Central PA Medicine - Summer 2017 - 29

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Pain continues to be a serious public
health, economic and social issue. According to the International Association for
the Study of Pain (IASP), global estimates
suggest that 2% of adults suffer from pain
and 10% are newly diagnosed with chronic
pain each year, costing billions annually,
and causing more disability than cancer
and heart disease combined.

Musculoskeletal pain (such as back pain,
muscle/soft tissue pain, joint pain)

heads, attitudes and expectations do make
a difference.

Mechanical/compressive pain (for example:
pain from a kidney stone, abdominal pain
from bloating, or tumor compression)

Pain is defined by IASP as an unpleasant
sensory and emotional experience associated
with actual or potential tissue damage, or
described in terms of such damage. This
definition emphasizes that pain is a subjective
feeling, sensory and/or emotional, that may
or may not indicate actual tissue damage.
At times, people do in fact have pain in
the absence of tissue damage or any likely
pathophysiological cause, which is generally
associated with psychological issues.

Doctors may perform tests to figure
out the cause, such as blood tests, X-rays
or other imaging tests, and nerve tests.
However, the cause of pain cannot always
be identified. Because of this, patients
may receive the diagnosis of fibromyalgia,
psychological disorders, malingering, or even
drug seeking. At times, the pain IS all in
the mind. Research has shown that in some
people the brain cannot process pain signals
properly and may have signals "stuck" in
the "on" position; for example, in the case
of central sensitization. However, this does
not necessarily mean that the patient has a
psychological disorder or is a drug seeker.

Oftentimes, chronic pain subsides on its
own over time. For more persistent pain,
help from medical professionals should
always be considered. Some pain conditions
are still mysterious to us. However, health
care providers, especially pain management
specialists, are always on your side to help
control your pain. As no single treatment
works for everyone, your provider will help
find the right combination for you using the
following options:

Pain can generally be categorized as either
adaptive or maladaptive. Adaptive pain
contributes to survival by protecting the
body from injury and/or promoting healing
when injury has occurred. The sensation of
pain is a protective mechanism, for example,
when you accidently touch a hot stove. It is
one of the reasons that diabetic patients with
nerve damage repetitively hurt themselves,
especially their feet. Maladaptive or chronic
pain comes in the form of a disease and
represents pathologic functioning of the
nervous system. This usually lasts longer
than 3 months or persists beyond the
expected normal tissue healing time from
a specific injury. Chronic pain tends to be
a more prevalent issue since acute pain is
normally very temporary and requires little
to no intervention. There are many causes
of chronic pain, but most fall into these two
common categories or a combination of both:

Inflammatory pain (for example: joint pain
from lupus)

Medications to relieve pain, improve
sleep and mood, and facilitate exercise
and activities
Physical therapy to learn exercises and
stretches, including the use of some
modalities (heating, massage, electrical
stimulations, etc.)

Working with a counselor, especially for
Here are factoids adapted from the Ameri- pain with a large emotional component

can Chronic Pain Association (ACPA) which
are helpful for people in pain:

Don't let a depressed mood or negative thoughts
control you. Chronic pain affects not just
the person with pain, but also the family.
Start seeking support from family members
as well as others who experience and understand chronic pain. Hearing others express
similar feelings and experiences caused by
pain helps reduce isolation.

Relaxation and cognitive therapy to
re-train your mind
Some procedures: injections (shots) of
numbing or pain-relieving medicines into
the spine or area with pain; or ablation
(killing the nerve sensing the pain, not the
motor nerve controlling the movement
of your legs and arms)

Staying active, within realistic limits, can help Acupuncture or other alternative
medicine
us remain flexible and strong and reduce our
sense of suffering. It may be difficult for
Although the adoption of pain as the
people in pain; however, being sedentary
is not going to help. It is important to set "fifth vital sign" in 2001 has helped increase
NEUROPATHIC PAIN (pain from nerve disorders: realistic goals and chart the progress towards awareness of pain as a serious medical issue,
some patients, pain continues to be ignored
either a peripheral nerve, such as pain from those goals.
or undertreated by our medical providers.
shingles or diabetes; or from the central nervous system, your brain or spine, including Recognizing emotions helps us to understand Particularly as it pertains to narcotic prepain after a stroke or from multiple sclerosis) ourselves; there are no wrong feelings. Learn- scription, health care providers are concerned
ing how to relax is essential.  Relaxation about drug addiction, narcotic-related
Nociceptive pain (pain from body tissue helps prevent tension and redirects our adverse events, and strict regulatory scrutiny.
other than nerves)
thoughts onto things we can control.
While our pain is certainly not all in our
Continued on page 30
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