Holding Hands with Pain
By Ronnie Biemans, Feb 9 2017 03:13AM
The tyranny of pleasure and of pain ;
They make us what we were not—what they will,
And shake us with the vision that's gone by,
The dread of vanished shadows—Are they so?
Is not the past all shadow?—what are they?
Creations of the mind?—the mind can make
Substances and people planets of its own
With beings brighter than have been, and give
A breath to forms which can outlive all flesh.
-George (Lord) Byron from The Dream
The International Association for the Study of Pain (IASP) defines pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage. “ There are essentially two types of pain: acute and chronic. Acute pain is a normal, time-limited, protective sensation that occurs in response to an injury or trauma. Pain receptors send signals to the brain that alert us to the need to take action. Chronic pain occurs when the acute pain response “goes rogue” and becomes a never ending state of discomfort that is debilitating and the signals just keep firing.
Chronic pain is the number one cause of adult disability in the United States. Although numbers vary, approximately 50 million Americans live with chronic pain today, according to a 2015 study by the National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) cited in The Journal of Pain in August 2015. Lower back problems, arthritis, cancer, complex regional pain syndrome, repetitive stress injuries, shingles, headaches, and fibromyalgia are the most common sources of chronic pain, with lower back pain being the most common.
According to the American Academy of Pain, “Millions suffer from acute or chronic pain every year and the effects of pain exact a tremendous cost on our country in health care costs, rehabilitation and lost worker productivity, as well as the emotional and financial burden it places on patients and their families. The costs of unrelieved pain can result in longer hospital stays, increased rates of re-hospitalization, increased outpatient visits, and decreased ability to function fully leading to lost income and insurance coverage. As such, patient's unrelieved chronic pain problems often result in an inability to work and maintain health insurance. According to a recent Institute of Medicine Report: Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, pain is a significant public health problem that costs society at least $560-$635 billion annually, an amount equal to about $2,000 for everyone living in the U.S. This includes the total incremental cost of health care due to pain that ranges from between $261 to $300 billion and $297-$336 billion due to lost productivity (based on days of work missed, hours of work lost, and lowers wages). Much more needs to be done to meet these challenges and to increase public awareness of them.”
The recent BBC documentary film, The Secret World of Pain, reveals that current research offers a deeper understanding of the origins of pain and pain response differences and hope for more progressive and responsive pain treatment. Neurological and genetic research identified the existence of the SCN9A gene which is principally responsible for individual variations in pain response. Key life experiences, particularly early exposure to pain in premature infants, have been discovered to be a significant contributor to later challenges with pain. In some cases, these early experiences appear to be a precursor to the rare neurological condition known as complex regional pain syndrome.
In their 2013 book, You Are Not Your Pain, Vidyamala Burch and Danny Penman describe the Gate theory as a model of pain perception. The theory developed by Ronald Melzack and Patrick Wall, suggests that there are gates in the brain and nervous system that, when open, allow you to experience pain. In a sense, the body sends a continuous low level “chatter” of pain signals to the brain, but only when the gates are opened do the signals reach your conscious mind. These gates can also close, which is what happens when your pains lessens or fades away.
The opening and closing of these gates is a phenomenally complex process. Although the details are still being worked out, pain is clearly far more subtle and complex than the traditional idea of damage signals being sent to the brain, which are then passively felt. Pain is a sensation, which means that it is an interpretation made by the brain before it is consciously felt. To make this interpretation, the brain fuses together information from the mind as well as the body. This means that the thoughts and emotions flowing through your mind, both conscious and unconscious, have a dramatic effect on the intensity of your suffering. Burch and Penzman comment, “Not without reason did the ancient Greek philosophers consider pain to be an emotion.”
Various factors contribute to pain and pain-related suffering. According to William Deardorff, PhD, ABPP, (http://www.spine-health.com/author/william-w-deardorff-phd-abpp), the brain can send signals down the spinal cord to open and close the nerve gates – allowing the pain signal to be experienced or not:
“The events and conditions that may open the pain gates and cause more suffering include:
• Sensory factors, such as injury, inactivity, long-term narcotic use, poor body mechanics, and poor pacing of activities
• Cognitive factors, such as focusing on the chronic pain, having no outside interests or distractions, worrying about the pain, and other negative thoughts
• Emotional factors, such as depression, anger, anxiety, stress, frustration, hopelessness, and helplessness.
Alternatively, influences that can close the pain gates and reduce suffering include:
• Sensory factors, such as increasing activities, short-term use of pain medication, relaxation training and meditation.
• Cognitive factors, including outside interests, thoughts that help the patient cope with the pain, and distracting oneself from the chronic pain.
• Emotional factors, such as having a positive attitude, overcoming depression, and feeling reassured that the pain is not harmful, taking control of one’s chronic pain and life, and stress management.”
According to the most current thinking of today’s pain experts, the optimal approach to assist those with chronic pain conditions should include the following:
1. Identification of the cause of the pain
2. Incorporation of a coordinated team approach
3. Use of multiple modalities developed with the person in pain to meet their unique needs
4. Making every effort to meet the needs of the whole person to restore quality of life
In the Discovery documentary Pain Matters, six individuals living with chronic pain describe their journey. Once the source of the pain is identified, each person then goes on to address their condition and rediscover a life worth living. For each individual it looks a bit different. What is most striking is how long it takes, how many years go by, before the source of pain is fully understood and they find the help that they need. It is encouraging that pain medicine and the medical establishment has evolved to find real, substantive answers in recent years. With the establishment of Pain Centers at local hospitals and in communities, chronic pain sufferers now have hope, better options and access to a team based multi-modality approach.
Living a Healthy Life with Chronic Conditions
( Drs.Lorig,Holman,Sobel,Laurent,Gonzalez,Minor - Bull Publishing Company)
You are Not Your Pain by Vidyamala Burch and Danny Penman
The Secret World of Pain - BBC Documentary: https://www.youtube.com/watch?v=75wkm9NTOb8
Chronic Lower Back Pain: http://www.spine-health.com/video/treatment-chronic-lower-back-pain-video
Pain Matters (sponsored by Teva Pharmaceuticals): https://www.youtube.com/watch?v=sfZJIwVQ2YY