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Since everyone else is creating topics on their specialist subjects i thought i would do the same.

So, any questions relating to chronic pain? I will endeavour to answer as best i can

I have always been curious as to the psycological aspect of chronic pain. I am not taking the "its all in your head" approach - but I do feel that mental and emotional health play a big part the equation. I am speaking mainly of chronic back pain - studies using placebos, effects of emotional stress, etc. What percent of the chronic pain equation is due to injury and verifiable tissue damage - and what percent is due to mental/chemical imbalances?

Also, what is the history of chronic pain? - like many disorders it seems to have come to the forefront in the last few decades - is it a "disease of modern civilization" or does it have roots in antiquity?

Originally posted by smass
Also, what is the history of chronic pain? - like many disorders it seems to have come to the forefront in the last few decades - is it a "disease of modern civilization" or does it have roots in antiquity?

When i was younger there was a condition mentioned called Scheurmans(sp?) disease which is a growing condition that effects mostly teenagers of 12 upwards.

The solution in previous eras was to keep the afflicted child in a body cast or stationary position in an effort to cure the condition, of course modern teaching would prove this to be nonesense.

It is my contention that these conditions have been prevalent for many years but are becoming diagnosed more and more recently due to a greater awareness. I have read articles in the past which concur with this assumption. (they are all on paper btw so i can't really link them) Of course as with every condition there is a factor of misdiagnosis, for instance with fibromyalgia (my condition) it can quite often by a thyroid condition but because of the doctors lack of experience he automatically assumes it is a different more serious condition.

I will get to your first question shortly.

Originally posted by smass
I have always been curious as to the psycological aspect of chronic pain. I am not taking the "its all in your head" approach - but I do feel that mental and emotional health play a big part the equation.

It is a fact that cognitive thinking can have hugely beneficial effects on chronic pain of all forms. The all in your head approach may be nonesense, but with the right tutoring the way a person thinks is as much a factor as the actual condition.

I am speaking mainly of chronic back pain - studies using placebos, effects of emotional stress, etc. What percent of the chronic pain equation is due to injury and verifiable tissue damage - and what percent is due to mental/chemical imbalances?

The term Chroic Pain is based upon the definition of different pain conditions. One either has Acute or Chronic pain, acute is for instance a broken arm, it is a current pain, it is something that effects you now and will heal with time.

Chronic pain however is quite often either an unknown cause or becomes more prolific many years after the original effector. I have known people whose chronic pain has come about due to a traffic accident and i have known people that have so called crumbling spine (sounds worse than it is - although still bad) which is a digenerative condition. Where as things like Fibromyalgia, ME or CFS may not have definable causes, and they are quite often caused by imbalances in the body chemistry. To my knowledge at the current time there isn't a definable difference between tissue damage or chemical imbalance chronic pain, the end result is the same and the treatment so far is similar.

On the subject of CFS that can be caused by viruses, but again that is not the only cause. it is very hard to put any definition, it is still a largely un explored field, although there are countless millions still spent on it.

I hope that explains some of your questions

I should also explain for any who don't know that i am not a practitioner or anything like that, rather i am a sufferer and so my comments should not be taken as absolute, it is just what i have reasearched myself..

Originally posted by mental_nomad
I will crawl out of lurking to reply to this.

I was diagnosed with a Degenerative Disc Disease when I was 16. That is actually what they call it. Degenerative Disc Disease, it always seemed a bit of a generic catch all phrase.

Anyway, it has steadily gotten worse over the last 23 years. It hurts even now as I type. In fact, I bought a wireless keyboard so I can lay flat while I type. So 90% of the time I am online I am in bed.

As to the mental aspects of chronic pain, I can attest to it. The feelings of...well...if I were in a wolf pack or whatever I would be killed. In a herd of wildebeast I would be lion bait right away. There is a sense of being a drain on mankind. No self worth.

The constant awareness of pain. The strain mentally is sometimes hard to bear and your mood turns angry too often. You have to struggle to just not sound irritable, even when you are in good mood. I don't know, I'm sorry. I am not saying it very well. I was awake all last night hurting so my mind is less than agile.

Your condition sounds worse than mine, but if it's any solice i know how you feel to some degree.

From my experience the worst time for me is always the morning, that point before getting up, should i bother? Should i just stay here the rest of the day and call in sick? Fortunately i have a very flexible job which means i can do that, although i try not to, i found once i let one day go then more start after that, the veritable vicious circle.

If i may ask, what kind of therapies have you tried?

Originally posted by mental_nomad
Physical therapy since I was about 25. exercises I must do to keep my muscles from atrophing(spelling). Some of the therapy does help keep disc aligned but some just plain hurt to do.
I had a TENS unit but it quit working. It seemed to help a little, mostly when the muscles spasm. I use a Hydroculator sometimes but not often. Usually for me I find regular Ice Pack works best. Just numb the heck out of it.

They probably say you have to do them all to keep your body in tip top condition. I used to do physio all the time, but after 2 and a half years i just couldn't stand it anymore and became complaicent, then i got worse again so i learned my lesson on that one. I actually don't do any stretches any more, i should but i just am not disciplined enough.

