New York Times includes an article: “Living With Pain
That Just Won’t Go Away” by Jane Brody.

Pain, especially pain that doesn’t quit, changes a person. And rarely
for the better. The initial reaction to serious pain is usually fear
(what is wrong with me, and is it curable?), but pain that fails to
respond to treatment leads to anxiety, depression, anger and irritability.

At age 29, Walter, a computer programmer in Silicon Valley, developed a
repetitive stress injury that caused severe pain in his hands when he
touched the keyboard. The injury did not respond to rest. The pain
became worse, spreading to his shoulders, neck and back.

Unable to work, lift, carry or squeeze anything without enduring days of
crippling pain, Walter could no longer drive, open a jar or even sign
his name.

“At age 29, I was on Social Security disability, basically confined to
home, and my life seemed to be over,” Walter recalls in “Living With
Chronic Pain,” by Dr. Jennifer Schneider. Severely depressed, he wonders
whether his life is worth living.

Yet, despite his limited mobility and the pain-induced frown lines in
his face, to look at Walter is to see a strapping, healthy young man. It
is hard to tell that he, or any other person beset with chronic pain, is
suffering as much as he says he is.

Pain is an invisible, subjective symptom. The body of a chronic pain
sufferer — someone with fibromyalgia, for example, or back pain —
usually appears intact. There are no objective tests to detect pain or
measure its intensity. You just have to take a person’s word for it.

Nearly 10 percent of people in the United States suffer from moderate to
severe chronic pain, and the prevalence increases with age. Complete
relief from chronic pain is rare even with the best treatment, which is
itself a rarity. Doctors and patients alike, who misunderstand the
effects of narcotics, are too often reluctant to use drugs like opioids,
which can relieve acute, as well as chronic, pain and may head off the
development of a chronic pain syndrome.

Why Pain Persists

The problems with chronic pain are that it never really ends and does
not always respond to treatment. If the pain initially was caused by an
injury or illness, it can persist long after the injury has healed or
the illness defeated because permanent changes have occurred in the body.

Mark Grant, a psychologist in Australia who specializes in managing
chronic pain, says the notion that “physical injury equals pain” is
overly simplistic. “We now know that pain is caused and maintained by a
combination of physical, psychological and neurological factors,” Mr.
Grant writes on his Web site, www.overcomingpain.com. With chronic pain,
a persistent physical cause often cannot be determined.

“Chronic pain can be caused by muscle tension, changes in circulation,
postural imbalances, psychological distress and neurological changes,”
Mr. Grant says on his site. “It is also known that unrelieved pain is
associated with increased metabolic rate, spontaneous excitation of the
central nervous system, changes in blood circulation to the brain and
changes in the limbic-hypothalamic system,” the region of the brain that
regulates emotions.

Dr. Schneider, the author of “Living With Chronic Pain” (Healthy Living
Books, Hatherleigh Press, 2004), is a specialist in pain management in
Tucson, Ariz. In her book, she points out that the nervous system is
responsible for the two major types of chronic pain.

One, called nociceptive pain, “arises from injury to muscles, tendons
and ligaments or in the internal organs,” she writes. Undamaged nerve
cells responding to an injury outside themselves transmit pain signals
to the spinal cord and then to the brain. The resulting pain is usually
described as deep and throbbing. Examples include chronic low back pain,
osteoarthritis, rheumatoid arthritis, fibromyalgia, headaches,
interstitial cystitis and chronic pelvic pain.

The second type, neuropathic pain, “results from abnormal nerve function
or direct damage to a nerve.” Among the causes are shingles, diabetic
neuropathy, reflex sympathetic dystrophy, phantom limb pain,
radiculopathy, spinal stenosis, multiple sclerosis, Parkinson’s disease,
stroke and spinal cord injury.

The damaged nerve fibers “can fire spontaneously, both at the site of
the injury and at other places along the nerve pathway” and “can
continue indefinitely even after the source of the injury has stopped
sending pain messages,” Dr. Schneider writes.

“Neuropathic pain can be constant or intermittent, burning, aching,
shooting or stabbing, and it sometimes radiates down the arms or legs,”
she adds. This kind of pain tends “to involve exaggerated responses to
painful stimuli, spread of pain to areas that were not initially
painful, and sensations of pain in response to normally nonpainful
stimuli such as light touch.” It is often worse at night and may involve
abnormal sensations like tingling, pins and needles, and intense itching.

Some chronic pain syndromes involve both nociceptive and neuropathic
pain. A common example is sciatica; a pinched nerve causes back pain
that radiates down the leg. In some cases, the pain of sciatica is not
felt in the back but only in the leg, making the cause difficult to
diagnose without an M.R.I.

Beyond Physical Problems

The consequences of chronic pain typically extend well beyond the
discomfort from the sensation of pain itself. Dr. Schneider lists these
potential physical effects: poor wound healing, weakness and muscle
breakdown, decreased movement that can lead to blood clots, shallow
breathing and suppressed coughing that raise the risk of pneumonia,
sodium and water retention in the kidneys, raised heart rate and blood
pressure, weakened immune system, a slowing of gastrointestinal
motility, difficulty sleeping, loss of appetite and weight, and fatigue.

But that is hardly the end of it. The psychological and social
consequences of chronic pain can be enormous. Unremitting pain can rob a
person of the ability to enjoy life, maintain important relationships,
fulfill spousal and parental responsibilities, perform well at a job or
work at all.

The economic burdens can be severe, especially when the patient is the
primary breadwinner or holds a job that provides the family’s health
insurance. Only about half of patients with chronic pain “who undergo
comprehensive multidisciplinary pain rehabilitation are able to return
to work,” Dr. Schneider reports.

As for the notion that chronic pain patients are often malingering —
seeking attention and escape from responsibilities — pain specialists
say that is nonsense. No one in his right mind — and most patients were
in their right minds before the pain began — would trade a fulfilling
life for the misery of chronic pain.

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