What Ails You: Dealing with the challenge of chronic pain

Everyone, at one time or another, will experience pain. It is an unwelcome intruder which warns us of impending injury (like when we are lifting too much weight) or that reminds us of mistakes already made (sprains and strains).

Acute pain is the pain immediately following an injury. Something has stimulated a nerve (your evil brother pinches pulls your hair), the nerve is sending a message to the brain and the brain, in turn, sends a message to the conscious — “Ouch!” With acute pain, frequently, remove the offender (put the evil brother in the corner) and the pain stops. This is nociceptive pain — pain caused by something which can be identified as the offending condition and at least treated if not healed.

Chronic malignant pain is ongoing pain that is associated with an ongoing problem. A bursitis that persists over several days or a few weeks, a disease eating away at an organ, the degenerative changes in a joint affected by arthritis are all examples of chronic malignant pain. Here again, the cause of the pain is clear and can normally be addressed fairly simply.

A more complex and frustrating condition is chronic nonmalignant pain or neuropathic pain. In this case, whatever started the pain is no longer an issue yet the pain persists. Many folks who have had back surgery know all too well about this pain. In fact, back surgery only offers complete relief of pain 35 percent of the time. For those in the sad majority, some degree of the preoperative pain stubbornly persists. With each surgery, the chances of completely relieving the symptoms is diminished. The success of a back surgery is measured in the patient's return to function, not in their recovery from pain and yet it is the pain which is no doubt the primary concern of the patient.

I use back surgery as an easy example most of us can relate to. There are many other conditions which leave lingering neuropathic pain. In fact, any surgery can leave a residual pain even though the procedure was technically perfect and completely resolved the target condition. Folks who have had a back injury resulting in leg pain that was never addressed by surgery can develop neuropathic pain.

In order to overcome neuropathic pain, you must first recognize the disease. You need to understand all of the implications of chronic pain. The pain will take over your life if you let it. After a dozen referrals, even more diagnostic tests, more doctor visits than you can count, victims of chronic pain can fall into the “sick role.” Pain is in your every conversation. You quit even attempting to do things because you fear the pain will not let you. Nearly two-thirds of all patients with chronic pain exhibit signs of depression or anxiety.

The pain is not “in your head.” It is real. Needing help to manage it is not a sign of weakness. You must get over any social phobia about psychiatry. In fact, it is antidepressant medications (Elavil, Paxil, Zoloft) managed by a psychiatrist which are the first line defense against neuropathic pain.

You will be the captain of a team of experts who will help you to overcome the disease and regain control of your life. Since your doctor will coordinate any other care you receive, find a physician well versed in treating this condition. You need a doctor with whom you can talk honestly, who you feel is responsive to your concerns and who takes the time to answer your questions. Your doctor should be familiar with all of the weapons in the medical arsenal against chronic pain. You will hear talk about morphine pumps, spinal stimulators, biofeedback sessions.

You are the cure. You will need to gather all of your inner strength, make a commitment to regaining your life and marshall as many professionals into your ranks as possible.

ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com