For some reason i can now cope better than i used to. Although i will say that i wouldn't be in my current position without them, i had to start and if i was to change my lifestyle i would have to take them back up again, but for now they aren't necessary.

Have you ever tried the more hollistic therapies. I personally don't put much sway in them, but it interests me to hear of peoples expereinces.

The thing that helped me most is a Pain Management Centre (pain clinic) they use several different factors like cognitive thinking, relaxation therapy, stretches and other therapies.

You are so right, mornings are the worst. Yet sex, the lack of being able to..errrrr perform better is absolutely crushing. You learn to adapt to slower gentler sytle but even then, it sucks when pain over-rides everything and you have to stop. It is like a full body impotence.

I shall have to bear that in mind for the future

One thing i will say regarding Chronic pain, although a lot of parts over lap (like feeling bad in the morning etc) each person has their own personal problems and experiences with their own conditions. That is possibly what makes it so unique, it isn't like most illnesses where one has a definable cure.

Well, only one thought really strikes me - What's chronic pain?

Originally posted by frogus
Well, only one thought really strikes me - What's chronic pain?

It refers to my statement earlier about the different types of pain. There are two different main types of pain, acute and chronic.

Acute is the state one is in with a broken arm or a sprained ankle, the pain is caused by a recurring problem if you like, until it is healed one still feels the pain. Of course a broken arm can lead to weakness in the bone etc, but that is something different.

Chronic Pain is a condition that seemingly happens for no reason, there is no direct cause, one doesn't have an open sign of injury or paralyisis. Quite often this is the cause of discrimination against sufferers since people assume one is faking it.

I wanted to comment a bit, if Mr. Sleep doesn't mind my additional opinions on the subject. As part of career, I do technical writing, which includes the creation of clinical protocols. I have written on the subjects of chronic fatigue syndrome (CFS), back pain, and peripheral neuropathy. One of the things I have learned through reading the medical literature on these subjects, and chronic pain in general, is that the central nervous system (CNS) is what can be called "plastic". This means that various feedback loops and reflex arcs can be created within the CNS even in cases where there is no underlying physical basis. For example, this is why people can have "phantom pains" after an amputation. The CNS creates a sensory model of each part of the body -- call it a virtual representation. Pain can result from actual physical pathology or -- and this is critical -- changes to the virtual model itself. So yes, pain can be "all in your head" but not in the way people typically mean it. Either way, chronic pain is a very, very difficult reality to deal with.

To key off what Mr. Sleep said about chronic pain, if the condition is well defined, there is usually specific periods of time that define what is acute, what is subactute, and what is chronic. For example, low back pain is commonly classified according to duration: acute--less than four weeks; subacute--four to 12 weeks; and chronic--lasting more than 12 weeks.

Someone asked about the history of chronic pain. Chronic pain has been around since antiquity. Leprosy, which is quite painful, was the leading case of peripheral neuropathy until the introduction of antibotics. In the past, people had a shorter life span and infectious diseases, which were frequently fatal, were the top medical priority. Thus, chronic pain was less of an issue.

Mental_Nomad wrote about DJD. Many, many elderly people have this, but are asymptomatic i.e. they have no pain. Some people have very little DJD pathology yet have huge pain. In naturopathic medicine, we say that a physician has to respect the biochemical individiuality of each patient. This is another way of saying each person is different and we don't know enough about how the body work to pigeon-hole people by disease. Holistic medical systems, like Chinese and naturopathic medicine, often have more options for chronic diseases because of their ability to tailor different treatments to different people, instead of grouping everyone with the disease as being the same.

Fibromyalgia (FMS) is very different than DJD. In fact, if a patient has joint pain, that is potential evidence that they do not have fibromyalgia, since the criteria for diagnosing this disorder rests specifically in the muscles (myalgia refers to muscle pain). Like CFS, there are numerous theories about how FMS develops. There is, of course, the theory that it is an imbalance of serotonin (and thus amenable to Prozac and other SSRI ). And, as Mr. Sleep mentioned, other theories as well.

When I work with chronic pain patients, I look at all potential inputs and causative factors. Is there an ongoing toxic exposure? Often dental problems, like amalgams or an infected root canal, can lead to FMS/CFS type symptoms. Is there a sleep disorder like sleep apnea? Is the patient depressed? Are they overmedicated? Are they eating poorly and thus experiencing food related issues like hypoglycemia? Is there a hormone imbalance? Do they have a food allergy? Is there an addiction issue?

I should stop here.... If Mr. Sleep would like me to continue -- kind of like a panel discussion -- I would be happy to support his expertise.

Originally posted by thantor3
I should stop here.... If Mr. Sleep would like me to continue -- kind of like a panel discussion -- I would be happy to support his expertise.

