1. Understanding Pain

Pain is an essential signal that something isn’t right with the body. It’s never pleasant, and it’s the most common reason people seek medical help.

Pain prevents us from seriously injuring ourselves. It also helps doctors diagnose underlying issues, be they chronic diseases or temporary ailments like a sports injury.

Since it derives from different sources, not all pain is created equal. For some, pain represents a burning, aching, stinging, or tingling sensation while others experience excruciating stabbing or chronic throbbing.

Certain cases go away on their own or with little treatment. Others last longer, causing more severe problems. For some, it’s long-term discomfort, which is the focus of this Special Health Report.

Acute vs. Chronic Pain

Acute pain is sudden onset pain. The pain resolves when the cause is healed.

Chronic pain is long-lasting, usually 12 weeks or more. The cause is often a disease, such as cancer or arthritis; however, chronic pain may lack a clear or identifiable cause.

The discomfort becomes an illness due to a combination of ongoing pain signals and changes in the way the body’s nervous system functions. Its severity and the underlying causes of chronic pain can be influenced by lifestyle, inflammation, or ongoing pain signals. (See “Chronic Pain Reclassified.”)

Pain Is Personal

Debilitating, long-term pain for one person may feel like a minor problem for another. It can be associated with a variety of physical and emotional problems, including depression and anxiety. Chronic pain can result in isolation and dependence on others.

Treatment for chronic pain may involve multiple therapies, including lifestyle change, and a team of doctors and other health-care professionals. People with chronic pain often suffer depression and frustration. Chronic pain can be complex in origin and difficult to treat.

Pain Signals

The medical term for pain receptors is nociceptors. They’re peripheral nerve endings that communicate pain to the spinal cord and our brain. Nociceptors are activated by anything that causes tissue damage, such as injuries, diseases, infection, excessive pressure, and burns. They send pain signals to the spinal cord by way of chemical neurotransmitters, so our bodies know where the pain is originating and the type of pain.

The speed at which signals are sent to the brain varies with the type of pain and a current theory is that there is a “gatekeeper” that puts pain signals through to the brain. In cases of severe, emergency, or life-threatening pain, the gate opens wide, allowing a message to pass through immediately. Lesser pain signals may be blocked or delayed.

Nerve Pain

Nerve (neuropathic) pain doesn’t start quickly, nor does it necessarily disappear after an injury heals. Chronic nerve pain is thought to be related to nerve damage or a change in how the nervous system functions. When the body’s sensory system is injured, the nerves are unable to work properly to send sensation messages to the brain, which can result in numbness, a lack of sensation, and most often, chronic pain.

Pain signals can be triggered by certain stimuli or have no apparent cause. They’re repeated over long periods, causing nerve cells in the spinal cord to change and become hypersensitive to the signals.

The dysfunctional nerve cells—not the original injury—cause chronic neuropathic pain. What should have been a temporary condition becomes a long-lasting or permanent change in the nervous system. Nerve pain can be severe and fluctuate throughout the day, but with appropriate treatment, its intensity can be reduced.

It’s in Our Genes

Evidence continues to support the role of genes as a precursor to some cases of chronic pain. Researchers have identified numerous gene variations that make individuals more vulnerable to chronic pain.

People have differences in type, density, and number of pain receptors. Everyone’s body controls pain signals in a unique way. One study found that a gene variant was 25 percent more common among those with a high pain perception than in those with moderate sensitivity.

In March 2018, researchers at the Wellcome Sanger Institute (U.K.) identified nine genes directly related to osteoarthritis. This research built on previous findings that heredity accounted for pproximately 20 percent of variations in chronic pain and the discovery of a gene that appears to play a role in triggering neuropathic pain related to medical conditions such as diabetes, kidney disease, and viral infections.

In May 2018, a research team at Northwestern University announced that it had identified genes and genetic sequences that soon will predict how people with rheumatoid arthritis will respond differently. These discoveries may lead to understanding the genetic causes of osteoarthritis and uncovering the mechanism behind the disease.

Epigenetics

By using epigenetics—the study of how genes are activated in response to changes in the body—it might soon be possible for us to control a genetic pain switch.

The journal PAIN described two practical applications for basic research conducted on gene-related conditions.

First, if a person knows his or her increased vulnerability to the process that leads to chronic pain, he or she might be able to avoid or lessen the chance of conditions that trigger the problem. For example, if you know you’re in a genetically high risk group for low back pain, you can work with a physician or therapist to prevent low back injuries.

Second, scientists and physicians are working to develop drugs that can “personalize” chronic pain treatment.

Precision medicine—the use of genetic profiles to make medical decisions, including those that involve pain management—is changing the current model of diagnosis and treatment for many diseases and conditions. Scientists at Northwestern University identified a gene sequence associated with the early stages of rheumatoid arthritis. By identifying people whose joints are improving and what medications they are taking, the researchers hope they can predict which people will respond to a therapy based on their specific genetic makeup.

Investigations. According to the American Academy of Neurology, people with nerve pain should see their doctor who may order blood tests which would likely include blood glucose, vitamin B12, and serum protein. For those with neuropathic pain, genetic testing and tests to measure the function of small-nerve fibers might be considered.

