Читать книгу Taming Chronic Pain - Amy Orr - Страница 10

In order to get anywhere with your pain, you have to understand it. So let’s start simple.

What Is Pain?

The nervous system runs throughout your body and sends electrochemical signals along its network of neurons, up the spine, and to the brain, where your brain interprets the signals it receives. The nervous system is the information highway for pain, but it is not the neurons themselves that “feel” the pain—your brain is what receives the information and draws your awareness to the part of the body that sent the signal. The central nervous system is an incredibly complex, highly developed system whose main purpose is to send messages between different parts of your body—from one cell to another. Pain is just one of these signals. When a part of you hurts, a signal is sent from the sensory receptors at that site, along the neural network to the brain, where the message “pain” is received and interpreted.

Pain serves many functions, but its most basic is to alert you, your consciousness, that something is wrong and a response is required. The response may be simple and reflexive (take your hand out of the fire), or even unconscious (causing your glands to secrete hormones to counteract the situation). Adrenaline may be released. Your body may tense up. Inadvertent and complex results may and do occur as the result of physical pain. But the thing you need to remember is: pain is there to help you. It warns you when something is wrong, makes sure you know to protect yourself. It is a valuable evolutionary tool.

But that is not to say it is infallible. Pain can be misleading. Your brain does not always interpret pain correctly and your sensory receptors do not always receive information accurately. There are many ways your body can fail you when it comes to pain, and one of the most common is for pain to be of a greater magnitude, of a longer duration, or simply from an insignificant cause, leading your brain to overreact and you to feel much more pain than is appropriate.

Broadly speaking, there are three traditional classifications of pain: acute, chronic non-cancer, and chronic cancer pain. While all pain is painful, not all pain is equal or behaves in the same way. Those who experience chronic pain feel changing effects over time, as their nervous system reacts to the environment of ongoing pain. In this way, acute pain is very different, and while they may be hard to differentiate in any given instant, chronic and acute pain are treated differently. Note, however, that acute pain can transition to chronic pain over time.

We’re not going to delve into all of the various pain disorders here, as there are many, and even the same disorders can have different effects on different people. There are also many types of non-physical pain, and this is where life can get really complicated, because emotional pain and physical pain are not mutually exclusive. Feeling physically crappy can cause a negative emotional response. Feeling anxious or overwhelmed or depressed, or any number of other negative emotions, can cause physical symptoms of pain. Emotional and physical pain can become a self-reinforcing vicious cycle. The two go hand in hand, and pretending they don’t means ignoring half of the problem.

Diagnosing and treating emotional pain is an enormous task and one that should, ideally, be tackled with the help of professionals. Later in this book, we will look at some of the specific emotional consequences of physical pain, but the analysis of purely emotional issues is not our target here. We want to narrow our focus to physical pain and its consequences, some of which are emotional.

So let’s look at physical pain in depth. Do you know what type of pain you have? Do you know where it’s coming from or what’s causing it? That can be a simple question to answer if you have a broken leg or a burned hand, and these are relatively easy problems to understand and treat, but it’s much tougher for amorphous pain. One of the most fundamental techniques you need to master, as a starting point for everything else, is understanding your pain. Know it, label it. This is not a one-step process. Your pain may well change over time. You need to be able to bring your awareness to whatever hurts, objectively assess it, and respond appropriately. You have to be able to depersonalize it, every time.

So what’s your pain like? Let’s break it down into some simple components and descriptors.

Classifying Pain

Duration

Acute Pain

Acute pain is typically sudden, intense, and short-lived. It is an immediate reaction to stimuli and is usually solved (or greatly ameliorated) by medical intervention.

Chronic Pain (Non-Cancer)

Chronic non-cancer pain is longer-lasting, often duller, and resistant to medical treatment. It can be linked to a physical or mental illness (other than cancer) but is not necessarily defined by it and can far outlast the original illness. The official definition of chronic pain is pain that lasts more than three months, and this definition can therefore encompass anything from prolonged recovery from injury to long-term illness.

