Category Archives: Chronic Pain

Pain is largely a misunderstood construct

Pain – Thomas Dikel – Medium – Aug 2017

Pain is largely a misunderstood construct. This is odd, as everyone has experience with pain, and it has been studied extensively. Nevertheless, it remains a mystery, even to those who believe they know it best.

What we understand as pain is not a unilateral function. There are in fact two basic and primary components to pain.

The first is the obvious: the physical or “nociceptive” aspect, which involves specific and particular nerve cells that respond to specific and particular stimuli.  Continue reading

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Cervicogenic Headache & Cervical Instability

Cervicogenic Headache – Physiopedia

Due to our overly-stretchable tendons and ligaments, we with EDS often get these headaches that arise from misalignments of our upper cervical spine.

Cervicogenic headache is a chronic headache that arises from the atlanto-occipital and upper cervical joints and perceived in one or more regions of the head and/or face

Continue reading

Over-the-counter pain relievers and your heart

Over-the-counter pain relievers and your heart – Harvard Health Blog – Harvard Health Publishing – May 15, 2017 –Monique Tello, MD, MPH,

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen are and have been the go-to “benign” pain medication for doctors and patients alike. Why?

They aren’t addictive, and it’s not easy to overdose.

But multiple studies suggest a clear link between all NSAIDs and heart attacks, strokes, and heart failure.   Continue reading

Neuroimaging for Chronic Pain: IASP Consensus Statement

Neuroimaging for Chronic Pain: IASP Consensus Statement – by 

health and disability insurance companies seek methods to confirm the pain status of beneficiaries to corroborate self-report, which is the current gold standard for pain assessment in clinical and research settings.

All parts of our health system (and its interface to the legal and financial systems) have difficulties with self-reported symptoms because they are all based on numerical values that are independently verifiable.

A blood test or x-ray taken by your doctor will not yield significant differences from the ones taken by your insurance company or lawyer, so these are seen as “factual evidence”.   Continue reading

Review of opioid-induced hyperalgesia

A comprehensive review of opioid-induced hyperalgesia. – PubMed – NCBI – Pain Physician. 2011 Mar-Apr – Free full text

Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids.

The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli.

When a patient has this (which has never been proven in humans), giving more opioids leads to more pain, instead of less. Continue reading

Why Doctors Don’t Like the EDS Diagnosis

Handle With Care: Why Doctors Don’t Like the EDS Diagnosis – Jenrose – Oct 2017

I feel like many doctors resist Ehlers Danlos Syndrome (EDS) diagnoses for their patients…  for a variety of reasons.

  1. They can’t fix it.
  2. It means admitting that they have wrongly dismissed symptoms as psychosomatic for decades.
  3. It answers too many questions at once.
  4. People who have it often have a lot of things going on and it feels to doctors like their patients are “diagnosis shopping.”
  5. Admitting that there is a legitimate source of chronic pain means another potential patient on opiates, which invites scrutiny.  

Continue reading

The science and philosophy of the meaning of pain

The science and philosophy of the meaning of pain – Body in Mind  – August 22, 2017 – This is the seventh in a series of posts on BiM about chapters in the edited collection, Meanings of Pain (2016, Springer).

The chapter commences with a reflection on the experience of sitting across from chronic pain sufferers reporting unrelenting pain at the “highest pain imaginable” level, while observing “no tangible, apparent, physical expression to match the elevated scores and the descriptions of a torturous internal state”.

Patients who exaggerate their pain like this make it difficult for any of us to be taken seriously.

If pain is truly the “highest pain imaginable”, a person would not be able to speak conversationally and might be on the verge of losing consciousness. For me, it was when I broke 3 bones in my foot as a kid and all I remember is a bright explosion in my brain and hearing my own screaming.   Continue reading

A classification of chronic pain for ICD-11

A classification of chronic pain for ICD-11 – Free ful-text /PMC4450869/ from NIH – 2015 Jun

Chronic pain is a frequent condition, affecting an estimated 20% of people worldwide and accounting for 15% to 20% of physician visits.

Chronic pain should receive greater attention as a global health priority because adequate pain treatment is a human right, and it is the duty of any health care system to provide it.

The current version of the International Classification of Diseases (ICD) of the World Health Organization (WHO) includes some diagnostic codes for chronic pain conditions, but these diagnoses do not reflect the actual epidemiology of chronic pain, nor are they categorized in a systematic manner.   Continue reading

Warning: Persistent Post-Surgical Pain Common

Persistent Postsurgical Pain – Practical Pain Management

Surgery is often counterproductive for chronic pain, so beware!

More than 45 million surgical procedures are performed in the United States each year. It has been estimated that acute postoperative pain will develop into persistent postoperative pain (PPP) in 10% to 50% of individuals after common operations.

Since chronic pain can be severe in up to 10% of these patients, PPP represents a major clinical problem—affecting at least 450,000 people each year.  Continue reading

Physiologic Effects of Pain on the Endocrine System

The Physiologic Effects of Pain on the Endocrine System – Free full-text PMC4107914 – Pain Ther. 2013 Dec – by Forest Tennant

Severe pain has profound physiologic effects on the endocrine system.

Serum hormone abnormalities may result and these serve as biomarkers for the presence of severe pain and the need to replace hormones to achieve pain control.

Initially severe pain causes a hyperarousal of the hypothalamic–pituitary–adrenal system which results in elevated serum hormone levels such as adrenocorticotropin, cortisol, and pregnenolone.

If the severe pain does not abate, however, the system cannot maintain its normal hormone production and serum levels of some hormones may drop below normal range.   Continue reading