the d’s of chronic pain

As science continues to reveal the effects of Chronic Pain on various areas of people’s lives (physical, emotional, psychological, sexual, etc), we are realizing that it potentially has some far-reaching consequences.  One of the most amazing findings that I have ever seen, has to do with atrophy (shrinking of the brain) seen on brain scans of people with Chronic Pain.  Brain scans of people with Chronic Pain frequently show patterns of atrophy (shriveling / shrinking) virtually identical to those of people with ALZHEIMER’S OR SIMILAR DEMENTIA. The biggest difference is that atrophy induced by CHRONIC PAIN can often be reversed — just get rid of the pain!  Another study says that the brains of Chronic Pain patients atrophy at nearly ten times the rate of the general population.

There is a great deal of debate within the medical community over what is the best treatment for people with Chronic Pain (all debate revolves around THE BIG FIVE).   There is one camp that says CORTICOSTEROIDS and NSAIDS (as well as similar fare like TYLENOL) are extremely dangerous to the musculoskeletal system (they are very degenerative), as well as the liver, kidneys, and heart.  They are correct in their analysis of this class of drugs.  Their solution?  Prescribe more NARCOTICS.  As you may be aware from watching the 6 o’clock news, this isn’t working out so well.  Enter camp two.

The other camp — the camp that does not like to prescribe anything other than anti-inflammation drugs or weak pain relievers because they understand that people get addicted to narcotics.  This camp also tends to rely more heavily on MUSCLE-RELAXERS and ANTIDEPRESSANTS as well  The truth of the matter is that both camps are freqently going about things the wrong way.  Using drugs to provide relief of long-term or ‘chronic’ pain, is a slippery slope that frequently leads to numerous problems (HERE is one), mostly because it does virtually nothing to change underlying pathophysiology (HERE). Fortunately for those of you dealing with Chronic Pain, although you may have to search to find it, there’s a third camp.

When it comes to the best ways to help people struggling with Chronic Pain, why not try and figure out what’s actually causing it, and then try to deal with it at its source?  Is this really such a novel idea? Apparently it is, because it is not uncommon for me to see patients who have been living with chronic pain for decades, that could have been dealt with in a fairly simple fashion (HERE is one example, and HERE are several others).  Most of these patients have been to more doctors than you can shake a stick at, and know exactly what it’s like to get stuck riding the MEDICAL MERRY-GO-ROUND.

I would never hope to insinuate that all Chronic Pain can be easily fixed in our office.  The truth is, there are about a million and one reasons that people end up with Chronic Pain and / or chronic illness (HERE are a few, along with potential solutions).  However, I never ceased to be amazed at just how many people we are able to help (HERE).  What do people who have Chronic Pain tend to look like? What characteristics do they have in common?  They frequently progress through patterns of what I call “The D’s of Chronic Pain”.  Follow along and see whether you fit into one or more of these categories.

