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The Pain Syndrome
Each year, chronic pain disabilities result in the
loss of an estimated 60 million dollars for employees
nationwide.
Chronic pain does not disable
A chronic pain syndrome does! By syndrome is
meant a collection of difficult, interacting problems
(symptoms) when added together with the pain experience
results in significant suffering and disability. These
problems grow out of our physical, psychological, and
behavioral reactions to the pain. Typical symptoms of
a pain syndrome can include:
- Persistent pain
- Insomnia
- Depression
- Medication dependence
- Weight gain
- Decreased sex drive
- Muscle wasting
- Social withdrawal
- Loss of employment
- Litigation
The first several months of pain we typically
refer to as the "acute" period. In the figure below, the
time-line for pain syndrome development is shown. In the
early, acute stages of pain onset, pain is clearly defined
and normal medical recommendations for rest,
drugs, and sometimes surgery may be
indicated and applied. As time passes, and pain persists,
a few symptoms of the pain syndrome emerge and unless
effective action is taken the pain will transition into
a full chronic pain syndrome or long-standing collection
of disabling symptoms (see Figure 1 below). These symptoms
are not only the result of the pain experience but they
can actually provoke the pain that created them. By example,
muscle wasting or "atrophy", which results from pain and
inactivity often creates increased pain with movement.
Clearly psychological depression, because our pain renders
us dysfunctional, can lead to lowered self-esteem which
can result in increased pain sensitivity (hyperesthesia).
This "sensitization" to pain is possibly the result of
neurological events taking place in the spinal cord and
brain. With some chronic pain syndromes even non-painful
stimuli can produce a painful experience (allodynia).
Figure 1: Chronic pain syndrome development
While pain may persist, the pain syndrome can be reduced and in some cases eliminated. Once the pain syndrome is managed, the patient usually reports improved
functioning and reduced pain awareness. It is our goal to reduce or eliminate the syndrome.
Acute pain is typically treated with acute methods medically, including diagnostic procedures such as radiological imaging (i.e., x-ray, MRI, CT scan, etc.) to
determine what is wrong structurally to cause pain. Medications for pain, muscle spasms, tension and sleep (i.e., narcotics and benzodiazepines) are often
prescribed in the acute phase of the pain experience to block awareness of pain and assist with the other problems mentioned above.
In addition to medications, rest of the painful area, if not entire body rest is advised during the acute period of pain experience. In some instances,
surgical correction is recommended to facilitate the ultimate reduction in pain.
Thus, rest, drugs, and surgery can be useful acute interventions in some cases of acute pain. In many instances, perhaps most, rest, drugs and surgery are effective in
significantly reducing or even eliminating pain. However, if these acute methods of medical management fail to "cure" the problem and pain persists, then continuing
these acute treatment methods for many months and perhaps years can be harmful. Continuing these methods into the chronic stages of the pain experience can result in
the following chronic pain syndrome.
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Acute
Stage |
Effect |
|
Chronic
Stage |
Effect |
| Rest |
healing time |
beneficial |
|
atrophy |
pain,
reduced confidence,
reduced ROM, ADL's
|
| Drugs |
reduced pain |
beneficial |
|
tolerance
dependence
depression |
addiction,
withdrawal syndrome |
| Surgery |
modify cause |
beneficial |
|
scar tissue
sensory loss |
permanence
of pain |
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Table 1: Effects of rest,
drugs, and surgery when taken into the chronic phase
of pain.
At Pacifica, we consider chronic pain syndromes most
effectively treated with safe non-acute methods. Using
acute treatments repeatedly over long periods of time
(chronically) risks creating more problems than are
solved.
Our approach to treating intractable chronic pain syndromes
involves methods from rehabilitation. In place of addictive
medications such as narcotics we work with safer categories
of medications such as non-steroidal anti-depressants,
channel blockers, anti-convulsants, and several other
non-addicting categories of medications. Our whole approach
however, is to avoid prescription medications altogether
by using powerful, non-drug techniques.
This outline does not address the unique pain problems
and specific pain syndromes that most of our patients
experience but it is an effort to summarize our approach
to understanding a difficult and complex set of disabling
problems.
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