Most of you are new to Pain Scored. Welcome! Our evolving service is meant to help you learn about your pain and help you make better decisions. One of our goals is to start with some education. Honestly, Chronic Pain is very complicated. I just read through a very dense article in the journal Anesthesiology, for example. Anesthesiologists, BTW, are physicians trained in pain medicine and do critical research in understanding pain.
Anyway, it occurred to me that most people don’t really understand what chronic pain means. We all know what acute pain is. Its when we get hurt and we feel pain in the area where the injury occurred. It can be from trauma, surgery or anything else. It happens because of the injury and the inflammatory cascade triggered by it.
But what’s chronic pain? It is much more complicated. First, lets start with the definition of pain itself. It is defined as an unpleasant sensory or emotional experience associated with tissue trauma or the perception thereof. The definition of Chronic Pain is somewhat confusing and more variable. Technically, chronic pain is pain lasting for one year or more in the absence of immediate injury after an appropriate healing period.
Evidence is growing that chronic pain is more than just pain lasting a long time. It’s a complicated mix of changes in the brain itself (called central sensitization) and the nerves (neuroinflammation). These changes can drive more widespread chronic pain as well as make you feel excessive pain to normally mildly painful stimuli (hyperalgesia) and to non-painful stimuli (allodynia).
As you transition to more chronic pain, it’s important to change your medicines to those that can address central sensitization and neuroinflammation. Opioids may actually make this worse! In fact, opioids can lead to other problems such as tolerance (requiring more to have the same effect), cause hyperalgesia, withdrawal symptoms (physically uncomfortable symptoms when you don’t take enough opioids), endocrine dysfunction, immune suppression, cognitive impairment, addiction, overdose and even death amongst other side effects.
The noninflammatory changes of chronic pain may lead to depression, anxiety, sleep disorders. In turn, developing these conditions can make chronic pain worse.
There are no perfect medicines to attack this “neuroinflammatory cascade”. There are some medicines, therapies and non-medical approaches to pain that may be able to help. Talk to your doctor about other medicines such as anti inflammatory, antidepressant and anticonvulsants. Anti-inflammatory drugs both oral (like NSAIDS) and topical help stop inflammatory molecules from causing pain and irritating nerves and tissue. Antidepressants are not just for improving mood (a helpful side effect). They can change pain signals to decrease the perception of pain. Similarly, anticonvulsants aren’t just for treating seizures. They help change the pain signals to decrease pain. Anticonvulsants may also erase the “memory recorders” of the spinal cord that remember and play back pain. However, antidepressants and anticonvulsants take weeks to months and sometimes half as long as you’ve had chronic pain for to see a noticeable improvement.
Additionally, ketamine (an NMDA antagonist) can help reset the opioid receptor activity and mitigate the progression of tolerance and opioid dose escalation. In addition, ketamine has potent analgesic (pain relieving) properties that may enhance ones pain control.
People have also had benefit from nerve stimulation (vagus nerve, ear, Spinal cord, Deep Brain, Transcutaneous Electrical Nerve (TENS), Transcranial Magnetic Stimulation (TMS), Dorsal Root Ganglia (DRG) Stimulation, for example). Acupuncture, and Electro-Acupuncture have been helpful for some.
Finally, yoga, medication and a healthy diet can help with “neuromodulation” or re-educating the nerves and brain to a more healthy state. Future therapies are evolving such as dietary supplements and cell therapies, but these are not ready for “prime time”.
Please let us know if this was helpful. Let us also know of any future topics you would like covered. We cannot speak to your individual medical problems, but we are able to answer general questions about chronic pain.