Once neuropathic pain has been accurately diagnosed, your pain-management team will develop a treatment plan, which will likely include these goals:

  • Relieve the pain
  • Treat the underlying cause
  • Maintain or improve physical function
  • Improve quality of life

Switch “Off” the Signal

Sometimes, in chronic pain, the pain-signaling neurons become hyperexcited and continue to fire despite the absence of the cause of injury. For example, with the herpes-zoster infection (shingles), the rash disappears, leaving no evidence of the virus in the bloodstream, but the damaged nerves continue to fire, causing continuous debilitating pain called post-herpetic neuralgia (see Chapter 2).

With neuroplasticity, the brain may be rewired to reverse the process that contributes to this chronic pain. Graded motor imagery—visual images—is being used to change the brain’s perception of pain after prolonged pain stimuli. The approach shows promising results in cases of complex regional-pain syndrome, phantom-limb, and chronic back pain.

Change Your Mindset

Think of pain as your body’s alarm system. Sometimes it’s vital for survival, signaling danger. Other times, the alarm keeps sounding after the danger has long passed. Understanding why you have pain may decrease your anxiety and your pain. Education establishes a foundation for managing chronic discomfort. Train your brain to relax by using techniques such as breathing exercises, meditation, yoga, and tai chi. By relieving stress, these activities reduce pain.

Be Positive and Realistic

People who anticipate the worst-case scenario have lower levels of pain tolerance than those with a more positive outlook. Pain is like an unwanted house guest. It will stay for as long as you allow it. In other words, dwelling on your discomfort makes it worse.

Decreasing the expectation of pain can reduce both the pain-related brain activity and the perception of pain intensity. People who accept the existence of chronic pain are more likely to have increased emotional, social, and physical function.

Acknowledge pain as a challenge and do something to manage it effectively.

Fear Makes It Worse

Anticipating pain can be as bad as experiencing it. Your brain expects pain, which disables your body’s ability to regulate discomfort.

Feeling sorry for yourself just worsens things, throwing the gate wide open and transmitting all pain signals to the brain. A positive state of mind—combined with education about the nature of pain and the use of distraction and stress management techniques—helps close the gate, thereby decreasing the intensity of pain signals.

Anticipation and fear of pain may affect your expectations from pain medications or other treatments. Multiple studies have shown that, for some people, placebos are as effective in reducing pain as a prescription medication.

Optimistic Relief

Change your negative attitude toward pain and you’ll notice positive results. Most pain-sufferers feel better once they are satisfied that their pain has been thoroughly evaluated and any disabling medical conditions ruled out.

Moving toward a positive attitude is especially important to avoid secondary problems, such as depression. Chronic pain can affect some people so severely that they need assistance to learn alternative coping mechanisms.

A 2017 study published in the Journal of Traditional and Complementary Medicine found that self-hypnosis/self-care and psychoeducation/physical therapy were associated with greater control and lower disability related to chronic pain.

Pain sensitivity can differ significantly among individuals. Some people can function well when they perceive their pain to be high, while others are unable to do anything, despite having a relatively low pain sensation. The experience of pain can even vary within the same individual.

Brain Scans Can Show Pain

Brain scans can allow researchers to see pain in the brain, measure its intensity, and determine whether a drug is relieving discomfort. The brain’s gray matter contains nerve cells and processes information. People with less gray matter record higher pain-intensity ratings than individuals with more gray matter.

Researchers found evidence that those who practice yoga have more gray matter than those who don’t, and that people with depression have reduced gray matter. The mind-body relationship is real.

Attitude is Hereditary

Attitudes and behavior regarding acute and chronic pain may be passed down from generation to generation. That means if your family members dwell on their pain, so might you. According to a November 2015 study in the journal PAIN, children of one or both parents who have chronic pain are more likely to suffer from it at some point.

Pain and Depression

The more pain you feel, the more likely you are to be anxious and depressed. A study published in the Journal of Affective Disorders showed that 50 percent of people being treated for mood or anxiety disorders also reported chronic pain.

A study published in Neural Plasticity (June 2017) reported that, although there’s considerable overlap between pain and depression, the exact reason for the association is unclear.

Earlier research showed that people with chronic pain are four times more likely to develop depression than those without pain. Although depression is a separate, treatable medical condition, the relationship between these two conditions cannot be overlooked. In addition, one person’s depression can influence others. Spouses and partners of people with depression are more likely to suffer from chronic pain.

Pain’s Gender Divide

Compared to men, women experience more pain, use more pain-relieving medications, recover from pain more quickly, discuss pain more often, seek help sooner, and use a wider variety of coping strategies. Because of these differences, a treatment that’s effective for men may not be as helpful for women.

Researchers found that women with knee osteoarthritis showed greater sensitivity to pain induced by heat, cold, and pressure. Another study showed that women were more likely to report certain types of pain than men. Certain conditions, including migraine headaches and fibromyalgia, are more common in women.

