Chronic Pain 2

chronicpain

2…..And the beat goes on

So where did I leave off?

I talked about how doctor’s try to measure our pain with a 1 to 10 scale. Pain is subjective. There are so many words to describe pain, probably 100’s but I will try to provide a few adjectives that I have heard.

Pain is a very personal experience.People with the exact same illness or injury experience their pain differently.

pain

WHY?

We experience pain differently because we all have different “perceptions” of our pain. So many things can influence our pain. Here are just a few.

*     CONTEXT: where and when the pain occurs. Say that you are in a plane crash. You are not alone. There are people laying on the ground with many types of injuries. You have a complex fracture of your left leg. Still, you crawl about trying to tend to victims with even more serious injuries. You barely feel your own pain until you are rescued and the crisis passes.

*     HOW YOU THINK ABOUT YOUR OWN PAIN: Sometimes my pain is so bad that I can barely think about anything else. I am up there around an 8 or 9 on the pain scale. I am a dishrag because I am totally immersed in the pain experience so I do not allow for “distraction”.

One of my worst fears is getting burned in a fire. I know through my research that burn victims suffer unimaginable pain as they undergo treatments or therapy. However, research also has found that burn victims experience less pain if they allow themselves to be distracted by playing interactive video games as they get treated. So, I guess the lesson here is that when I am in severe pain, I need to “distract” myself with  music, TV, movies (not too intense), etc. Most recently I started playing solitaire on my tablet (so long as my pain does not  rest in my wrists) and I believe it is helpful. Not completely, but it may bring the pain down to a 6 or 7 which is more manageable.

    ANXIETY AND FEAR – sometimes I fear that I have absolutely no control over my illness/pain. Negative emotions contribute to pain. However possible, added stress needs to be avoided. To avoid those awful feelings I have no power in my illness, I try to “participate” more in my treatment by discussing medications, procedures, surgeries and diagnostic procedures with my doctors. It really helps you feel like you are more of a “partner” in your care, as opposed to being somebody’s “patient” with no will of my own.

•      MEMORY – Ask yourself if you have ever felt “this kind of pain” before. We all have expectations of pain. I had a very painful inflammation of my rib cage awhile ago. Practically any movement (lifting, raising my arms, breathing, etc.) caused pain in the range of 9. Just a few days ago, I thought I was feeling the onset of another bout of “chondroitis” and almost felt like I had to cancel my mini-vacation as I was certain the pain was going to be debilitating. I had the “expectation” that the pain would be incapacitating. Instead, whatever the “pain” was it disappeared within 24 hours. I went on that vacation!

Doctors have found that when they as their patients how the pain was after a “procedure”, patients often rate their pain as a 3 or 4. But ask them again 10 days later and they report that their pain was much higher.

 

There is sometimes what is referred to as “anticipatory” pain. I had an embarrassing experience with my rheumatologist. My wrist was very inflamed. I could barely move it. ,It was time for another “injection”. Getting injections in your wrist is no laughing matter. It really hurts. The doctor went to touch my wrist to assess my pain and before his fingers even reached my wrist, I cried out in pain. What I was feeling was “anticipatory” pain. I remembered how awful I believed it was going to hurt like and responded to that expectation.

*   FAMILY MATTERS-  Your “expectations” for pain can really determine how much you “feel” your pain. Say that as a child you suffered from a chronic illness or just had frequent colds or allergies. If your parents doted on you (pots of chicken soup, cartoons and, of course, no school) you may grow up subconsciously enjoying being ill. As an adult, you may expect from your caregivers the same degree of attention and nurturing you received as a child. If, however, your parents provided just routine care and said something like “it’s just sniffle now get yourself out of bed and on the school bus”, you may view illness and pains simply as  a nuisance. The risk: if you ignore or minimize your pain you may miss something important as pain is a warning.

 

*     Personal and Cultural Beliefs-  As a man do you believe it is not acceptable for a man to express his level of pain/distress? Do you believe that women are more susceptible to pain than men or that women are allowed to express pain more than men?
•      FINALLY,  there are coping abilities: Do you have good stress management skills? Stress management is essential as stress adds to the perception of pain. I know that when I am stressed, I experience far more pain than typically from my fibromyalgia.

So I guess that sums it up. There are a lot of influences that determine how much pain we feel and how we allow it to limit our lives.

GATEWAY THEORY OF PAIN

I have done a lot of research on what is known as the “GATEWAY THEORY” but I do not completely understand it so I will keep this brief.

I know that my emotions influence my pain. No doubt about it.

Pain messages travel from the spinal cord to our brain. Somehow, the spinal cord is able to differentiate between the types of nerve fibers that carry pain and those that do not.

Pain messages travel along the peripheral nervous system until they reach the spinal cord. This theory says that there are “gates” in the spinal cord that either allow pain messages to continue on to the brain or they are “blocked”.

The “gates” determine how the gates will manage the pain signals. It depends on a lot of factors, including:

  • How intense is the pain
  • What other incoming nerve messages are competing (touch, heat, etc.)
  • Signals from the brain telling the spinal cord to increase or decrease the priority of the pain signal.

THEN…

The pain messages are handled in one of the following ways:

  • They may be allowed to pass directly to the brain…OUCH.
  • They may be modified before being sent to the brain (influenced by your expectations, perhaps?)
  • Prevented from reaching the brain.

ANYWAY,

What determines if the pain gets through?

*     PHYSICAL CONDITIONS – If the injury is bad, the pain is usually allowed through the gate. Sometimes the gate remains closed if there is pain but it is being mediated by the natural production of endorphins.

*     EMOTIONS – the “gate” may be open if someone is experiencing anxiety, worry, tension, depression but remains closed if person is experiencing JOY.

*     COGNITIVE– The “gate” is open when the person is focusing on their pain or are bored. However, if the individual can distract themself or concentrate intensely on other things (creativity, perhaps?), the gate may remain closed.

Do Not Despair! 

 

It is possible to manage one’s pain and there are all sorts of ways to do it and people to help. But, I have learned that I am my own worst enemy when it comes to pain. I allow stress to rule my life some  days. I have a Major Depressive disorder but it is treated and only rarely raises its’ ugly head (but it does dampen my life experiences but we will about mental illness and pain later.

Somatization is a medical term for the experience and reporting of “somatic” concerns.

No physical cause for pain can be found to explain a patient’s physical symptoms (which usually include pain) in 25-50% of all patients visits to their doctors.

No matter what your age, gender, intelligence level, culture, personality type you are. Many of us have come to use the expression of pain as a way of communicating psychosocial problems. How do you explain how a husband of a pregnant wife experiences “sympathy” pains? Pain, no matter its source, can be very debilitating. We feel pain when we deny distress, anxiety, shame, etc. 

One last thing before I close for now.

PANIC ATTACKS ARE REAL!

When many people experience a “panic attack” , they have chest discomfort, heart palpitations, shortness of breath and often, pain. It is not surprising that they go to an EMERGENCY ROOM as their symptoms mimic a heart attack.

Doctors can trivialize your discomfort once it has been determined that you have not suffered a cardiac event. “It is only a panic attack. Breathe in a paper bag” does not do much to help you (although I have found that the paper bag often works!).  Just because someone tells you it is “all in your head” does not mean you are not in pain. If the doctor or others want to really help, they can find the words or a way to diminish your pain. It may be reaching out. The source of your pain may not be “physical” but it may be caused by that fight you had with your spouse, loneliness, emotional distress, fear, PTSD, etc. But it is REAL.

COMING SOON…The Psychology of Chronic Pain.

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