Chronic Pain (Cancer)

Chronic cancer pain is long-term pain caused directly by cancer. Most cancer pain is caused by a tumor pressing on a nerve, bone, or organ. It can also be a result of cancer treatment—for example, pain experienced due to chemotherapy.

Breakthrough Pain

Breakthrough pain isn’t technically its own category, as it’s a form of pain that occurs when an ongoing chronic pain problem suddenly becomes acute—but we’ve kept it separate here because it does behave differently than chronic or acute pain. Breakthrough pain is often caused by a change or failure in medications, and although it is a function of the chronic pain, it acts and feels acute. This is most common among patients who are under treatment and have bouts of severe pain that break through their medication at intervals.

Location

Localized Pain

Most pain stays where it was caused; you break a leg, your leg hurts. You get stung by a bee on your finger, your finger hurts. Localized pain stays at its origin site.

Referred Pain

Referred pain is when pain from one part of your body is felt somewhere else.

Phantom Pain

Phantom pain is where there is pain in a part of the body that has been removed.

Intensity

Traditionally, pain is rated on a simple scale, from one to ten, depending on how it feels to you.

Mild Pain

A rating of one on the scale is effectively no pain at all. Anything between one and four is considered mild pain and can be ignored or easily treated.

Moderate Pain

Moderate pain is a five or six on the scale; it hurts, and you know it hurts, but it’s not blotting out rational thought or your basic functionality.

Severe Pain

Severe pain is anything from a seven to a ten on the scale. If one is no pain at all, ten is the worst pain you have ever experienced. A ten on the scale is mind-numbing, searing, extreme pain that blocks basic functions such as walking or even breathing.

Note that, although we have split the pain scale up here to illustrate the range of severity, these are not different types of pain—just different levels. A pain of intensity one on the scale may behave exactly like a pain of intensity ten; it’s just that the effect on you is different.

Pain Inventory

Many clinics now use a more sophisticated methodology than the simple one-to-ten pain scale. While helpful in acute situations (like in a hospital’s emergency room), the one-to-ten scale doesn’t reflect the changing nature and effects of chronic pain. Almost all chronic pain clinics use some form of pain inventory, pain interference, or pain functionality system to measure pain’s severity and effect, as well as the effectiveness of treatments.

These systems may vary slightly by clinic and region, but, essentially, they record the pain at its high and its low, and the level of disruption the pain causes in key areas of life, such as sleep, work, mood, etc. This gives a better overall illustration of pain and how it impacts daily life on an ongoing basis, and doctors can use these systems to find ways to reduce the impact of the pain (even when they can’t change the pain itself).

Cause

Pain is often classified by the damage that causes it, and there are layers of classification, depending on how in-depth you want to get. Let’s look at them, starting with the broadest terms:

Nocioceptive Pain

Nocioceptive pain is a fancy way of saying pain from any of the physical structures of your body. This can include organs, muscles, skin, joints, and tissues.

Neuropathic Pain

This is the type of pain caused by damage to or a disease of the nervous system itself; it can affect any area of the body and can come in many forms: a stabbing pain, an ache, a shock, tingling or numbness, a burning sensation, a spasm. It can be continuous or episodic. Neuropathic pain is notoriously hard to treat and often is the most persistent, least understood of all types of pain.

Algopathic or Central Sensitization Pain

This is pain caused by the brain’s perception of the sensations reaching it. It is not a function of the physical body, the tissues, joints, muscles, organs, or even the central nervous system, but rather is caused by neurological disorders that affect the way the brain interprets information.

These three basic types of pain are the main classifications.1 But we can go down a level into different types of pain:

Visceral Pain

Visceral pain is associated with injury to the internal organs and is usually acute until the underlying illness is treated.

Somatic Pain

This is the most common form of everyday pain, affecting sensory receptors within the muscles, soft tissues, or skin. Examples of somatic pain are mild burns, muscular inflammation, an insect bite.

Psychogenic Pain

Psychogenic pain refers to physical pain that is caused by psychological factors only, with no physical cause component. This is extremely rare. Mood can magnify pain in many ways, but very rarely does it cause pain all on its own.