• DRAMATIZATION OR DENIAL:  These are the opposite ends of the spectrum as far as not being honest with yourself or others about your Chronic Pain is concerned.  Sometimes people with Chronic Pain tend to be overly-dramatic about their pain — their goal is to try and get others to understand their pain, while still others in this group are guilty of CATASTROPHIZING.  On the flip side of this coin are what I call ‘minimizers’ (men are far more guilty than women).  These people minimize their struggle with pain, attempting to hide it from others — particularly people outside of their family circle.  Ask them how they are doing and they’ll throw up a forced smile and say “fine”, even when it is painfully obvious they are anything but (HERE).
• DYSFUNCTION & DISUSE:  This is a vicious cycle, within a vicious cycle.  Chronic Pain leads to an inability to function; and inability to function leads to disuse.  And because the old statement, ‘use it or lose it,’ is far more true than it’s simple cliche-like name would imply, disuse leads to chronic pain.  Repeat these cycles until you are six feet under (see final bullet point). People with Chronic Pain have to find some way to EXERCISE and / or move their bodies.  Talk to me if you cannot figure out some sort of way to put your body in motion.  If you cannot move on your own, WHOLE BODY VIBRATION has shown some amazing results.  Bottom line, sitting in the chair, watching TV, and giving in to your pain is unfortunately going to lead to more of the same.
• DEGENERATION: A cold, hard, medical fact is that joints that don’t move properly wear out. This loss of motion can be either sectional (MY NECK DOESN’T MOVE) or segmental (my C3 vertebrae is not moving on my C4 vertebrae).  Although doctors, THERAPISTS, masseuses, can easily determine whether or not there is a loss of sectional movement, it usually takes a chiropractor to figure out where the segmental losses of motion are (HERE).  Fail to restore and maintain proper joint integrity, and the vicious cycle of abnormal motion, arthritis, and pain is where you are headed (HERE).
• DRUGS & DIALYSIS:   Many people with Chronic Pain have tried all sorts of drugs to relieve their pain (both legal and illegal).   If you suffer with Chronic Pain, I not need to remind you that these do not typically work well.  Although there are plenty of drugs capable of bringing short-term symptomatic relief, there are no drugs that effectively deal with Chronic Pain over the long haul; and most have a wide array of SIDE EFFECTS including addiction, destruction of collagen-based tissues, heart problems, liver problems, and on, and on, and on…..   However, it is the drug-induced kidney problems (requiring DIALYSIS) that have factored heavily into recent health-related headlines.
• DEPENDENCY:  When we think of dependency, most of us think of substance dependency (some sort of drug or alcohol addiction).  While this is often true, the dependency can be related not only to a substance, but to a person or device as well.  People become dependent on whatever allows them to cope with their pain.  That could be MEDIA (internet, T.V., movies, etc,). It could be SUGAR OR JUNK FOOD.  It could be something like a TENS unit (that unfortunately lose their effectiveness over time). It might be a wheel chair.   Or it could even be another person, a spouse, child, caregiver, etc.   While some of these things might be necessary and even critical, the unfortunate truth is that any sort of dependency results in a continuing erosion of personal freedom and independence. 
• DEPRESSION, DEMENTIA & DESPONDENCY:  These three are definitely related (I touched a bit on dementia earlier).  For years I have been treating patients who have been told repeatedly that their Chronic Pain is being caused by DEPRESSION (this is why so many Chronic Pain patients are prescribed SSRI’S.)   Be aware that not only is this not what the medical literature is mostly saying, it is frequently saying the exact opposite.  People are often depressed because Chronic Pain is preventing them from doing the things that they love to do. And Despondency is the next step in the cycle.  These are the people who sometimes go as far as taking their own life because of Chronic Pain (HERE).
• DISTRESS:  Distress is exactly what it sounds like; this stress.   Webster’s has this to say about ‘Distress‘.  It is a state of great pain, affliction, or suffering.  Believe me when I tell you that Chronic Pain is a never-ending, stressful event.  Unfortunately, a steady state of stress fries the Adrenal Glands and causes Adrenal Fatigue.  And interestingly enough, ADRENAL FATIGUE is the old name for FIBROMYALGIA.
• DISASTER: When people live in a chronic state of pain and stress, disaster seems to follow them like the cloud of dust that follows Charlie Brown’s Pigpen.  These could include divorce (another “D”), loss of income, loss of property, poor decisions, GULLIBILITY, etc.  These people often become desperate (still another “D”).  Much of this is due to the following bullet.
• DISABILITY: The legal definition of ‘Disability’ is, a physical or mental impairment that substantially limits one or more of the major life activities of such individual. This is a rather generic definition to say the least!  Without getting into a discussion over the incredible numbers of freeloaders who have figured out how to game the system in order to draw monthly checks from the government, suffice it to say that Chronic Pain prevents large numbers of people from doing things that they want to do — including work.
• DISSECTION & DEATH:  Sooner or later, people who suffer with Chronic Pain are going to be offered a surgical solution to their problem.  In some cases this is great.  If you have a COMPLETELY WORN OUT HIP, by all means get it replaced.  But no one can argue that much, perhaps even the majority, of surgery done in the United States is unnecessary.   Back in the 1990’s, the massive actuarial and consulting firm, Milliman & Robertson, published a study for the US government showing 60% of all surgeries are unnecessary.  This lines up fairly well with a decades-old study from JAMA saying that as many as half of all surgeries are unnecessary. As far as the last “D” is concerned, just remember that  Chronic Pain kills.  The end result of all of this is Death. 

Although I wouldn’t go back and do it again for a million dollars, my experience with seven or eight years of horrible foot pain (there were plenty of times I wondered if simply having it amputated and going with a Long John Silver style peg might be better) helped me understand where so many of my patients are coming from.  It’s also why I’m not only relentless about trying to solve your chronic pain (HERE), it’s why I give away tons of DIY information free of charge.  That’s free as in free — no strings attached.