The Problem of Pain
The body’s primary distress signal, designed to warn about injury or
illness, can sometimes outlast its usefulness.
By Lisa James
For Kimberley McCoy of Lakewood, Colorado, pain had practically become a way of life. “I was in a couple of car accidents, one of which was pretty severe. I worked for about 10 years in construction and another 12 in warehousing. All of that took a major toll on my body,” says McCoy, 42, who now works as a corporate trainer.
It’s not like she hasn’t tried to find relief. “I have done a ton of stuff: acupuncture, chiropractic, massage therapy, physical therapy,” McCoy says. “I have a TENS unit (a low-intensity electrical nerve stimulator), medication for when the pain gets really bad. All of that helped a tiny little bit, but it just made the pain go away for a while.”
McCoy’s story isn’t unusual. In a survey conducted by the Clarus Research Group, 46% of respondents suffered from pain at least several times a week; 17% said their pain was either “bad” or “severe.” Another survey in North Carolina found that rates of lower back pain have more than doubled since the early 1990s, a result the researchers believe may represent a national trend (Archives of Internal Medicine 2/9/10).
Serious pain can have serious consequences. It has been linked with digestive problems, poor wound healing, increased risk of blood clots and, in seniors, an increased risk of falling. People in their 50s who suffer from chronic pain have the physical limitations of pain-free people in their 80s (Journal of the American Geriatric Society 9/09).
The back is the most common site of chronic pain, along with the hip, shoulder and head. Discomfort can arise from nerve pain (known as neuropathy) caused by disorders such as diabetes and joint pain caused by arthritis. Other types of pain include thoracic outlet syndrome, nerve and/or blood-vessel compression affecting the arm, shoulder and neck; sciatica; pain in the lower back and leg caused by nerve irritation; and fibromyalgia, marked by widespread pain and points that are tender to the touch.
The problem posed by chronic pain is that it isn’t a disorder per se—it’s a symptom gone awry. “Chronic pain has not only lasted a certain amount of time but has lost its usefulness,” says Jennifer Schneider, MD (www.jenniferschneider.com), a pain specialist in Tucson, Arizona and the author of Living with Chronic Pain (Hatherleigh Press). “If you put your hand on a hot stove, the body gets a signal that you need to take your hand away. That’s useful pain. Chronic pain is no longer giving you a signal that something needs to be fixed.”
What causes acute pain to become chronic? “That’s the $64,000 question,” says Margaret Caudill, MD of Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire and author of Managing Pain Before It Manages You (Guilford). “The only predictive marker that has been found to be associated with chronic pain is the severity of the pain when the injury first occurred.”
The problem, says Schneider, is that the nervous system can establish seemingly unbreakable pain pathways. “If you drive down a rutted country road you tend to drive in the ruts and they get deeper and deeper. The same thing happens with the nervous system,” she explains. “Pain becomes disconnected from whatever caused it.” Hormones may also influence pain perception, which helps explain why women seem to feel pain more readily than men.
Persistent pain can also originate in the muscles. Sometimes they develop trigger points, hard nodules that show abnormal neuromuscular activity.
Another source of muscular discomfort is called adaptive muscle shortening. “Due to posture and the fact that everything we do—driving, working on the computer, cooking—is in front of us, the muscles across the shoulder, chest and neck become chronically shortened and very tight,” says Joan Sloss, CMMT, medical massage therapist at Healing Unleashed in Lakewood (www.healingunleashed.com). “We call it locked-short. There’s a constant pulling on the muscles in the back; they become locked-long. It’s always the locked-long muscles that hurt.” Sloss says that locked-up muscles can put pressure on nerves, a condition called undiagnosed peripheral neuropathy.
The complex nature of chronic pain means that many people go years without receiving a proper diagnosis. “Some are on pain medications, some have had surgery and it didn’t really correct the problem,” says Wanda Bedinghaus, MD of Healing Unleashed. “Often the underlying cause of the pain hasn’t been addressed.”
Feelings About Pain
Pain not only afflicts the body. It also affects the mind and, through the limitations it imposes, a person’s entire life.
“A lot of journal articles have shown that depression and pain reinforce each other; people with pain are often depressed and vice versa,” says Schneider. “So many bad things have happened to these people: They’ve lost a job, sex is uncomfortable, they can’t do sports.” She notes that people respond to pain differently based on genetics, personality and childhood experiences. Bedinghaus agrees. Among the patients at her practice, she says, “we often see an emotional release. We see people who have not been able to forgive a parent; they hold that tension in their body.” One study has even found a link between back pain and financial woes (BMC Public Health 12/6/09).
What’s worse is that some patients, particularly those with disorders such as fibromyalgia, “have been told ‘It’s all in your head,’” says Schneider. “They have been under-treated, so they now have emotional and psychological issues.”
Chronic pain doesn’t have to run your life. “If you have people map out their pain experience as sensation versus the emotional reaction to the pain, you’ll see after a time that the pain level really doesn’t change that much but the distress does,” says Caudill. “When you learn how to manage the stress and sleep better, that helps manage the symptom of pain.” She recommends that her patients track discomfort levels through use of a pain diary. Caudill then helps patients pinpoint forms of negative self-talk, such as all-or-nothing thinking or overgeneralization, and learn how to use relaxation exercises and other techniques to change negative thought patterns.
