So called chronic pain (longstanding pain that continues for months and even years) is an unfortunately common problem for all people with major physical impairments – whether these were caused by spinal cord injury, brain injury, stroke or any other “disabling” medical problem. A disrupted nervous system or major injury can mean that you often have to live with pain that few other people are willing or able to understand.
In this issue I am going to talk a little about types of pain - -and then go on in the next few issues to talk about the things that can – and should be done to manage pain properly.
While this type of pain can be very difficult to treat it is important to remember that there are many things that can be done to relieve and control pain when you have it. As with all health issues the first thing to do is to understand what is happening – and then to make sure that you handle it the right way.
As always, it is important that you are able to talk about your pain with a doctor who understands your whole medical problem – and who does understand pain management. It will often be important to exclude reversible or treatable medical problems before accepting the presence of chronic pain.
There are two main common types of chronic pain – and it is important to be able to distinguish between them the treatment for each is often quite different.
The first broad category of pain is musculoskeletal pain, which is caused by injury to bones, ligaments, muscles and joints. This type of pain is usually only experienced in those parts of your body that have at least some feeling – like a painful shoulder, elbow, wrist or upper back. It is usually either a dull ache, but may feel sharp like a stab or a cut.
This type of pain most often results from overuse or misuse of the affected part (due to poor posture and adaptive mobility strategies) – and is called an “overuse injury” – but can also be caused by falls, fractures and even different types of arthritis – or joint inflammation.ï€
Chronic musculoskeletal pain is often caused by “wear and tear” of muscles or joints or because of problems with posture or muscle imbalance. Importantly, when your doctor examines you there will often be some sign of a detectable problem – which will often be treatable – and with correct management may even resolve.
The second type of pain is usually the one that leaves us all (patients, their families and their doctors) frustrated and desperate. This type of pain has been labeled neuropathic (sick nerve) pain. It is directly caused by damage to the brain, spinal cord or spinal nerves or even peripheral nerves.
In the case of spinal cord injury it is often felt at or below the level of the injury or below the level of the injury. With brain injury, stroke and other neurological problems the site varies according to the site of the injury to the brain itself. In the case of amputations and nerve injuries it is felt in the area that was supplied by the injured or severed nerve itself.
This neuropathic pain may be sharp, burning, stinging or shooting and is often difficult to describe. Many people complain that is gets worse when the weather is cold, windy or wet. It may also flare up when there are other medical problem – like bladder infections or constipation.
It is very important to understand that even though this pain may be felt in the limbs, back, chest or stomach it is not caused by problems in these areas but because of damage in the brain, spinal cord or nerves at the site of the original injury. The painful body parts are usually quite healthy.
It is equally important to understand that if you have this type of pain, ordinary pain relieving medication will often be ineffective and may even aggravate your pain.
So, it is clearly important to work out with your doctor what type of pain you have. If you have musculoskeletal pain due to neck, back, shoulder, elbow or wrist problems, you may need to see and orthopaedic surgeon to see if this problem can be resolved in order to resolve your pain. This type of pain is usually a useful message that there is something wrong – something that needs attention. It’s a message that needs to be listened to!
If you have excluded musculoskeletal pain with your doctor and you have, between you, decided that you have neuropathic pain then your pain is a whole different story and while I will discuss its treatment in future issues there are some really important principles to remember.
Firstly, the way you think and feel affects your pain and this in turn affects the way you think, feel and behave. So, a sick person may be irritable or depressed - a very appropriate and natural response to his illness, injury or pain. This is a natural response to pain and suffering, but realising that this occurs has changed the way we manage pain. Pain medication alone – no matter how strong, is seldom enough to treat chronic pain. We need to combine appropriate medication (that will help and not aggravate) with physiotherapy, occupational therapy and counselling if we have any hope of achieving success. We need to acknowledge and address the problems of living, relationships and family that “happened” around chronic pain – and without doing so will never manage reduce, control and cope with pain.
What’s the take home message? Well apart from the obvious “stay tuned for the next instalment”, it is really important to go ahead and work with you doctor to ensure that you do know what kind of pain you have. Make sure you’ve identified and treated all treatable sources of pain. If you have neuropathic pain – be reassured that there is nothing wrong with the painful part of your body – and know that by putting together the right medication with attention to the fallout of pain in your life, much can be done to treat you pain. But more about that next time.