Chronic Pain

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Chronic Pain

What Is Pain?

When you first experience pain, it is a symptom of illness or injury in the part of your body that is having the pain. The sudden onset of pain is called acute pain. It gets your attention and prompts you to take action to prevent further worsening of the condition causing the pain. This could be a simple action such as the reflex that makes you jerk your hand off a hot stove, or it could be more complex such as cooling, resting, or elevating an injured ankle. Or the pain could prompt you to see a doctor.

We take for granted that we will feel good most of the time. When pain strikes, we feel bad. Pain interrupts our work, our recreation, and our relationships with our families. Comfort, that is, not being in pain, is one of your goals if you are sick and should be one of the goals of treatment for the doctor who is treating you for any illness, but especially for an illness associated with chronic pain.

Once the cause of your pain is found and proper treatment is started, the pain may serve the useful function of keeping you at rest so that the injury or illness can heal. But if the pain comes from an illness that is incurable and will never heal, the pain loses its usefulness and becomes harmful. This type of pain keeps you from normal activity, and inactivity decreases your strength.

Why pain can become worse: There is a "wind-up phenomenon" that causes untreated pain to get worse. Nerve fibers transmitting the painful impulses to the brain become "trained" to deliver pain signals better. Just like muscles get better at sports with training, the nerves become more effective at sending pain signals to the brain. The intensity of the signals increases over and above what is needed to get your attention. To make matters even worse, the brain becomes more sensitive to the pain. So your pain feels much worse even though your injury or illness is not getting any worse. At this point, pain may be termed chronic pain. And it is no longer helpful as a signal of illness.

The goal in treating pain: When you consult a doctor, your goal is to be cured. That means that you want the cause of your pain to be found and cured so that you can resume normal life without needing medication or further visits to doctors.

Treating lifelong pain: Unfortunately, many illnesses do not have known cures. The treatment of illnesses such as diabetes and high blood pressure is often lifelong. In these chronic illnesses, as in the treatment of chronic pain, your goal is to live as normally as possible. Sometimes medication is needed for the rest of your life in order to achieve that goal.

A sensible view of addiction: In this respect, chronic pain is no different from diabetes or high blood pressure. If you need to be on pain medicine for the rest of your life, you should not be said to be "addicted" to pain medicine any more than a person with diabetes who needs to be on insulin for the rest of his or her life should be said to be "addicted" to insulin.

Use of pain medications: Some doctors are reluctant to use powerful pain medications known as opioids (also known as narcotics) to treat pain even when non-opioid medications have not worked. If your doctor is reluctant to prescribe opioids in this situation, and you have chronic pain, talk with another doctor or get a referral to a pain specialist.