Chronic Pain
By Katie-Ellen Hazeldine
Chronic pain is defined as pain that persists. It goes on and on until it becomes a tyrant in everyday life, not only for the sufferer, but for family, friends and colleagues who are also affected by its consequences and who dearly wish to help, but may not know how.
Chronic pain is a difficult and still not fully understood problem amongst medical practitioners. Acute pain, while it can indicate a life threatening situation, is a simpler issue, because the links between the pain and its causes (injury or acute illness) are understood in physiological or chemical terms. We know what the body is doing and can act to lessen its effects. Chronic pain behaves differently and its signals travel on different pathways in the body.
We know that chronic pain can ensue from trauma, infection and stress. The link between pain and anxiety, while known to exist, is not clearly understood in scientific terms. Interestingly Dr Anthony Jones, a pain specialist at Hope Hospital in Salford (whom I once met in my capacity as patient; a deeply kind as well as distinguished physician) has observed that the pain associated with rheumatoid arthritis uses pathways in the area of the brain where anxiety and fear are experienced.
Studies have observed certain patterns in chronic pain, including reduction on serum sodium, changes in urinary volume and in protein metabolism. Changes in the homeostasis (the body’s maintenance of a constant internal environment) of nitrogen have also been observed. There is a suspicion that sometimes chronic pain is being driven or made worse by the continued presence in the system of hostile pathogens (‘bugs’.) Certain illnesses are classically associated with chronic pain – MS, ME, cancers, disorders of the gut and bowel such as IBS, and many forms of arthritis. For more information on the different types of pain visit www.pain-management-info
Gaps in existing scientific knowledge mean that where the cause has not been identified, care should be taken before complaints are dismissed as being in the sufferer’s imagination. What could be more intolerable for the person in the grip of it?
Research is ongoing. There is interest in the idea of using high dose capsaicin in topical patches(a warming substance with anti-inflammatory properties that is derived from chillies). Capsaicin is already readily available in an array of low-dose applications - gels and creams.
There are many ‘natural’ or traditional remedies available to try. Some, such as slippery elm for use in IBS and in Crohn’s disease, have been reported as highly effective, though not for everybody. Prescribed medicines, likewise, work well for some, yet are not effective for others.
We all experience acute pain at some time in our lives, due to injury or illness. The acute discomfort of childbirth may be considered to fall into this category. This kind of pain, while not welcome, is performing a valuable role. It warns of danger, or warns of the need for attention, and indicates where in the body it is required – except in the case of referred pain where the pain sensation may occur at a distance from the site of injury. Our central nervous system is a hugely complex and subtle information network. Information travels, more than we know, and maybe more than we can imagine.
We are equipped to cope with acute pain and are likely to respond quickly to analgesics; simple aspirin, paracetamol or to comforters such as cold or warm compresses. For severe acute pain, opiates and other strong pain-killers may be used, but in chronic pain their long term use may carry increased risks for the sufferer, and this is the dilemma sufferers may face. Steroids too, can be powerful pain suppressors but can have significant drawbacks in long-term use.
Chronic pain, however bravely it is endured, is a challenge, physically, mentally, emotionally and socially. It taxes the entire body. It will often leach iron from the system, for instance, producing anaemia. The adrenal glands may become depleted, owing to the hormonal demands of chronic stress, leading to adrenal insufficiency and prostration. Left unassisted such pain starts to generate its own problems, over and above the original cause – like a hydra, growing extra heads. So what can be done?
Get a sword and get lopping.
One remedy or approach does not work for all. The sufferer may need to do some research and be prepared to experiment.
Your family doctor is the logical first port of call - and don’t wait until you have become exhausted. The doctor may refer you onwards, to a specialist in the relevant field such as a consultant physician, pain specialist or pain clinic.
Allopathic (doctor’s medicine) may not have the answers you need. Some people find that complementary approaches, such as the Bowen Technique, aromatherapy, reflexology, homeopathy or herbalism help them.
Supplements may also help, depending on the nature of the problem. Good nutrition is a must as chronic pain is often accompanied by depletion.
