sleep have been published. EMG (electromyographic) studies have been done. The affected muscles were tested during the various phases of sleep. Despite the fact that the hand position stayed the same, the EMG activity was not continuous as might be expected.

Researchers aren’t quite sure what to make of all that. They suspect the circuits of the nervous system are not balanced. Perhaps some pathways got turned on and stuck in the on position. If trauma is what ignites these two conditions, how is the fuse lit in the first place? That’s the question facing many scientists as they search for answers to this perplexing problem.

Most agree that it is not a psychiatric or emotional problem. The nervous system is the problem area but the exact mechanism is still unknown.

You may be describing a condition called complex regional pain syndrome (CRPS). CRPS occurs after trauma such as a soft tissue injury, fracture, or surgery. Pain, extreme sensitivity to touch, and increased skin sweating are common symptoms of CRPS.

In up to half the patients, additional symptoms of tremors or a movement disorder called dystonia may occur. Dystonia is a sustained muscle contraction causing abnormal postures. The flexion of your fingers, hand, and wrist may be the result of a movement disorder such as dystonia.

You may need some additional testing. It might be a good idea to ask for a referral to a neurologist for a more specific diagnosis. CRPS-related dystonia is not caused by a psychologic reaction to trauma.

Scientists believe this condition is most likely the result of a problem in the nervous system. The central circuits get turned on, but never turn off again or even down regulate once the traumatic event is over. The exact mechanism for this to happen is still unclear.

CRPS stands for complex regional pain syndrome. CRPS occurs in many people after some kind of trauma. Fracture is a common injury to set it off. With CRPS there is pain, swelling, and abnormal sensitivity to any touch. The skin may start to sweat and grow dark patches of hair.

The abnormal posturing of her hand may be a secondary problem called dystonia. Once CRPS develops, dystonia can occur any time from right away to up to five years later. Not everyone with CRPS has dystonia. Studies report a wide range from nine to 49% of patients who have CRPS-induced dystonia.

The two problems you’ve described here are fairly common but don’t seem to be linked with age. Women are more affected than men but the reason for this remains unknown. The question often asked is: what went wrong? The answer lies in the nervous system’s processing of sensory information.

Researchers are still trying to figure out exactly what went haywire but so far the exact mechanism remains unclear. More studies are being done to find ways to treat CRPS and dystonia. The goal is to prevent these problems from happening in the first place.

Many studies have been done on pain perception and differences by age, gender, and even personality type. Measures of acute pain have been made looking to see if some people just experience pain sooner and more intensely than others.

In a recent study from Vanderbilt University, pain intensity was compared for two groups of people based on their anger management styles. One type of anger management is called the anger-in management style. This refers to the person who holds emotion in and doesn’t express it.

The second anger management style is called anger-out. This is the person who verbally and/or physically expresses anger easily. Your husband may be an anger-out individual, while you may be more of an anger-in person.

In the study, everyone was exposed to three types of pain. There was pressure as the tip of the index finger was squeezed with 2000 grams of pressure. Forearm ischemia was next. Ischemia refers to cutting the blood supply off to the area for a short time. And third, heat was applied to the forearm. The temperature was raised until the person couldn’t take any more.

It turns out that there was no difference between the sexes. The main difference was whether or not the person was in the anger-out group. This group had more intense pain and less natural (endogenous) opioids released. Or at least there were fewer opioids measured in the blood.

It’s possible that both groups release the same amount of opioids but they just don’t get picked up and used by the cells in the anger-out group. Or perhaps their tolerance level for pain is higher and the opioids aren’t released until much later.

The person smashes the thumb then screams and hollers. About that time, the natural pain relievers are released and they feel much better. This is just one way to explain it. There are many explanations but very few facts known about pain response/pain control.

The factors and variables affecting pain perception are not clear. Studies trying to match predisposing factors with pain and outcomes are ongoing. It’s a little like the chicken and the egg question. Which came first: the pain and then the response to it? Or does the difficult personality predispose the individual to higher pain intensities?

We just don’t know yet. Perceived unpleasantness and a generally negative outlook on life do seem to go hand-in-hand with increased perceptions of pain. But some early studies looking at the natural chemicals released by the body in response to pain suggest a different explanation.

It’s possible that people who express anger more easily than others are slower to release these natural pain killers. They may have a higher threshold for triggering the release of the body’s natural opioids. They may not have a deficient opioid analgesic system after all.

According to at least one study, anger management style has more to do with it than just general negative affect. Affect refers to our outlook and approach to things. It turns out that people who are more likely to hold anger in and not express it, have a higher release of the natural body chemicals against pain.

The opposite is also true. People quicker and better able to express anger have lower levels of the natural opioids to fight against pain. Finding ways to trigger the release of natural opioids is the focus of future studies.