Category Archives: Chronic Pain

Overview of Depression Mgmt during Pain

Depression Management during the Presence of Pain: An Overview – January 20, 2015 – free full text article

Depression and anxiety are frequently associated with increased risk of medical problems. The severity of these problems varies from persistent pain to severe cardiovascular illness.

The pathophysiology of chronic pain and depression overlap in the noradrenergic and serotonergic pathways.

Antidepressants, especially dual acting which affect both pathways, are a frequent and effective choice of treatment for chronic pain.

The effectiveness of antidepressants for pain has not been proven and many pain patients get zero relief from them, including me.n Continue reading

Chronic pain leads to epigenetic changes

Chronic pain changes our immune systems | Channels – McGill University – By Cynthia Lee – Jan 2016

Many anti-opioid folks believe it’s always better not to prescribe/take opioids because they are so extremely dangerous, while pain is “just a feeling” that a person can “deal with”.

However, they are wrong. Pain is not just a “feeling”.

Leaving pain poorly controlled can lead to changes in how our genes are expressed, especially in the immune system.

Pain is the body’s alarm system, intended to get you moving to either fight or flee. It’s an extreme stressor which initiates a chain of biochemical consequences, including those that turn some of our genes on and off.  Continue reading

Pain and Suicide: The Other Side of the Opioid Story

Pain and Suicide: The Other Side of the Opioid Story | Pain Medicine | Oxford Academic – March 2014 – Lynn R. Webster, MD

Here is a very sad story about a pain patient’s suicide that will resonate with many of us. It illustrates how arbitrary opioid restrictions put doctors in an impossible situation and leave patients without hope. 

A former patient whom I’ll call Jack came to me for help after three back operations. He was on disability because of his pain. I treated him for about four years, struggling all the while to get his insurance to cover his therapies. I tried to get him to see a psychologist, but his insurance would not pay for the service. He was on what most physicians today would term a high dose of opioids and other medications.

He was mostly inactive and reported little improvement in pain or function while on his medication.   Continue reading

Reward Processing by the Opioid System in the Brain

Reward Processing by the Opioid System in the Brain – free full-text PMC article – Physiol Rev. 2009 Oct;

The opioid system consists of three receptors, mu, delta, and kappa, which are activated by endogenous opioid peptides processed from three protein precursors, proopiomelanocortin, proenkephalin, and prodynorphin.

Opioid receptors are recruited in response to natural rewarding stimuli and drugs of abuse, and both endogenous opioids and their receptors are modified as addiction develops.

Mechanisms whereby aberrant activation and modifications of the opioid system contribute to drug craving and relapse remain to be clarified.  Continue reading

Beta-endorphin and endogenous opioid function

What do plasma beta-endorphin levels reveal about endogenous opioid analgesic function? – Sept 2003 – free full-text PMC article

Plasma levels of beta-endorphin (BE), an endogenous opioid analgesic, are often reported as they relate to acute and chronic pain outcomes.

However, little is known about what resting plasma BE levels might reveal about functioning of the endogenous opioid antinociceptive system.

This study directly examined associations between resting plasma BE and subsequent endogenous opioid analgesic responses to acute pain in 39 healthy controls and 37 individuals with chronic low back pain (LBP). Continue reading

Pain Catastrophizing: A Review from 2012

Pain Catastrophizing: An Updated Review | Indian J Psychol Med. 2012 | free full-text PMC article

Pain catastrophizing has been described for more than half a century which adversely affects the pain coping behavior and overall prognosis in susceptible individuals when challenged by painful conditions.

This is the first time I’ve heard that catastrophizing only affectssusceptible individuals”. It makes me wonder what they mean by “susceptible”.

It seems that any patient who needs opioids is assumed to be catastrophizing – otherwise, their pain wouldn’t be “that bad”.   Continue reading

Glial Cells: “Missing Link” in the Physiology of Pain

The “Missing Link” in the Physiology of Pain: Glial Cells – Practical Pain Management – May 2016

glial cells and their interactions have become recognized as having a critically important role in the generation and maintenance of acute and chronic pain… and may now be a “missing link” in our understanding of the conversion of acute to chronic pain and the development of chronic neuropathic pain

This conversion process has been called “chronification,” and includes

  • central sensitization,
  • neuroplastic changes,
  • altered pain modulation, and
  • changes to the “neuromatrix” of the central nervous system.

Continue reading

Neck Pain and Ehlers-Danlos Syndrome

Neck Pain and Ehlers-Danlos Syndrome | Pain Neck Blog – PainNeck.Com by LMatthews – December 12, 2011

Ehlers-Danlos Syndrome may be the cause of neck pain in some patients and at least three of the most common types of the disorder can contribute to chronic pain in the neck.

ligaments, blood vessels, joints, internal organs, skin, and the inter-cellular matrix are affected by the defect leading to a variety of symptoms.

it is well understood that individual experiences of the disease are extremely variable.

Most patients suffering from neck pain due to Ehlers-Danlos syndrome will also be experiencing pain in other joints of the body and a degree of hyper-flexibility that can cause them to become injured even performing fairly routine activities.

It is thought that EDS is under-diagnosed due to the overlap of symptoms with other illnesses, general aches and pains, and the complexity of the effects of the connective tissue disorder.

