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Partners Mission
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| The Partners mission is to create greater
understanding among Healthcare Professionals, individuals and
families member when your partner is struggling with pain
management. Offer a comprehensive network of resources and knowledge
about issues in pain management and build understanding and support
that can help your loved ones with chronic and acute pain lead
better lives.
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| Pain
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| Pain can be classified into
"mechanical"
or
"inflammatory" then "acute" or "chronic". It can
be described as an unpleasant sensory and emotional experience
associated with actual or potential tissue damage or described in
terms of such damage. Another terminology for pain is nociception
from the word noxious for the experiencing of a stimulus that is
tissue damaging.
Pain can vary greatly from person to person and each person has
a different threshold and tolerance. A combination of factors can
also contribute to pain intensity including both physical and
emotional. Here are some practical steps you can take to help reduce
the intensity of the pain you are experiencing.
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| Pain Management
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| There are many ways to manage your pain but
the most important tool is self-management. Find out which pain
management tools are most beneficial for you. Visualization is a
powerful tool. Your response to pain is determined by many factors
such as your emotional outlook. If you think you feel unable to cope
it is best to talk to some one and seek help. Try to minimize
negative thought patterns and learn to listen to your body when it
is telling you that it is tired or in pain.
Choose activities that are not stressful and take your mind off
the pain. Keep a diary of your pain; this exercise can help you
understand if your pain is made worse by certain activities. The
more aware you are of when the pain intensifies the more in control
of the pain you will be.
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| Pain Scale Tests' (PDF Files)
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| Survey of Pain Attitudes (SOPA)
details
McGill Home Recording Card for Pain
details
Clinical Pain Assessment
details
Questionnaire of von Korff et al for grading the severity of
chronic pain
details
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| Chronic pain
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| Chronic pain is broadly defined as pain
persisting or recurring for more than 3 months, or pain associated
with tissue injury that is expected to continue or progress.
Vegetative signs, sleep disturbance, decreased appetite, loss of
taste for food, weight loss, diminished libido, constipation often
develop gradually, and depression may follow. Pain is the body's way
of responding to an injury.
Chronic pain can affect all areas of your life. It is advisable
for patients to talk with their Healthcare Provider. Informing your
Healthcare Provider about having chronic pain can create an
opportunity for a multi-disciplinary course of treatment involving
both a physician and a mental health professional. It's not a sign
of weakness but one of strength, by taking control you are able to
make insightful decisions over your chronic pain and that is half
the battle. It's important for your Healthcare Provider to
understand what changes the symptoms of pain and can it also be
related to changes in your mental state. Chronic pain that does not
respond to exercise, massage or manipulation is usually a ligament
problem.
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| Acute Pain
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| Acute pain is brief, intense and arises
suddenly, limiting your activities almost immediately. Acute pain is
usually associated with injury or a medical intervention (for
example, surgery) and goes away when the body heals. Medication is
given as needed, for a short period. Acute pain lasts a short time;
typically 1 month. It is often associated with anxiety and with
hyperactivity of the sympathetic nervous system.
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| Persistent Pain
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| Persistent pain is ongoing, background pain.
It can range from mild to severe. It may feel like a highly
uncomfortable ache to a grinding agony. Persistent pain is usually
treated with medication. Alternative and complementary methods may
also help. Because persistent pain lasts day after day, it can steal
the quality of your life and leave you feeling weak and dependent on
others. Persistent pain may interfere with your ability to feel
interest in anything other than your condition. This may isolate you
from friends, places you love, and the more pleasant aspects of your
normal life.
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| Breakthrough Pain
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| Two-thirds of people with persistent pain
also have breakthrough pain, which is usually related to what is
causing the persistent pain. Breakthrough pain is a sudden worsening
of the persistent pain for brief periods (on average, 30 minutes).
The pain
"breaks through" the relief provided by long-acting medications
and becomes intense. Breakthrough pain caused by body movements is
called incident or triggered pain. Breakthrough pain caused by a
non-specific source is called spontaneous pain. If you know you're
likely to have breakthrough pain when you do certain activities, you
can plan to take treatment ahead of time.
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| Fibromyalgia
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| Fibromyalgia Syndrome (FM) is a very common
condition of widespread muscular and connective tissue pain and
fatigue. FM is characterized by chronic widespread pain and a
heightened and painful response to pressure (allodynia).
Other symptoms may include:
tingling of the skinprolonged muscle spasms
weakness in the limbs,
nerve pain,
functional bowel disturbances
chronic sleep disturbances.
FM sufferers may also experience cognitive dysfunction (known as
"brain fog"), which may be characterized by problems with short
and long-term memory , short-term memory consolidation, impaired
speed of performance , inability to multi-task, cognitive
overload, diminished attention span, anxiety, depressive
symptoms26
and impaired concentration.
Diagnosis
1. A history of widespread pain of 3 months or more.
2. The palpation of 18 specified locations of tenderness (so
called " tender points").
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| To
make a diagnosis of fibromyalgia there needs to be pain on
digital palpation of 11 or more out of the 18 specified
tender points.
Fibromyalgia Impact Questionnaire
go to
Treatment
There is currently no cure for fibromyalgia and fibromyalgia
patients may be symptomatic for many years with a reduced quality of
life and varying levels of dysfunction. However engagement in a
productive lifestyle and minimization of dysfunction can usually be
achieved by paying attention to 4 major areas : pain, exercise,
sleep and psyche.
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The location of the 18 tender points
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| Understanding The Pain Process
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| Acute pain is transmitted quickly to
your brain causing you to react at once, without even thinking about
it.
