A Look at Chronic Pain

 is an unavoidable part of the human experience...

Pain is a sign that something has gone wrong and itself is not a disease or necessarily a bad thing. Pain has been a crucial ingredient of human evolution and without it we would not exist in our current form of existence. One suffering from the neuropathic anesthesia of advanced diabetes can testify to the disadvantage of losing the sensation of pain in the limbs when they suffer from burns or cuts that may have been avoided had the sensation of pain been intact to warn them of the danger of tissue damage at the time of injury. Pain triggered by sensors in the skin signal us to remove our hand from a hot object or sharp object. In the diabetic, sometimes the nerves are damaged and rendered useless by an excess of the sugar glucose in places where it doesn't belong.

My work involves the diagnosis and treatment of depressive illness which often is associated with the symptom of pain, both physical and emotional. My experiences have led me to believe that many times the two can be almost one and the same. When a depressed patient presents with chronic physical pain, no amount of morphine or other pain killers provide satisfactory relief. Many have visited several other medical specialists with unsatisfactory results. Those of weaker character often end up strung out on large doses of opioid medications that they are eventually required to obtain by any means necessary. True fighters usually won't allow themselves to be controlled by a chemical substance and will not accept their life being controlled and dictated to by intractable pain. They will do whatever it takes to find an answer.

I have found that a patient who is capable of developing insight can usually accept the concept of psychosomatic illness which basically entails the nervous system being overwhelmed by environmental stressors and no effective outlet. When this occurs this excess of emotional energy may be converted to a neurological or medical condition. Prime examples include, migraines, fibromyalgia, irritable bowel symptoms, chronic fatigue, and even loss of consciousness. When the brain is overwhelmed by stress it ceases to make endorphins in sufficient amounts to allow natural pain control. Artificial endorphin effect can be provided through opioid pain medications. Often these meds can provide an irresistible sense of euphoria. Certain individuals are susceptible to attempting to maintain such a pleasurable feeling indefinitely. This is unnatural in the balance of nature for we aren't meant to live in endless bliss while on earth. Chasing such a feeling via chemical means will damage the normal chemical balance within the brain and nervous system. After a while large amounts of a chemical substance is required just to be able to function at the minimal level and the initial euphoria can never be reached again. At this point the individual is a slave to the chemical and most of their waking life is centered around getting more of their drug of choice.

The main principle of successfully treating chronic pain involves not quickly eradicating all of the pain which is the unrealistic expectation of many sufferers. It is better to convey the fact that there will always be some pain but eventually it may become irrelevant in the big scheme. The sufferer must accept and understand the fact that the brain cannot sense both severe pain and happiness at the same time any more than it can feel heat and cold at the same time. If a person is depressed, sad, anxious, and experiencing severe somatic pain there are certain nerves transmitting these sensations to the brain. The brain cells and nerves that transmit the sensations of pleasure, joy, happiness, and euphoria are inactive. All of the brains' attention goes to to the former set of sensations. In a healthy individual both sets of sensations can be excited with little difficulty. The positive sensations will over ride the negatives when the individual feels in control and there is not the sense of hopelessness and negativity often present in the negative mental state of the depressed individual. This feeling of hopelessness is a real motivation killer and often is a key in a depressed person choosing to stop fighting.

Anti depressants and certain medications such as gabapentin help to turn off the negative nerves and effect the positive fibers favorably. When the individual has adequate support and a life to re plug into their chances for recovering from the pits of depression and chronic pain are favorable if they comply with treatment. Majority of the time chronic pain is accompanied by depressive illness and or severe anxiety symptoms. Interestingly, a severe panic attack often mimics the pain of a heart attack. After a negative EKG and cardiac work up many will again experience the same chest pain with their panic attacks. The analogy I frequently use to explain the emotional and chronic pain overlap speaks of the small child with a newly skinned knee running to mother crying loudly. With simple blowing on the painful spot and a few loving words the crying instantly ceases and soon laughter and happiness are restored. What does that mother's breath possess that relieves pain so effectively? You guessed it. It is the love and affection that cancel out the pain. The breath trick is a clever distraction. Sometimes the pain meds function as the breath and the real effect is due to the doctor's attention and caring.

Unfortunately, for those believing there is magic in the percocet or vicodin, they will madly seek more and more until they wake up or until they die. These are the patients roaming from one doctor's office to another week in and week out pursuing one more bottle of pills. For them, one pill is too many and a thousand is not enough. I have found that many suffer from severe and persistent emotional pain since childhood, usually because they never received that breath on the knee from mother. Their life becomes basically a quest for analgesia. As adults they still receive little genuine love because they never learned to give love. Chemical abuse has become the preferred coping mechanism. Many such patients are diagnosed with personality disorders and the potential to develop insight into their condition is often lacking. Sometimes the pain they feel can never be relieved. Many doctors and therapists would rather not treat them because they remind us of our very finite limits as healers.