Works for me, you seem to have more clinical knowledge than i do anyway, so if you want to answer the question or counter my points or whatever, feel free

Some information on chronic fatigue syndrome:

Chronic fatigue syndrome (CFS) is a debilitating condition characterized by neurohormonal symptoms, cognitive impairments, sleep disturbances, and immune system abnormalities. It is now thought to have afflicted humanity for centuries under a variety of names, including febricula, "the vapors," neurasthenia, Icelandic Disease, effort syndrome (noted to affect Civil War and World War I soldiers), DaCosta's syndrome, myalgic encephalomyelitis, "yuppy flu", nervous exhaustion, postviral fatigue syndrome, chronic brucellosis, chronic candidiasis, and chronic mononucleosis (Komaroff & Buchwald, 1998; Caplan, 1998; Evengård et al, 1999; Fuller & Morrison, 1998; Goshorn, 1998). Chronic fatigue syndrome became a validated disorder in 1988 when a case definition was developed through the auspices of the US Centers for Disease Control and Prevention (CDC) (Levine, 1998).

Though fatigue itself is very common, chronic fatigue syndrome is much less so. Ninety-five percent of patients who present with fatigue are found to be suffering from an underlying medical or psychiatric illness (Caplan, 1998). Due to the lack of diagnostic testing or pathognomonic physical findings, the precise prevalence of chronic fatigue syndrome is unknown (Levine, 1998). However, community and primary care based studies in the United States and the United Kingdom have reported the prevalence of the condition to be between 0.2 to 2.6 percent of the population (Reid et al, 2000; Demitrack & Engleberg, 1997). The prevalence is thought to vary in different geographic areas and different sub populations. For example, there appears to be a higher occurrence in pediatric nurses, primary school teachers, and Latinos (McCluskey, 1998). Chronic fatigue syndrome occurs in all ethnic, racial and socioeconomic groups, as well as men, women, and children of all age groups, although the prototypical patient is a middle-class female in her thirties (Komaroff & Buchwald, 1998). The female-to-male ratio is three-to-one and the peak age of onset is twenty to forty (McCluskey, 1998). There is an increased frequency of onset in the fall and winter (McCluskey, 1998).

@Mr. Sleep: Could you tell me what kinds of things you have found helpful for fibromyalgia?

Originally posted by thantor3
@Mr. Sleep: Could you tell me what kinds of things you have found helpful for fibromyalgia?

One of the most important things for me was cutting down my weight, as i have previously stated in other threads i was seventeen and a half stone (now 13 if not less), now that is a lot of weight for a 6ft'er, basically i did a great deal of the cliches like comfort eating. It was always chocolate i comfort ate.

That is something else i cut out, chocolate. Although i read an article this morning that suggested it has similar properties to marijuana and can in fact be beneficial, but all i ever found was a gain in weight and mood swings.

For some reason chocolate effects my mood quite strangely, it can also bring on bouts of pain, i am not sure why and i haven't exactly tested it specifically but there is a strange correlation.

Other things, like stetches, although as previously mentioned i no longer partake in them. They did help me a great deal to start off with, limbering up the joints seems to have made me permanently flexible and i am not that different than i was when i was regularly stretching. I would personally recommend it to anyone, it is useful, after the first few weeks of discomfort it can help dramatically.

Relaxation therapy, something that helps a lot of people with chronic pain is self hypnosis and other forms of relaxation therapy, although i no longer use them i did at one point and these were greatly beneficial. I can still "go under" and all that, i just don't need to.

Fresh air Not the most vital of ingrediants but i find FMS is a condition where one gets a fogging on the mind, where one starts to forget or misplace thoughts, i quite often lose the thread of what i am talking about. One sure fire solution is to go outside and breathe in some nice fresh air, have a stroll or something like that.

I will continue later on. Possibly with more indepth descriptions

More things that helped.

Recovery time, i think it is difficult for people to change their life patterns over night. One of the worst things i think that is done to Chronic Pain sufferers is a method of forcing them to get better. It is a long process of contemplation and understanding, one can not just hardline the newest strength paracetemol, of course people have more serious conditions than me and they do need the aid of drugs, it's just important that it doesn't become a dependency for dealing with the pain.

I had to accept that i had my condition for long term, if not life. This was very gruelling to accept at first, but once i had accepted that, then i could get better.

I got better without the use of drugs. Drugs always made me feel worse, i just forced myself to understand my condition and deal with the consequences of it.

I wouldn't have been able to do that with the help of the Pain Management Centre, they were an inspiration and a great help.

Platapus poison.

Originally posted by craig
Platapus poison.

@Craig, I'm not quite sure what you mean, in context. Are you saying that platypus poison causes chronic pain? But by definition, chronic pain *has* no apparent cause.

The Craig interpretator appears....

I think Craig is referring to the idea that platypus poison is believed to have some painkilling effects...I'll check. If so, it might be of relevance for treatment of chronic pain.

Re: The Craig interpretator appears....

Originally posted by C Elegans
I think Craig is referring to the idea that platypus poison is believed to have some painkilling effects...I'll check. If so, it might be of relevance for treatment of chronic pain.

Interesting. Yes, thanks, @CE. I'd appreciate hearing about that.