Chronic pain reaches the brain more slowly and, unlike acute
pain, it passes through the hypothalamus, which orders stress
hormones to be released, and through the limbic system, which is
responsible for thoughts and emotions.
Neurotransmitters of Pain
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Mechanism for transmitting pain is by the chemicals found in
every nerve cell, called neurotransmitters. These either send or
block pain messages.
Serotonin is one such neurotransmitter.
It blocks pain and induces a feeling of well-being.
Endorphin is another neurotransmitter, a natural pain killer
similar to morphine. The level of these chemicals varies
between people and their production can be voluntarily
increased, for example by vigorous exercise. That is one reason
why exercise is an important facet of pain treatment.
Based on these facts we can begin to understand why therapies
that help us to change our minds about pain are helpful. For
some people, pain is cyclical - pain produces anxiety and this
anxiety intensifies the pain. Fear and anticipation of the
physical problem can also heighten the pain, leading to feelings
of
depression and helplessness. When experiencing such pain, it
is natural to limit one's activities. This can lead to a
"chronic pain cycle", which can adversely affect one's
confidence and self- esteem.
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| Pain Cycle
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| Being aware of the chronic pain cycle as well
as understanding its psychological effects can help you avoid being
drawn to it: The cycle generally begins with prolonged periods of
rest and inactivity, causing a loss in physical strength, endurance,
and flexibility. As a result, you may begin to lose confidence in
your ability to do things, causing a lowering of personal goals.
Inability to perform usual activities at home or work is likely to
promote feelings of frustration, and you may begin perceiving
yourself as unproductive. This sense of lowered self-esteem may
further lead to depression.
During times when the pain subsides or is more tolerable than
usual, you may overexert yourself in an effort to prove to yourself
and others that you can still do the things you did before the
chronic pain began. As a result of the overexertion, the pain often
returns and may be more severe than before. You may find yourself
unable to finish tasks or accomplish goals. Discouraged and in pain,
you begin limiting your activities, and the cycle begins again.
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| Types of Pain
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Chronic pain with insufficient or no organic
explanation is a common problem. Although such patients truly
experience pain (i.e., the pain is not factitious, and the patient
is not malingering), these syndromes are better understood as
psychophysiologic rather than physical disorders.
Most of these patients have organic pathology, but in many,
evidence from the clinical assessment suggests that a psychological
disorder is the predominant influence on the intensity of pain and
degree of disability. Some patients have psychogenic pain, with no
identified organic explanation. Some cases of psychogenic pain can
be further diagnosed as somatization disorder (numerous, often
dramatic physical symptoms, including pain, typically affecting
several organ systems) or hypochondriasis (pathologic preoccupation
with minor symptoms).
Allodynia back
Allodynia meaning "other pain", is an exaggerated response and can
be either static or mechanical. Allodynia is a clinical feature of
many painful conditions, such as fibromyalgia, and migraine.
There are different kinds of Allodynia:
Mechanical allodynia (also known as tactile allodynia)
Static mechanical allodynia: pain in response to light
touch/pressure
Dynamic mechanical allodynia; pain in response to brushing
Thermal (hot or cold) allodynia; pain from normally mild skin
temperatures in the affected area.
Hyperalgesia
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Hyperalgesia is an extreme sensitivity to pain.
Primary hyperalgesia can be described as pain sensitivity
that occurs directly in the damaged tissues.
Secondary hyperalgesia can be described as pain
sensitivity that occurs in surrounding undamaged tissues.
Migraines back
Migraine and tension-type headache, often are associated with
musculoskeletal abnormalities, particularly postural and myofascial
dysfunctions. Migraines are characterized by throbbing pain and
sometimes by other symptoms, such as nausea and visual disturbances.
Migraines are more frequent in women than men. Stresses such as
chronic pain, can trigger a migraine headache.
Cluster headaches
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Cluster headaches are characterized by excruciating, piercing
pain on one side of the head; they occur more frequently in men than
women.
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| Chronic Pain Truths
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| People with chronic pain don't mean to be
unreliable.
When feeling better we promise things and mean it, but when in
pain these goals seam unattainable.
An action or situation may result in pain several hours later, or
even the next day.
Delayed pain is confusing to people who have never experienced
it.
Pain can inhibit listening and other communication skills. It's
like having someone shouting at you, or trying to talk with a fire
alarm going off in the room.
The effect of pain on the mind can seem like a lack of
attention. So you may have to repeat a request, or write things
down for a person with chronic pain.
The senses can overload while in pain. For example, noises that
wouldn't normally bother you seem too much. Patience may seem
short.
It is normal to be depressed occasionally when you hurt.
Pain can sometimes trigger psychological blocks, (usually very
temporary).
When in pain, a small task, like hanging out the laundry, can
seem like a huge task. An hour later the same job may be quite
OK.
Pain can come on fairly quickly and unexpectedly. Pain
sometimes lessens after a short rest.
Small acts of kindness can seem like huge acts of mercy to
a person in pain. Your offer of a cup of tea can be a really
big thing to a person who is feeling temporarily helpless in
the face of encroaching pain.
Not all pain is easy to locate or describe. Sometimes there
is a body-wide feeling of discomfort, with hard to describe
pains in the entire back, or in both legs, but not in one
particular spot you can point to.
Our vocabulary for pain is very limited compared to the
body's ability to feel varieties of discomfort. Medical
science is still limited in its understanding of pain.
Many people have pain that is not yet classified by
doctors as an officially recognized. That does not reduce
the pain; it only reduces our ability to give it a label and
to have you believe us.
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