Pain And Pain Management Series - Part 1

I have decided to do a series on "Pain." Many of us are dealing with a pretty hefty amount of chronic pain. It is a specialty all of its own. There is still a lot that is not known about pain and the management of pain. I believe we are going to have to examine and study pain a lot more to find the answers we need to help manage chronic pain. I believe we are going to have to look beyond medications for some of the answers to pain management. So, I am going to devote this page to several articles that I would like to do on Pain and Pain Management. I hope you will find the information on Pain and Pain Management to be helpful in understanding pain and also to use in helping you to deal with chronic pain.

We all know that pain is a very useful life saving mechanism that the body performs. We actually could not make it through one day without the use of the body's pain awareness mechanisms. I am not going to go into the anatomy and physiology of how the body works causing the nerve endings to create the sensation we call pain. I do want to share with you the "theory" of pain that is shared today in the medical profession. It is called the "gateway theory." In the gateway theory it is believed that all pain signals are sent to the spine and from there they send their messages to the brain. So, if you think about it all organs have a direct link to the spine at some level and the nerves are threaded and go up the spine to the brain. As you can see the brain is the computer for the body to differentiate all messages in the body and sends the answers back through the spine to the designated point that has triggered the pain nerve response. Using this knowledge it is believed that all pleasure and pain sensations take this route to the brain and the brain interprets the sensations and sends the response back through spine to the originator of the pain message. But the key here is that no two impulses can make their way up the spine to the brain at the same time. So, if you are feeling pain and another sensation is added artificially that one of those two impulses can not make its way up to the brain to notify the brain that there is a pain or pleasure response needed. This is where the concept for the "TENS" unit comes from. There is an external TENS and an internal TENS that is placed in certain areas of the spinal area where the pain impulse is making its way up the spine to the brain. The TENS unit sends an electrical impulse up the spine competing with the pain impulse that is coming from a certain place in your body. In many cases this does stop the pain impulse from having priority and does stop the pain in some people. This was a great breakthrough when the gateway theory was discovered. We can now trace the nerves from the spine back to their organ of origin. So we know where all organ nerve impulses originate and what path they travel to get to the brain. We are learning how the brain interprets the pain pleasure principles and how we can control these principles in the brain.

OK, now since we have this theory about how the impulses travel and how blocking these impulses works, these pain centers cropped up all over where they do spinal injections by injecting a steroid, something to numb the nerve and sometimes a pain medication. This has been a big breakthrough in controlling pain. But we still don't have an exact science in knowing exactly where the root of the pain impulse is and how to control the medications once they are injected into the spine. These medications spread out once they are injected into the spine and you can not control where they will go. We still have a long way to go in developing this part of the pain control system.

So there is the TENS unit way and many branches of this concept used in the spine to try to control chronic pain. And we have the method of injecting medications into the spine to help control chronic pain.

Then there is putting in a spinal pump which again is using the gateway theory where the doctors implant a morphine pump into the back and connects into the spine where morphine is pumped straight into the spine to give relief of chronic pain. This is a local way to control pain so that the patient does not have to deal with the systemic side affects of narcotic use. This is used in very chronic situations.

Then there is what they use to do spinal blocks in surgery and child birth where they again inject straight into the spinal area paralyzing the nerves from the waist down again because they have not been able to perfect how to localize the medications. The draw back there is you can't feel anything and you can't function from the waist down. Also it doesn't help any pain that is above the waist.

In some situations the doctors go in and "sever" the nerve that the pain impulse is coming from like in the bladder cutting the nerve so the patient can no longer feel the bladder pain. Again drawbacks is sometimes they don't always get the right nerve. Or when they sever the nerve it may also sever your ability to feel sexually or the need to urinate or defecate or you may not be able to feel the sensations in all of these areas.

Then we have the use of pain medications, antidepressants, anti-anxiety medications, seizure medications all used to help control pain. These have a whole mess of side affects that some time have to be dealt with and if any one has gone through narcotic withdrawal you will know exactly how bad these side affects are. Then there are the draw backs of just being on these medications, loss of sexual desire, anticholinergic affects, like dry mouth and the mucus membranes. The loss of a sharp memory, inability to function normally, a flattened affect, dullness of mental functioning and of the senses. Last but not least narcotic addition, which is inevitable after two weeks of narcotic use. The body immediately takes to narcotics and for the rest of your life the body has receptor sites that link to the narcotic receptors and remembers them. All the kinds of medications I have listed are dangerous. They are not easy to withdraw from and no matter what, it is painful to withdraw. I will go over withdrawal on another page on pain and pain management.

