# Saturday, March 1, 2008
                 

Living With Chronic Pain

Every year, millions of Canadians suffer from chronic pain. More than half of these Canadians do not receive adequate treatment to alleviate this devastating pain. A recent study actually showed that in one large Canadian medical centre the majority of patients who were in moderate to severe pain were not even asked by medical staff if they were in pain. Statistics Canada has recently released a study which showed that over 25% of Canadian seniors who live at home, and nearly 40% who reside in a institution are living with chronic pain, severe enough that it interferes with daily life.

While pain is a natural part of everyone's life, chronic pain has distinct characteristics. There are 2 basic types of pain, acute and chronic, which are very different from each other.

Acute Pain: Results usually from disease, inflammation or injury to tissues. It generally comes on quickly, i.e. after surgery or trauma. It may be accompanied by emotional distress and/or high anxiety levels. The cause of acute pain can usually be quickly diagnosed and treated. As well, the pain is usually confined to a given period of time as well as severity. Only in rare cases does acute pain become chronic.

Chronic Pain: Lasts for a much longer duration than acute pain and is more resistant to medical treatment. Chronic pain is widely believed to represent disease itself, and can be made much worse by environmental as well as psychological factors. Chronic pain can be a result of an initial accident such as sprained back, infection, or can be the result of an ongoing condition such as cancer, arthritis. Chronic pain can also occur without any previous injuries and/or evidence of body damage. Severe and frequent migraines can also fit into this category.

There is no test that tells a physician just how much pain a person is in, or how intense their pain is. The physician can ask questions about whether the pain is dull or sharp, location, burning or aching, etc, but these are only general indicators. Physicians can however, use technology to find the source of the pain. The most common are:

Electrodiagnostic Procedures: Electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies can help physicians tell precisely which nerves and/or muscles are affected by pain and/or weakness. EMG consists of thin needles being inserted into the muscles so the physician can see or listen to the electrical signals displayed. Nerve conduction studies involve the use of two sets of electrodes that are placed on the skin over the muscles. The first set sends a mild shock that stimulates the nerve that runs to the muscle. The second set makes a recording of the nerve's electrical signals, from which the physician is able to detect nerve damage. EP test follow the same theory, but with the second set of electrodes set on the patient's scalp in order to determine the speed of nerve transmission to the brain.

Magnetic Resonance Imaging: A MRI provides the physician with pictures of the body's tissues and structures, which can help determine where and why pain is occurring.

Neurological Exams and X-Rays: The physician will test movement, reflexes, balance, sensation as well as coordination. X-rays will show if any bones or joints are the cause of the chronic pain.

It is important for those who suffer from chronic pain to communicate effectively with their physician in order to receive the appropriate treatment and relief. Many different people in the medical field may be helpful in pain management, includes nurse, physiotherapists, psychologists, and occupational therapists, as well as your physician. If needed, your family doctor can refer you to a pain specialist if the pain is not self-resolving. To help your physician give you the proper care, be prepared for your appointments. By keeping a daily pain diary, and recording the amount of pain, the time it occurred and what you did to alleviate this pain get be a great assistance to your doctor. Make sure to use descriptive words such as throbbing, stabbing, burning, aching, tingling, dull, sharp, deep, pressing etc as well as rating it from 1 to 10. As well, keep a list of any and all medications that you take or have taken for pain control. It can also be helpful to list any activities you participated in either just before or at the onset of the pain.

Chronic pain can be managed in different ways, depending on the individual. This can be achieved usually through the proper pain medications, as well as such therapies as acupuncture, massage and chiropractic treatment. Some of the most common ways drugs that physicians use to treat chronic pain are:

Analgesics: The class of drugs that includes most painkillers such as aspirin, acetaminophen and ibuprofen. It is used in most nonprescription medications for mild to moderate pain.

Anticonvulsants: Usually used for seizure disorders, but can be effective for pain that is associated with neuropathic origins.

Antidepressants: Depression is now being associated with chronic pain, especially back pain. Some antidepressants in the psychotropic drug class can be used for treating both conditions. Some anti-anxiety drugs also contain muscle relaxants, and can be effective as well.

Antimigraine Medications: These medications are only for people who suffer from serious and/or frequent migraine headaches. The are only available by prescription, and should only be used under a physician's care, as some do have serious side effects.

COX-2 inhibitors: Used for the treatment of arthritis pain. These drugs are relatively new to the market, and have not yet been tested for long-term side effects. They do, however, seem to lessen some of the negative side effects commonly associated with older anti-inflammatory medications (NSAIDS).

Nonsteriodal anti-inflammatory drugs (NSAIDS): These drugs are effective for relieving pain by reducing the inflammation in the affected tissues. These can however, cause some people to suffer from upset stomachs.

Opoids: The oldest class of drugs known to mankind; they derive from the poppy plant. Codeine is a very mild form of opoid; morphine is one of the strongest forms of this drug. Opiates are a narcotic, and can induce sedation as well as pain relief. Opiates are physically addictive, and should only be taken with a physician's supervision and monitoring. Opiates do have such side effects as nausea (including vomiting in some cases) and constipation.

Methods other than medication can also be an effective measure to combat chronic pain. These may be used alone, or in conjunction with pain medication, depending on the individual.

Acupuncture: Is a traditional Oriental method of healing which involves applying needles to precise parts of the body. Although some consider this method controversial, it has been a popular method to help various conditions.

Biofeedback: Used mostly for headaches and back pain. A special electronic machine is used to train the patient to become aware of and ultimately control certain body functions. By learning to control things such muscle tension, heart rate and skin temperature, the patient will be able to effect a change in their response to pain by using techniques such as relaxation exercises.

Chiropractic: This can be very effective for those with acute lower back pain and other back disorders. This involves a licensed chiropractor manually manipulating the spine.

Counseling/Therapy: Psychological help and support can help patients by giving them much need coping skills to deal with chronic pain. Support groups can be helpful for those going through multiple surgical procedures as well as diseases such as cancer.

Physical Therapy/Rehabilitation: Exercise, massage, and/or manipulation can help not only alleviate pain, but help to speed up recovery from certain injuries.

It's important to let your physician know if you are experiencing pain that doesn’t seem to go away, or appears for no particular reason, as it may be symptomatic of a serious condition. There is no one specific cure for chronic pain; one of the above methods, as well as a combination of methods may be the right choice for you.

Many individual health insurance plans, as well as employee benefits packages offer coverage for not only the prescription costs, but for non-medicinal treatments. If you do not currently have coverage for such items as chiropractic visits, you can always enquire about adding these features to your current coverage.

 

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