What we perceive as "pain" is an interaction between several chemicals in the brain and spinal cord. These chemicals are called neurotransmitters. These neurotransmitters conduct nerve impulses from one nerve cell to another, and on to the brain. They do this by stimulating receptors found on the surface of nerve and brain cells, which function somewhat like gates, opening and closing to allow messages to pass from one nerve cell to the next. Many pain-relieving drugs work by acting on these receptors.
Pain can be roughly divided in to two types: Acute pain, and chronic pain. Pain is described as acute when it basically doesn't last very long - it is usually caused by an injury, illness, or surgery, and subsides as your body heals.
Chronic pain is usually said to persist for at least 6 months after your body has healed from the illness or injury that first caused the pain in question. There are forms of chronic pain that defy diagnosis. This usually adds to the emotional lows, anger, and self esteem problems that can already arise from experiencing the chronic pain in the first place. Many patients who experience chronic pain can also find that it interferes with the day to day activities of their lives.
Up to one-third of the entire population of the United States is affected by acute or chronic pain during the course of a year1.
Given the passage of a significant amount of time, all of these problems, compounded with anxiety, can lead to poor response to treatment, and set up a vicious cycle of unending discomfort.
You can, however, take steps to reclaim your life, and break the hold that pain can have over you!
Find, and Bond With Your Doctor
If you, like many other people, have had care from many different physicians, you may want to pick one, and stick with them. In addition to your family physician, you may want to consider also seeing a speCialist, if you know what is causing your symptoms. If you don't, you may want to consider a pain management speCialist. Bear in mind that you will still need to have a primary care physician to coordinate care and manage your general health. This is especially important in avoiding harmful drug interactions or conflicts in therapy.
When you're choosing a doctor, you'll want to make sure that, besides being someone that you feel you can trust, they are also knowledgeable about chronic pain issues. Beyond that, they should encourage and allow you to ask questions, and even to disagree with them. You should have a positive, proactive outlook on the road ahead, and your doctor should also share that.
Tell Your Doctor Everything
Your doctor can only help you if you give him or her as much information about your pain as possible. You should explain to your doctor the nature of your pain, where it is, how bad it is, and how often it occurs. If there are triggers that cause your pain, explain them also. Also, tell your doctor if anything makes the pain better. Don't forget to think about other, external factors that may not be readily apparent. Changes in your day-to-day schedule or even activities within the course of your day may be affecting you without your knowledge.
Your doctor will want to also go over other health problems with you. Besides directly affecting your pain, they may also affect his or her choice of treatment for you.
All of this will also assist in what is traditionally the first step in treating chronic pain: assessing the cause.
Treatment
Your doctor may prescribe various combinations of different therapies and medications to treat your pain. Generally, treatment can take the form of physical, behavioral, or occupational therapy, combined with various pain relievers, antidepressants, or anti-inflammatories.
Physical therapy can include walking, biking, etc, according to your situation, while behavioral therapy can teach you other pain control methods, such as meditation. Occupational therapy involves teaching you to more safely and efficiently accomplish everyday tasks, to minimize the risk of injury.
A little about drugs:
There are many pain-relieving drugs being used today. Opioid drugs block pain by locking onto opioid receptors in the brain. Other drugs control pain outside the brain, such as non-steroidal anti-inflammatory drugs (NSAIDs). These drugs, including aspirin, ibuprofen, and naproxen, inhibit hormones called prostaglandins, which stimulate nerves at the site of injury and cause inflammation and fever. Newer NSAIDs, including Celebrex (Celecoxib) and Vioxx (rofecoxib) for rheumatoid arthritis, primarily block an enzyme called cyclooxygenase-2. Known as COX-2 inhibitors, these drugs may be less likely to cause the stomach problems associated with older NSAIDs, but their long-term effects are still being evaluated2.
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Lifestyle Changes
Lifestyle changes can be invaluable in the treatment of chronic pain. If you smoke, or drink alcohol fairly frequently, you may want to modify your behavior. Quit smoking and drinking, or at the very least, cut back drastically.
A healthy diet will help not only directly, but indirectly, by reducing the strain on your cardiovascular system, and reducing stress.
Using recreational drugs can also impact your health in a myriad of ways that you could not possibly foresee.
Again, communication with your doctor is paramount. You and your primary care physician can map out all the things that you can do to try to reduce pain, and, if they work, you can modify your treatment accordingly. The key is to identify goals and obstacles to reducing pain, and tackling those goals and obstacles one at a time; then you can move on to the next challenge. Don't set unrealistic goals, because this will only lead to failure and frustration.
It is most important for you to take a long, hard look at your life, and how your pain has affected the way you live it. Then, take the necessary steps to "take your life back' - to change your behavior to reflect that you will no longer allow yourself to be controlled by pain.
References
1. NIDA Research Monograph, No. 36 (1986)
2. FDA Consumer Magazine, March/April 2004. Pub No. FDA 04-1336C
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