And going further still into specific types of pain within the body:

Joint Pain, Bone Pain, Muscular Pain, Nerve Pain

Rather obviously, these labels refer to a specific type of body part that is affected by pain. If you pull a muscle, you have muscular pain. If you have arthritis or another illness affecting the joints, you have joint pain. If you have a broken bone or a form of bone disease, this is bone pain. Or, if you have nerve damage, this causes nerve pain. These are simple classifications, but you probably already know the feel of each one—most of us have pulled a muscle in our time or overdone it and had a sore back.

Sensations

There are a lot of different ways that pain can feel. No two people experience pain identically, and you are the only person who is feeling the pain that you’re feeling. No one else can tell you how it feels. It is important that you can name your pain, describe it, and distance yourself from it. Not only will this help you to understand it, describe it to your doctor, identify what is happening in your body, and analyze your possible responses, but it will also help distance you from it emotionally. You are not your pain, and your pain does not define you. Try imaging your pain as a really unwelcome, disliked family member you simply cannot get rid of.

Here are some helpful words that you can use to describe the feel of your pain(s):

spasmachingdullsharpacutestabbingpoundingrasping

tinglingnumbitchingburningcoldshockradiatinggrinding

episodicpersistentirritantticklingpricklingthrobbingboringswollen

stingingsearingtwingecramptendernessinflamedpinchinglacerating

rawthumpingtightpressure/vise-likemildintensepulsingnagging

Common Causes

of Chronic Pain

Chronic pain can be anything that lasts longer than three months, but some chronic pain ailments are permanent and others are, ultimately, temporary. There are many different illnesses that can cause chronic pain; below are just some of the most common. Even these can come with complications, comorbidities and unusual presentations, so this is not intended to be an exhaustive or prescriptive list—just a rough guide to the most widely diagnosed chronic pain ailments at present.

Arthritis

Arthritis is the most common cause of pain, affecting almost one in every two adults over the age of sixty-five. Arthritis is not simply a disease of the elderly, however, with over a third of working-age adults experiencing it in some form at some point in their lives. Arthritis affects the joints through inflammation and can make movement painful.

Chronic Back Pain

According to research, almost 85 percent of adults will experience chronic back pain at some point. This may be due to injury, accident, arthritis, or through normal wear and tear, but anyone who has suffered this particular issue knows it can be immobilizing and very difficult to treat. It is rare for chronic back pain to become permanent.

Fibromyalgia

Fibromyalgia affects the nervous system and is associated with widespread pain in the muscles and bones without apparent cause. It can cause severe fatigue and general bodily tenderness, as well as cognitive impairment. It is the second most common condition affecting bones and muscles but, because of its amorphous symptoms, is often misdiagnosed.

Psychogenic Pain Disorder

Pain problems associated with psychological factors only, without physical cause, are known as psychogenic disorders. They can be caused by stress, anxiety, depression, or mood disorders and can present as headaches, migraines, back pain, stomach pain, or muscular pain. Given the wide range of possible affected areas, psychogenic pain is usually diagnosed when all potential physiological causes have been ruled out.

Chronic Headaches

Headaches are commonplace, but some people suffer from headaches which last at least fifteen days per month, for consecutive months, thereby becoming officially chronic. These can be tension headaches, migraines, cluster headaches, or eye-related headaches, but are exhausting and debilitating, whatever the cause.

Sciatica

Sciatica occurs when the sciatic nerve, the largest peripheral nerve in the body, running from your spine down your leg, becomes irritated. This is most common among patients with a herniated spinal disc but can also occur due to accident or other injury. Symptoms include electric-shock-like pain down the leg, numbness and tingling, and muscle weakness. Sciatica can be persistent unless the root cause of the problem is addressed.

All pain is personal, because it’s happening to you, but that does not mean it is you. As we’ve seen in this chapter, pain is an evolutionary tool that can and does get out of hand, but that doesn’t mean you are lacking in control. Sun Tzu advises us to “know your enemy,”2 so become acquainted with your pain. Give it a silly name if it helps. Talk to it. Scold it. Describe it. How can you expect to live with it if you don’t take the trouble to get to know it?