Chronic Pain and Joint Degeneration

The severity of the pain and the effect of this on a patients’ quality of life are variable with some requiring significant intervention to prevent serious joint damage occurring

The chronic pain which usually characterizes the disease is often reported as worsening during a patient’s lifetime, perhaps due to progressive wear and tear and damage to the joints.

Neck pain may then result from

due to vascular manifestations of Ehlers-Danlos syndrome.

Effects of Ehlers-Danlos Syndrome

Disruption to sleep and physical activity are two of the most frequently reported effects of EDS, both of which have wide-ranging ramifications for general health and well-being.

The connective tissue disorder also affects patients’ ability to study and to work, and almost half of all patients report that Ehlers-Danlos syndrome adversely affects their sex life

Hyperflexibility, Neck Pain, and EDS

Hypermobility type 3 Ehlers-Danlos syndrome is usually considered the least severe of the classifications of EDS although it is still likely to cause significant pain and disruption in a patient’s life

Dislocations and subluxations are common, occurring with even minor trauma or no apparent cause in some cases but frequently resulting in severe pain

Joint degeneration is common, as is chronic pain not connected to specific dislocations or osteoarthritis.

Patients often bruise very easily when they have Ehlers-Danlos syndrome and many have difficulty maintaining bone density, leading to the increased risk of osteoporotic fractures in later life.

Neck Pain Relief in Ehlers-Danlos Syndrome

Treating EDS involves physical therapy appropriate for the degree of disability and symptom severity in each patient.

Where mobility is affected, patients may use braces, wheelchairs, and scooters but are usually not advised to rely on crutches, canes, or walkers as these can put extra strain on the upper body.

Pain medication is often prescribed but patients may have a difficult time finding a suitable analgesic with manageable side-effects

A combination of therapies is usually beneficial in order to reduce acute suffering whilst attempting to reduce future injury or degeneration of joints. Low-resistance exercise can be helpful in maintaining the strength and stability of joints and ergonomics are very helpful in reducing strain whilst at work or study.

Spinal Stenosis, Pinched Nerves, and Neck Pain

Neck pain from Ehlers-Danlos syndrome can be a result of

  • pinched nerves in the neck,
  • muscle strains or sprains from accidental hyperextension,
  • ischaemia following damage to the vasculature in the neck and cervical spine, and even
  • fracture, subluxation, and spinal stenosis resulting from the condition.

Fibromyalgia, CFS, EDS and Neck Pain

Myofascial spasm and muscular pain is also seen in many patients, with aching joints that throb or are stiff and tender. This is particularly common in the spinal muscles and can contribute to back and neck pain

Hypermobility in the cervical spine may produce similar symptoms to those of whiplash associated disorder as the spinals structures are repeatedly exposed to excessive movements which wear down the cartilage, intervertebral discs, and bones in the spine

Neuropathy and Neck Pain in Ehlers-Danlos Syndrome

Neck pain with neuropathy is also possible in EDS, with radicular pain such as pins and needles in the arms and hands, numbness, burning sensations, and feelings of heat or cold also experienced by some.

Nerve conduction studies are not commonly used during diagnosis and the nerve fibers may be normal in patients with the pain and altered sensation originating instead from spinal nerves that are pinched by 

Neck pain and headache are not uncommon and are thought to be caused by

  • tension in the neck muscles,
  • reduced circulation to the head and neck through vascular damage and blood vessel compression, and
  • possible dysfunction on the temporomandibular joint (the jaw).

Managing EDS

Where neck pain is caused by Ehlers-Danlos syndrome, patients are likely to require physical therapy, pain medications, and assistive devices as well as regular check-ups to monitor the progression of the condition.

Pain medications are thought to be underprescribed in cases of Ehlers-Danlos syndrome and physicians are advised to tailor medication to the subjective experience of patients rather than simply taking objective findings into account.

Neck Pain Relief for Patients with Ehlers-Danlos Syndrome

Patients may be given the best chance of managing their symptoms effectively when their condition and all direct and indirect effects are taken into consideration.

Treatment of neck pain from Ehlers-Danlos syndrome needs careful management in order to reduce the risks of nerve damage and spinal cord compression.

How to Understand Someone With Chronic Pain

How to Understand Someone With Chronic Pain

This is the most compassionate and understanding (and understandable) article about understanding people with pain I’ve read. While I was reading it, I could feel that warm fuzzy feeling inside, the one so rare when you always have pain.

With chronic pain, however, pain signals continue abnormally. This can be both distressing and exhausting for chronic pain sufferers. In some cases of chronic pain, there was an injury, illness or infection that first caused the pain. In other people, though, chronic pain appears and continues without a history of these events.

To understand chronic pain sufferers, you should learn about chronic pain, be supportive and know what to say and what not to.

A great resource to send your friends and family: How to Understand Someone With Chronic Pain

Public is oblivious to impact of pain

NFMCPA Press Release: Impact of pain misunderstood by public, survey shows – PAINS – Pain Action Alliance to Implement a National Strategy – February 24, 2017

According to results from an end-of-year survey issued by the National Fibromyalgia & Chronic Pain Association (NFCPA).

  • Over 70 percent of pain patients feel that people do not believe their pain,
  • 78 percent of respondents do not believe people should learn to live with pain, while
  • 77 percent live in fear of not being able to find health care to control their pain.  

The opinion survey results imply that pain diseases are generally misunderstood by the public.

See also: “How do you Explain Chronic Pain to Someone who doesn’t have it”   Continue reading