- - Friday, August 25, 2017

ANALYSIS/OPINION:

Part one of three.

At some point in our lives, we all experience the misery of physical pain. An injury or accident; pulling a muscle; bumping into an obstacle; a hard fall; touching a hot surface; a chronic condition like arthritis; pinching a nerve; a tooth or ear ache; a sore throat – the list goes on and it is l-o-o-o-o-n-g. The common denominator is an unpleasant feeling in our body that makes us want to stop and change our behavior.  

When your body is injured in some way or something else is wrong, your nerves—cells that help your body deliver and receive information—send millions of messages to your brain about what’s going on. Your brain then makes you feel pain. And while it is an unpleasant experience, the truth is that in the amazing way our bodies operate, we all need the sensation of pain to let us know when our bodies need extra care. It is a very important warning signal.

Once we sense pain, it generally helps us to pay attention to that area and supports us to take the steps to fix what hurts – while helping to prevent us from injuring our body even more. If your ear didn’t ache, you might not go to the doctor to treat the infection. Or, if it didn’t hurt to lift an object with a broken arm, you might continue using it which could cause even more damage.

Doctors and other health professionals use your pain as a clue in figuring out what is wrong – and how to proceed with treatment that will make you feel better (and heal). The best doctors will talk to you about the cause of your pain – and the line of questioning can extend from facts about the injury or accident to whether it’s aggravated by a lack of activity, your stress level, a condition like arthritis, your mattress, or other causes.

This is Part 1 of a three-part understanding about pain, pain management and treatments.

Dr. Nina’s What You Need to Know: About Acute and Chronic Pain

Understanding Acute and Chronic Pain?
It is vital to have an understanding of the difference between acute pain and chronic pain. Acute pain is provoked by the body’s normal response to damage such as a cut, an infection, or other physical injuries. This type of pain usually comes on fast and often goes away in no more than a few weeks or months if treated properly.

Unlike acute pain, which generally follows a straightforward path of cause and effect, the course of chronic pain varies broadly. The International Association for the Study of Pain defines Chronic Pain as “ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3 to 6 months, and which adversely affects the individual’s well-being.” Essentially, it continues when it should not. It typically occurs in our back, neck, head, or joints, but can exist anywhere we can think of on our bodies.

Additionally, pain signals vary from person to person. In fact, the standard definition of pain is “whatever the experiencing person says it is, existing whenever the experiencing person says it does.” Consequently, this creates several challenges to patients and healthcare professionals. How do you effectively and consistently treat pain when you cannot see it and it is subjective? In other words, when a diabetic’s blood sugar levels are elevated or a hypertensive has increased blood pressure, it can be objectively measured and there are a number of medications to treat it—and, too, the efficacy of the treatment can be assessed, objectively.
 
What are the effects of chronic pain?
In the case of chronic pain, the signal keeps firing and the feeling of pain continues — for weeks, months, or years. The pain can be excruciating. And chronic pain can have a significant effect on our quality of life—our ability to enjoy activities, be gainfully employed, how we interact with others (co-workers, family, friends), and, too, the way we sleep (which in turn impairs our body’s immune system). Over time, it can wear a body down, drain energy, as well as cause isolation—a path that can lead to depression.  

Another very important understanding is that research shows that after time, our brain actually changes. Initially when we experience (acute) pain, our sensory centers in the brain are activated. However, over time, (chronic) pain causes our emotional centers to also become activated. In other words, brain signatures of pain start taking on an emotional nature.  

When pain moves from an acute phase to a chronic stage, other factors unrelated to tissue damage and injury become as equally important in understanding. Anxiety, depression, and declines in physical condition due to lack of exercise and quality sleep can all have an influence – taking a toll on your body.

Get professional help
There are times when it can be challenging to determine when you should see a doctor for a pain condition. Obviously accidents and injuries as well as excruciating pain such as with kidney stones and broken bones, sends millions of Americans to emergency rooms every year. But what about lower back pain or joint pain that starts off subtly, or any pain that lingers, or gradually worsens? Generally, if your pain lasts more than a few days, is worsening, or interfering with your activities of daily living (including sleep), you should consult with your healthcare provider.

Getting help earlier—compared to later— is key, if possible. It puts you on the road to increasing your function, improving your quality of life, and reducing your sense of suffering. In some cases your healthcare provider may refer you to a pain management specialist that can tailor and monitor a multi-modal treatment plan. After all, we are uniquely different and what worked for your family members or friends may not work for you.

Be Aware of the “Do-It-Yourself” Conundrum  
For the occasional ache or pain, over-the-counter pain relievers, such as acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Aleve), may be the right treatment if used at the proper dose. In fact, the World Health Organization (WHO) identifies acetaminophen as a front-line treatment for pain. However, it is important to understand that they are not intended for long-term use or to be taken in higher than recommended amounts. Heavy use of acetaminophen is associated with kidney disease, increased risk of heart attacks, stroke, high blood pressure, and even premature death (by as much as 60 percent!). Additionally, the Food and Drug Administration (FDA) has issued a warning that NSAIDS (non-steroidal anti-inflammatory drugs which include ibuprofen, naproxen) can increase the risk of heart attack and stroke.

If you find you are not getting relief or need more than one week of treatment in a row, it is time to enlist your healthcare provider to help navigate through the problem and avoid these serious side effects.  

Too many people suffer in silence, from stigma, or inadequate relief.  While there is still no magic solution, researchers continue to gain important new insights into the nature of pain and the process that turns the acute pain from an illness or injury into persistent, chronic pain. A holistic approach includes both the body and mind when dealing with chronic pain — with steps to help manage it in order to get folks back to the activities in their life. A deeper knowledge will help to address pain head on, allowing you to set realistic goals and monitor your progress (and too for those you care for). Stay tuned for more about pain in the coming weeks.

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