There are physical therapies that are designed to help in dealing with pain management. They are used in structural problems and damage as in neck pain, back pain and trauma induced pain.

Then there are many natural and alternative methods in practice today that try and many that do control pain and some that eliminate pain. We have all heard of acupuncture, hypnosis, massage therapy and chiropractic treatments. There are also many that therapies are not very widely known about but that does not lessen their ability to control or stop chronic pain. I will list a few rolfing, light therapy, yoga, meditation and visualization to name a few. If you would like to know more about alternative pain control alternatives write me and I will send you a list of them for you to research.

There are also many diet therapies that can control and stop pain. I am very impressed with how certain foods have such power over the functioning of the body and that can definitely exacerbate pain. In taking away any such foods can lessen or stop pain. An example of this is with migraine headaches being stopped by the stopping of milk products. Back pain being lessened by eliminating simple carbohydrates as in sugar. There are many foods and food products that are to be eliminated in Interstitial Cystitis patients and it really makes a difference in the pain in the bladder.

Then there is the dangerous use of surgery in the brain to find the nerve impulse center for that area of the body but this is just being experimented with so don't go looking to have your head cut open.

The last option in dealing with pain is the option of having surgery. But it is a widely held believe that in dealing with pain the more surgery the more chronic pain and the more likely that pain will be permanent especially in dealing with back and abdominal pain. All surgeries cause adhesions, which is the scaring of the internal areas where the trauma of surgery took place. The surgeons use a laser now and some kind of internal anti-adherent before they close in many kinds of surgery. The thing is no matter what they use there are going to be adhesions. These adhesions become rigid after a while and can cause severe pain. So then you have your original pain and now adhesion pain. Adhesions can be totally debilitating in their own right. If any of you remember Tammy Wynette, she had a morphine pump in her back, which was used to treat the severe pain she lived in from adhesions. She had over 9 surgeries to cut and treat her adhesion problem. The problem is every time the surgeon went in to cut the adhesions it ended up causing more adhesions than before and the pain just got worse. Surgeons don't always tell their patients about these well documented problems with adhesions that occur with any type of invasive surgery.

I think within my realm of knowledge, that I have covered the pain management options available today.

When I look at these options for pain management I feel like I live in the dark ages of medicine. The neglect of studying and working on ways to control pain is very obvious by our lack of options that are pain specific and that really work at controlling and eliminating pain. We are able to walk all around the pain but we have nothing that has been developed in our methods of dealing with pain and pain management. We are not able to focus in exactly where each person's pain exists and target just that area and be exact in treating that pain. Rather we can not get cause specific in dealing with pain. Obviously with the millions of people who live in chronic pain we are in the dark ages and have much work that needs to be done by making pain management a priority. But as usual the government has cut NIH's funding where pain control is studied. There are university hospitals that study pain management but I don't see much results yet in the medical journals on pain. In fact we are just getting more and more medication oriented which can never become exact in dealing with pain. There will always be systemic affects and consequences from using medications long term. But that is where the money making is in dealing with pain management.

When I started in medicine pain and pain management it was pretty much negated and ignored as drug seeking on the part of a patient who complained of pain 3 or more days after surgery or two weeks after a trauma. We all had to be text book and that is what they taught doctors about pain, there was "limited" knowledge on how to deal with pain. Dope them up for 3 days after surgery or 2 weeks after a trauma anything after that send to a Psychiatrist or physical therapy. I have only been practicing since 1982. That was not that long ago where pain was so mistreated. It is still underrated and under treated by the majority of the medical profession because of the "fear" of the DEA which is the governmental "watch dog" that still thinks pain medication should be used with caution. So, if you want someone to direct your anger towards when a doctor acts paranoid about giving heavy duty narcotics or long term narcotics write the DEA. Doctors who have been known to help people who are in chronic pain and gave these patients the correct medication and correct dosage for pain management the DEA and the AMA have put them out of business and taken their DEA number away. The DEA number is what all doctors must have to write what is called scheduled medications and narcotics fall under the schedule medications. Then there are doctors who just believe that there is no such thing as chronic pain and that we who are seeking pain relief are just drug seeking or need to "get a life."

That is the overview of pain and pain management. Next I will write about the dynamics of pain and how it affects us and what "control" you can have over your pain. There are methods and perceptions that we can use to control pain and lessen it to a very large degree. I will show you how taking control over your health and pain can lessen your pain. By developing your own pain management program and using it, so that pain does not run your life and medications are not affecting your quality of life...