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Pain, Part 2

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In our pain group, we are attempting to create community with people who have been trained to avoid community. Our American culture trains people who are in pain to isolate which only serves to increase their pain.   So often, I hear people in pain say, "I hate other people."   We have to make them come to the group at first in order to get their narcotics.   They must come twice per month.   Some eventually come more often.   Some eventually begin to find that they enjoy coming to group and come more often.   Slowly the stories we tell in group begin to diffuse into the people.    Some begin to feel that they could have an influence by what they do on how much pain they feel.


No correlation exists between the perceived severity of chronic pain and tissue pathology.1 Chronic pain is diffuse and often spreads well beyond the original area of injury.   The measures that are successful in treating acute pain rarely work for chronic pain.   This is because chronic pain is manufactured in our brains as a modifying response to acute pain.   Chronic pain is very much a phenomenon of our brains and must be addressed as such.   It's something we invent after an acute pain.   This is why we need each other to manage our chronic pain.                                                                                                                  


Eighty million Americans suffer with chronic pain and nearly one-third obtains little or no relief from conventional approaches to pain.2 Therefore, new approaches are needed besides the conventional model of writing prescriptions.   We need to combine medicine with physical therapy, family therapy, cognitive/behavioral therapy, biofeedback, support groups, and more. In addition to caring for the chronic pain patient, the entire family is affected and needs to be involved in the recovery process. Care needs to involve all the stakeholders in the chronic pain patient's life.


Treatment with opioids alone is not enough for chronic pain.3     For some people, opioids may reduce chronic pain to a more tolerable level. However, they should not be prescribed with the expectation that they will completely alleviate chronic pain, treat depression or a sleep disorder, or completely relieve suffering.   For other people, opioids are ineffective.   The deeper issue is, as Peter Blum puts it, how can we allow ourselves to feel what we don't want to feel?   Our culture is formed from stories that teach us to avoid pain.   We are full of magic potion stories in which a substance takes that pain away.   Unfortunately, the stories don't seem to fully work.   They are incomplete.   The pain doesn't leave.   The magic potions are not fully effective.   What are we to do in those cases?


Specific regional gray matter decreases correlate with duration of chronic pain, its intensity, and the interaction between duration and intensity4-6, suggesting that being in chronic pain changes the structure of the brain.   Distinct chronic pain conditions have differential impacts on brain anatomy. These brain changes are reversible with pain relief .7-9 Apparently, some of the brain changes are a direct consequence of the presence of the pain, and most likely the underlying mechanism is based on synaptic plasticity that tracks the impact of the pain on the brain. Structural brain changes can be observed at early time points from initial injury as well as after long periods from injury, best illustrated in 2 animal studies.10,11


People with chronic pain rarely just feel pain.   They have a myriad of other symptoms, including fatigue, poor sleep, depression, anxiety, migraine, and so many more.1.   Persistent stress alters neuroendocrine rhythms.   Chronic pain quickly becomes a comprehensive mind-body-community-spirit phenomenon.   It must be addressed from all those levels.  


"We found that of the people who have tears in their discs [between the vertebrae in the spine], some manage well with it and some manage poorly with it," said Dr. Eugene Carragee, associate professor of functional restoration at the Stanford University Medical Center in California.   Carragee and his team compared the results of magnetic resonance images and vertebral disc tear tests among 96 patients who had known risk factors for disc degeneration. Such tears have traditionally been thought to directly cause lower back pain, with ruptures in the discs that cushion contact between the vertebra bones resulting in painful pressure being placed on sensitive nerves.


The researchers were surprised to find that those patients with disc problems were only slightly more likely to have back pain then those without any disc degeneration. They also noted that 25% of those who did have disc problems had no lower back pain at all. Carragee and his colleagues concluded that torn discs are not always painful, and not all lower back pain is a result of a torn disc.


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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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