Where the physical cause is specific – a badly healed bone injury, for instance, or sciatica, it may be worth seeing a chiropractor, osteopath or physiotherapist, whether privately or through the state system. Whatever the condition underlying the chronic pain, gentle –physical activity prevents loss of muscle mass and bone density.
‘Use it or lose it,’ as the old saying goes.
Strength is quickly eroded by non- activity, the good news being that regular gentle movement also restores lost muscle and bone density brought on by forced inaction, as well as maintaining tone of the gut and bowel, and boosting mood.
Mood can become an issue. People in chronic pain may feel frightened at times. They may feel excluded and lonely, particularly if illness and/or injury have forced them to stop working. They may be worried about money and the future.
Time is a valuable gift that a relative or friend can bestow. This goes for medical professionals too. Unfortunately, they are often working under tight time constraints and a patient who feels rushed may fail to mention something that is of importance.
If you are the patient, ask if you may book a double appointment, and think about what you want to say beforehand. Write things down. Note symptoms, starting with the most troublesome first. Note the times of day when it is better or worse. Identify if you can, any activities or foods or other triggers that you suspect may be associated with changes in the pain. You are looking for patterns. Take your notes and list of questions along to the appointment as a prompt. This helps will help a receptive doctor to help you with minimum waste of time.
If the doctor is not helpful and not receptive, see someone else next time. You are not a beggar. You are owed a duty of care by the NHS. A doctor whom you dread going to see is not likely to do you any good, however technically competent he or she may be. ( This is known as the Nocebo Effect. A nocebo is the opposite of a placebo, which may make you feel better, though containing no active ingredients, because your brain chemistry is tricked into co-operating.)
For further information visit www.painmanagement.org.uk
For details about medications used in chronic pain visit www.familydoctor.org go to the search box and type ‘chronic pain’.
Other links that may be helpful:
www.painrelief.co.uk
www.arc-research.org
www.cancer-pain.org
www.chronicfatigue.co.uk
www.nationalmssociety.org
www.crohnsonline.com
Finally, here are some suggestions based on personal experience. Feel free to disagree with anything. I have not managed to act on them myself 100% of the time, but they really have helped me. There came a point where I had to stop work because of inflammatory arthritis, aged 32, and was semi-bed bound for a long time. Now, aged 45, I run my own small business from home. The pain has not magically vanished, but it is calmer. I have found that while some doors in life did shut, new ones opened. They can do the same for you. Please don’t despair.
• Take charge. Inform yourself about help that’s out there. Doctors don’t know it all – they can’t. Expect to make an effort. Do some reading. Ask questions.
• When pain is severe, besides medication (if you have none, consider having a few nips of brandy or whisky at least at bed-time) try timely rest/sleep – or try distraction. Try not to get into a daily habit of sleeping too long – it can make matters worse. Distraction – becoming totally absorbed in an activity can work amazingly well on pain in bursts, and may also help you build new skills. Meditation -combines the benefits of both rest and distraction and can be done free of charge any time, in your own home. Visit www.lifepositive.com to find out more.
• Stay as active as reasonably possible, mentally and physically. Keep up with old pleasures where you can, and add new ones. Reading, listening to music, puzzles, watching the birds in the garden…it helps with the dodging of depression.
• Looking nice and smelling nice is vital for morale – yours and others. Smile if you can – nine times out of ten, people smile back and we all get a bit of a boost. No-one wants to be around a sour-faced grumpy-guts slumped in self-pity, highly justified though the grumpiness may be.
• Continue to be a contributor. Ask for practical assistance when you need to, but not sympathy. It’s tough, it’s asking a lot of ourselves, but we must understand it’s not humanly possible for others be sympathetic all the time. They have their own challenges to deal with. The human contract is based on exchange and we want help, not charity. You still have plenty to offer if you choose, even if it’s only a kind word. Stay connected – if you can’t move, then be someone’s anchor. People who know they are needed don’t feel so lonely.
I wish those in pain, and those who are caring for them, all luck and speed in their quest for relief.
Katie-Ellen Hazeldine
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