Gender affects the way different parts of the brain respond to pain. Brain scans measured the reactions of men and women who were subjected to the same pain stimulus. The results showed greater activity in the emotion-based centers of female brains, while male brains showed more activity in the analytical regions.

Gender may make a difference in treatment as well. Multiple studies demonstrate that males and females respond differently to common analgesics, but in most cases, the same treatments are being used for males and females. Research shows that the long-held theory that pain is transmitted through microglia cells is only true in males. Different types of cells appear to trigger the pain signal in females. Understanding these differences is essential to designing future pain medications.

Chronic Stress and Pain

Chronic pain can cause high levels of anxiety. This, in turn, can lead to emotional distress and disability. Those who suffer from chronic low back pain, for instance, appear to be more susceptible to pain due to higher levels of the stress hormone cortisol.

Some stressors are positive, and some are negative. The key is to recognize stress and manage it in a way that doesn’t result in or worsen chronic pain.

If you aren’t sure what’s causing your stress, become familiar with the warning signs (see “Signs of Stress”). Once you can identify the signals, you can learn how your body responds to stress and take steps to reduce it. For practical stress management techniques that don’t require counseling or professional care, see “10 Stress-Busters.”

Sleep Disorders

Sleep is no easy feat when you’re in pain. A study in the Journal of Clinical Sleep Medicine revealed a connection between chronic pain and sleep (or lack of it). Another study in Arthritis & Rheumatology found that “non-restorative sleep” is not only a result of pain but also an independent predictor of future pain. Non-restorative sleep refers to restless, non-refreshing, or poor-quality sleep.

Finally, a review of 16 studies involving more than 30,000 adults in 10 countries published in Sleep Medicine delved deeper into the link between lack of sleep and pain. It reported that a general decline in both the quantity and quality of hours slept led to a two- to three-fold increase in the pain problem over time. The study also showed that the impact of sleep on pain often is greater than the impact of pain on sleep.

Sleep reduction leads to impaired responses to bacteria, viruses, and other foreign substances related to pain, more inflammation, and higher levels of the stress hormone cortisol. Newly developed insomnia doubled the risk of chronic pain.

Ways to improve your sleep quality:

  • Stick to a sleep schedule.
  • Don’t go to bed hungry or on a full stomach.
  • Sleep in a cool, dark, and quiet room.
  • Limit daytime naps to 30 minutes.
  • Exercise regularly, but not close to bedtime.

Pain Worsens with Age

As many as 75 percent of people over age 65 have a problem with persistent pain, and the rate is even higher for those living in assisted-living centers and nursing homes. That’s likely because older adults are more likely to have multiple medical conditions that can lead to chronic pain. It’s even more evident in older adults who try to manage one or more common conditions plus obesity, which accounts for 27.4 percent of those 65 and older.

The most common conditions suffered by the elderly are osteoarthritis, muscle/joint pain, and nerve pain associated with other conditions such as diabetes. Many people can manage one or two conditions, but as new ailments develop, this becomes more difficult.

Drugs Work Differently

Older adults process medications differently than younger people. Aging causes the kidneys and liver to become smaller and receive less blood flow. The kidneys become less efficient, and it becomes more difficult for the liver to break down medicines. Also, oral drugs might be poorly absorbed because of changes in stomach-acid levels. Decreased saliva production can interfere with swallowing drugs.

Under-Reported Pain

Research suggests we may become more sensitive to pain as we age, but many older adults fail to report their pain or claim it’s less than what they feel. Some worry about additional tests, excessive medical costs, or they’re concerned the pain may indicate the progression of a disease. Still others don’t want to bother anyone with it, and a few want to avoid taking pain medications, worried they will be labeled as “addicts.”

Opioids

Opioids are effective and powerful painkillers but should only be used in severe pain and for short periods, as they are extremely addictive. Opioid misuse has become a public health crisis. What often begins as innocent pain relieving can quickly morph into dependence and addiction. Drug overdoses, sometimes fatal with opiates, are on the rise. According to the Centers for Disease Control and Prevention, as many as one in four people receiving opioids on a long-term basis struggle with opioid addiction (see “Cutting Back on Opioid Use Is Serious.”)

In addition to contributing to an increasing number of overdoses, misusing opioids has boosted the number of babies born with neonatal abstinence syndrome (due to their mothers using them during pregnancy). Plus, a whopping 80 percent of heroin users first misused prescription opioids, leading to the spread of infectious diseases like HIV and hepatitis C. In the United States, over 130 people die from an opioid overdose every day, says the National Institute on Drug Abuse. The drugs used in these overdoses included prescription opioids as well as heroin and fentanyl.

Sadly, opioids may not be as effective at relieving chronic pain as once thought. A 2018 Journal of the American Medical Association (JAMA) study of 240 people with moderate-to-severe chronic back, hip, or knee osteoarthritis pain found that opioid medications were no better at relieving pain over a 12-month period than non-opioid drugs. Plus, those taking the opioids suffered from more adverse medicine-related symptoms than the other volunteers (see Chapter 3).

The post 1. Understanding Pain appeared first on University Health News.

Read Original Article: 1. Understanding Pain »