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JOINT AND BACK PAIN

Joint and back pain account for a very high percentage of the pain experienced in the world. Joint and back pain can be under the umbrella heading of Musculoskeletal Pain. Symptoms can range from muscular spasms to inflammed joints. Nerve pain can also be experienced and it is characterised by aching – felt sometimes like an electric sensation (an electric current) running up your nerve, and a tingling sensation (a feeling of edginess). You may feel a stabbing or burning pain as well.

We are talking about pain, so let us address these questions:

– Can we accurately measure the various levels of pain people experience?

– Do we know how the brain works and responds to pain?

– Why is pain tolerated at different intensities by each individual?

– Does gender or age make any difference to how we feel and react to pain?

– What is a pain threshold?

– Can endorphins produced by our bodies be as efficient as a painkiller?

Let’s start with what pain is.

How can we define PAIN?

The International Association for Study of Pain (IASP) define pain as:

‘An unpleasant sensory and emotional experience which is due to actual or potential tissue damage or which is expressed in terms of such damage’.

Pain works as the natural warning system. It is a message sent from any part of the body to the brain (the mind) through our nervous system, to tell us that something is wrong.

Pain can be broken down into the following categories.

Types of pain

Acute Pain: The term ‘acute’ indicates a relatively abrupt onset with evident symptoms and limited duration. This can be caused by a physical event such as a fall, a sprain or break, as well as an inflammation or infection. Acute pain normally resolves itself as healing occurs.

Chronic Pain: This is long-term pain, unlike acute pain, which is normally temporary and disappears with time and treatment. Chronic pain persists after healing has occurred. Chronic pain is constant and nagging. There are many conditions which produce chronic pain including arthritis, gout, joint pain, and back ache, among others. This type of pain may be either constant or sporadic. It may be difficult to identify its cause.

Referred Pain: Referred pain is felt some distance away from its origin. Osteoarthritis of the hip, for instance, causes pain in the knee.

It is extremely important to seek professional medical advice if your pain persists or has no obvious cause.

Emotional pain: Pain is usually thought as physical, though emotional pain or mental distress can manifest itself in the body. This type of pain can be caused by being rejected, from bereavement, from problems with relationships, etc. One acute form of emotional or psychological distress is depression, a term that covers anything from feeling down and sad to extreme mental and emotional agony. Emotional or mental pain can manifest physically as a headache/migraine, stomach upset, ulcers or even muscle pain (through tension and stress) for example. The causes of these pains can include nightmares, fears, phobias, obsessions, and addictions to food, drink, drugs, etc.

It is important to recognise that long-term emotional pain can lead to physical symptoms as well as the other way around.

Words to do with pain

Describing pain can be very difficult. Here is a list of words that might be associated with pain:

Ache – Anguish – Misery – Suffering – Torture – Affliction – Agony – Discomfort – Pangs – Twinge – Distress – Torment – Wretchedness How would you describe your pain? These are some symptoms:

You might feel:

– a sharp pain

– a nagging pain

– a persistent/constant pain

– edgy (ie.: nerve pain)

– a stabbing pain

– a niggling pain

– a tight (stiffnes) pain

Pain can result in the following side effects:

– stomach ache

– constipation

– insomnia (difficulties in sleep)

– nausea

– dizziness

– lethargic/spaced out

– very low in energy/tired/exhausted

Describing your mood while carrying pain can also be difficult. These are some descriptions:

– Fed up

– Worried

– Anxious

– Confused

– Depressed

– Angry

– Embarrassed

– Very sad from feeling sorry for yourself

– Frustrated

– Introverted

– Aggressive

– Moody

– Impatient

Other nagging thoughts can be:

– Will the pain stop?

– Financial worries

– Will I lose my job?

– Sexual problems

– I am always loosing my temper

– Why me…?

– I used to be very strong and independent, now look…?

– What will other people think of me? Look at me…

– Will I end up… severely damaged?

in a wheel chair?

being rejected?

– Self-pity

Personal experince - I reacted to pain very badly with a negative response. I got very angry, had mood swings sometimes feeling sorry for myself allowing the pain to get me down. Right through my first phase I suffered from regular migrains, which were sometimes severe. I was not in control. In the second phase I began to realise how my mental state affected me physically. Talking about nagging thoughts, I experienced most of those mentioned above, including the thought of ending up in a wheelchair in the future, as mentioned by the doctor I first saw right after my injury. This could be described as the poor me syndrome. To summarise, right through my first phase (40 years, from 1961 till 2001) I suffered from regular lower back pain, pain to my sciatic nerve down my right leg, pain to my upper back and migrains. By 2001, I realised that I needed to be more self-aware and to devise a method of how to respond to pain, in order to feel in control of my situation.

How we respond to pain

It is difficult to establish why one person appears to feel less pain than another in similar circumstances. Pain perception is more likely to stem from a combination of factors which may include:

– the state of the individual person’s nervous system: This could be due to genetic make-up and/or degenerative consequences. Some people’s nervous system is naturally more efficient.

– the consequences of reducing health: Younger people are usually better able to deal with trivial injuries than the majority of older people. In addition to the general effects of ageing, some people become weakened further by chronic disabling illnesses or injuries.

– personality: Where people are of similar age and comparable health, inherent personality may be a motivating factor. People with strong will power, often try harder to conceal what they perceive as deficiencies, whereas other people tend to be more sensitive and less likely to disguise their feelings.

– circumstances: In extreme conditions a person with a focussed mind is often capable of blocking out unpleasant stimuli. An example of this is when soldiers in battle continue to fulfill their mission despite severe injuries, because of their overriding struggle to win and their survival instinct masks everything else.

Physical pain and psychological pain are very much linked together. One can affect the other. Many medical practitioners, both alternative and conventional are considering a wholistic approach as a more effective form of healing. This means mind and body being treated as a whole rather than as separate entities: the mind can heal the body and the body can heal the mind. For instance using a treatment of diet and exercise, and in addition adopting a positive mental attitude towards his/her living and working conditions, may diminish the symptoms of mental or emotional pain.

Our attitude to pain is absolutely crucial. A negative attitude may lead to extra tension, stress and unhelpful messages being sent from the mind to the body, which consequently aggravate the on-going pain situation. We need to accept pain and work with it, especially those who suffer from chronic pain. The ability to control our reactions, the response of those around us and the situation causing the pain will affect our tolerance to it. Knowledge and understanding could help towards our ability to implement Pain Management.

Personal experience - During my second phase I was not mentally strong enough to deal with chronic pain. My negative attitude did not help. I was not in complete control of my stressful life either. I began to realise that I had to juggle lots of things at the same time. Lets go back a bit, between 1973 and 1975, while I was a post-graduate student in London, I started to try different alternative solutions.

My GP referred me to St. Thomas’ Hospital. At first they tried Traction Treatment, which included some traction exercises for me to do at home. This was not successful. The doctors then tried epidural injections which were also ineffective. After these unsuccesful treatments they recommnded acupuncture which unfortunately did not help either.

Later I went to see a back specialist at East London Hospital. After a thorough examination and looking at my past history, he recommended specific physio exercises in order to strengthen my back muscles, rather than surgical intervention. At this point I was still hoping for a magical medical cure. Exercise did not seem to me to be a proper medical solution.

During these two years in London, I was not often in control of my pains and mental state. When I practiced pain management I was more in control of my life in general, while at other times, when I allowed pain to take over, the pain was more intense. It is possible to endure chronic pain without being controlled by it. It is a matter of knowing how to minimise the pain, knowing that “pain can be let in the gate”, as the scientists Melzack and Wall found out.