One way to help body and mind deal with pain is through exercise. “It’s important to understand that physical activity can help,” says Schneider. “Initially it hurts but once you strengthen the muscles it becomes more comfortable.” Researchers have found that physical activity isn’t recommended often enough by practitioners (Arthritis & Rheumatism 2/09).
Yoga and acupuncture are other commonly used techniques for pain relief. Acupuncture has helped some people; one study found it most useful for back and neck pain, headaches and osteoarthritis of the knee (American Family Physician 9/09). Yoga helps cultivate inner awareness and calm along with breath control. If you try yoga, find a teacher who is willing to work with any limitations you may have.
Massage is helpful, but you might need more than a regular rubdown. Sloss says that there are two types: standard massage and massage combined with bodywork, such as therapeutic stretching and manual therapy. Known as orthopedic or medical massage, Sloss says it is “based on an evaluation of the body, not just, ‘Oh, my neck hurts, please rub my neck.’ It uses the same protocols a physical therapist or orthopedic surgeon would use to determine the exact cause of the pain.”
Sloss says that bodywork is often necessary to relieve deeper muscular issues such as adaptive muscle shortening. “I will stretch a muscle for at least 45 seconds, more like one or two minutes,” she says. “We need to create a long-term stretch of the muscle.”
Bodywork “has helped tremendously,” says Kim McCoy, one of Sloss’s patients. “The type of massage she does gets down to the systemic forces instead of just fluffing over the symptoms. I can tell that my body functions better.” McCoy may also try homeopathy, which Bedinghaus offers. (To find a medical massage therapist in your area, Sloss suggests asking several physical therapists about massage specialists they refer their own patients to.)
Body awareness can help people in pain maintain improvements—and help people in general avoid chronic discomfort. “Most people have so little awareness of their bodies,” Sloss says. “People need to have posture awareness and awareness of ergonomics—how they work, how they drive a car, how they sit. A lot of low-back pain comes from the furniture we sit on.”
“I see the possibility in the not-too-distant future of understanding why chronic pain occurs,” says Caudill. That would be ideal. But in the meantime it’s good to know that pain doesn’t have to leave you helpless.
There’s the pain of a bad headache…and then there’s a migraine, which most sufferers (known as migraineurs) would say is in a class by itself. It’s more than just the throbbing ache, usually on one side of the head. A migraine can also include symptoms such as nausea and vomiting; sensitivity to light, noise and odors; blurred vision; and irritability or depression. An attack can last up to three days, with exhaustion or weakness (and sometimes confusion) afterwards.
About 12% of all Americans experience migraines, according to the National Institutes of Health; women outnumber men three to one. And although a recent HarrisInteractive poll found that 66% of those surveyed continue to work during attacks, migraines are still responsible for an annual loss of roughly 80 million workdays.
The two major types of migraine are migraine with aura, which includes neurological symptoms such as visual disturbances and tingling or weakness that appear up to an hour before the pain does, and migraine without aura, which doesn’t include such symptoms. Other, rarer, forms include abdominal and basilar-type, which mostly affect children and teens; those related to the menstrual cycle; ophthalmoplegic, which is associated with droopy eyelids, dilated pupils and double vision that can last for weeks; hemiplegic, which can cause temporary one-sided paralysis and often runs in families; and status migrainosus, in which pain and nausea may be so severe that the person needs to be hospitalized.
Migraines are caused by problems with the blood vessels embedded within the membrane that covers the brain. Scientists aren’t sure what sets off this vascular response, although the trigeminal nerve, the one that controls facial sensation, may be involved. Migraines often occur in people with other conditions, such as anxiety, depression, epilepsy and sleep disorders. One study has linked migraines with increased cardiac risk (Neurology 2/10/10 online).
A number of factors can trigger migraines such as sleep disturbances, strong odors, sudden weather changes, stress, loud noises, tobacco, flashing lights, some medications and hormonal changes. Attacks in half of all migraineurs are triggered by specific foods. The most common culprits include aged cheeses, cured or processed meats and fish, chocolate, sourdough bread, fava or lima beans, fermented foods such as sauerkraut and pickles, soy sauce and other sources of MSG, red wine and excessive caffeine.
While many people take medication to help prevent or control attacks, many others rely on more natural methods. Studies suggest that chiropractic treatments can provide some relief, especially if someone also suffers from neck pain. Some sufferers have found relief through acupuncture, which practitioners say can also help ease the anxiety, fatigue and insomnia that often plague migraineurs.
Researchers have found that 50% of all migraine sufferers have low levels of magnesium, a mineral that is known to reduce muscle spasms; arterial walls contain smooth muscle that allows them to contract and dilate. Additional supplements that have been linked to reduced migraine frequency include vitamin B2 (riboflavin), CoQ10, 5-HTP and SAMe. Feverfew (Tanacetum parthenium) is the best-known herbal remedy for migraines; others include passionflower (Passiflora incarnata), skullcap (Scutellaria lateriflora) and valerian (Valeriana officinalis). All should be taken in tincture form at the first sign of an attack.
For more information on migraines, visit the National Migraine Association at www.migraines.org.