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All In Your Head?

By Bill W, MD

Pain. We all have experienced it. A stubbed toe. A strained back. A scraped knee. It can be a prick, tingle, sting, burn, or a dull ache. Pain is a signal that something is not right. It can be all over, or it can come from a specific part of your body.

Pain can also be acute or chronic. Acute pain is the kind that tells you something is injured or there is a problem you need to take care of, to relieve the pain. Chronic pain is different. There may have been an acute problem at one time, perhaps from an injury or infection, yet pain persists despite the injury or infection having resolved. This kind of pain can last for weeks, months, or years. And sometimes, there is no clear reason for the pain. It just is.

It is estimated that more people suffer from chronic pain than those with heart disease, diabetes and cancer combined. It is one of the most common reasons people seek medical care. Further, it continues to be perplexing when looking for answers.

So where am I going? September is Pain Awareness Month. The objective is to remind organizations to work together to raise awareness of how pain affects persons, families, communities, and the nation and to support national action to address pain.

 

Pain has a history

Apparently, the ancient Greeks considered pain a passion. They believed pain to be more of an emotion rather than a sensation. During the Dark Ages, pain was viewed as punishment that would be relieved through penance.

When I was in practice during the ‘90s, pain as a purely physical phenomenon reached its height. As care providers we were encouraged to see pain as the “fifth vital sign,” along with temperature, breathing, pulse, and blood pressure. We would have patients rate their pain. The goal was to quash it.

“All in your head” is the wrong message to give a person who is suffering chronic pain. Here’s the challenge however, our brains play a huge role in how we experience pain. When the pain signal hits the brain, it undergoes significant “reprocessing.” The perception of pain is always a personal experience. It is affected by our stress levels, our environment, our genetics, and other factors.

When you have pain from a specific cause (an injury or a specific disease process like arthritis), treatment should be targeted at the underlying cause of the pain or disease. What can happen to some of us, usually after about three months is that the pain gets reprocessed and thus becomes “centralized” or chronic. This usually happens after whatever the original problem has passed, or is healed, but there are lingering perceptions of pain. This is where education becomes critical for a patient. There must be a focus on reducing fears like “something is wrong” or “hurt means harm.” Living with pain can be debilitating and reduce your quality of life. When patients can begin to understand what is going on with their body and their perceptions of the pain, they are more successful in getting better.

 

When you see your doctor

These are questions to ask your doctor:

  • What is the likely cause of my pain?
  • Why won’t it go away?
  • What is the best treatment option for me? Will I need medicine?
  • Will physical, occupational or behavioral therapy help relieve my pain?
  • What about alternative therapies, such as yoga, massage or acupuncture?
  • Is it safe for me to exercise? What kind of exercise should I do?
  • Do I need to make any lifestyle changes?

It may be necessary to take pain relievers. These are medicines to relieve sore muscles, headaches, arthritis or other aches and pains. There are many options, and each have their pros and cons. Your provider may initially suggest an OTC (over the counter) medicine such as acetaminophen or anti-inflammatories such as ibuprofen or naproxen. The most powerful pain relievers are called opioids. They have a high risk of addiction and further, they have been shown to worsen pain if you take them for too long.

The evidence continues to mount about effective ways to manage pain beyond medication. Depending on the condition, your doctor may suggest:

  • Acupuncture
  • Biofeedback
  • Electrical stimulation
  • Massage therapy
  • Meditation
  • Physical therapy
  • Psychotherapy
  • Relaxation therapy
  • Surgery on rare occasions

Research has shown that “talk therapies,” such as CBT (cognitive behavioral therapy), can help many people with chronic central pain. What does this do?  CBT helps you change negative thinking patterns and behaviors. This often can help patients with chronic pain change how they feel about their condition. Cognitive behavioral therapy can also help people with chronic pain manage related health problems, such as problems sleeping, feeling tired, or trouble concentrating. This can increase quality of life for people with chronic pain.

 

There is hope

If you made it this far in your reading, do know the options for treating pain successfully have increased considerably over the last 20 years. The first thing you or your loved one tries may not be successful. Don’t give up. Working with your doctor or therapist you can continue to explore the various approaches that have worked for many people. This is about living life to the fullest.