Pain Management Archives - Center for Complex Conditions of Rhode Island

Category: <span>Pain Management</span>

The reason why modern medicine has not been able…

May 28, 2019
by Pradeep Chopra, M.D.

The reason why modern medicine has not been able to keep up with changing medical conditions such as Mast Cell Activation Syndrome (MCAS), Ehlers Danlos Syndrome (EDS), Postural Orthostatic Tachycardia Syndrome (POTS) / Dysautonomia.

Start with a cage containing five monkeys. Inside the cage, hang a banana on a string and place a set of stairs under it. Before long, a monkey will go to the stairs and start to climb towards the banana. As soon as he touches the stairs, spray all of the other monkeys with cold water. After a while, another monkey makes an attempt with the same result; all the other monkeys are sprayed with cold water.

Pretty soon, when another monkey tries to climb the stairs, the other monkeys will try to prevent it. Now, put away the cold water. Remove one monkey from the cage and replace it with a new one. The new monkey sees the banana and wants to climb the stairs. To his surprise and horror, all of the other monkeys attack him. After another attempt and attack, he knows that if he tries to climb the stairs, he will be assaulted.

Next, remove another of the original five monkeys and replace it with a new one. The newcomer goes to the stairs and is attacked. The previous newcomer takes part in the punishment with enthusiasm! Likewise, replace a third original monkey with a new one, then a fourth, then the fifth. Every time the newest monkey takes to the stairs, he is attacked. Most of the monkeys that are beating him have no idea why they are not permitted to climb the stairs or why they are participating in the beating of the newest monkey.

After replacing all of the original monkeys, none of the remaining monkeys have ever been sprayed with cold water. Nevertheless, no monkey every again approaches the stairs to try for the banana. Why not? Because as far as they know that’s the way it’s always been done around here. And that, my friends, is how medical training and how hospital work.

If a patient goes to a hospital with EDS, MCAS or POTS, they are treated poorly with incorrect diagnosis such as Conversion disorder, Munchausen, depression or anxiety because that is the way it has always been and no one knows why. We need monkeys who can think for themselves.

Pain Management

Gabapentin and pregabalin (Lyrica) – very poor choice for…

May 22, 2019May 22, 2019
by Pradeep Chopra, M.D.

The truth about gabapentin and pregabalin (Lyricaâ) as published in a recent article in The New York Timesâ. You can read about an excellent investigative article here. Both drugs (including a long acting form of gabapentin known as Gralise) are not effective for pain. The following are from a well researched article written by Jane E. Brody published in The New York Times on May 20, 2019. I have written down the pertinent points and have placed a link the actual article. Two reviewers, Dr. Christopher W. Goodman and Allan S. Brett of the University of South Carolina School of Medicine reviewed the published evidence.

“Patients and physicians should understand that the drugs have limited evidence to support their use for many conditions, and there can be some harmful side effects, like somnolence, dizziness and difficulty walking”.
:Gabapentin and Lyrica, both sold by Pfizer, have been approved by the Food and Drug Administration to treat only four debilitating pain problems: postherpetic neuralgia, diabetic neuropathy, fibromyalgia and spinal cord injury. Even for these approved uses, the evidence for relief offered by the drugs is hardly dramatic, Drs. Goodman and Brett reported in JAMA Internal Medicine online”.
“In many well-controlled studies they found there was less than a one-point difference on the 10-point pain scale between patients taking the drug versus a placebo, a difference often clinically meaningless”.
Johansen cited several serious concerns about overuse of gabapentinoids, including “a dearth of long-term safety data, small effect sizes, concern for increased risk of overdose in combination with opioid use, and high rates of off-label prescribing, which are associated with high rates of adverse effects.”

For the full article please click on the link below or copy and paste into your browser

https://www.nytimes.com/2019/05/20/well/live/millions-take-gabapentin-for-pain-but-theres-scant-evidence-it-works.html?smid=nytcore-ios-share

Dysautonomia

EDS – Connecting the dots – Dr. Chopra

January 28, 2018December 13, 2018
by Pradeep Chopra, M.D.

EDS Connecting the dots

Ehlers Danlos Syndrome is a complex condition. Managing the different issues with EDS is to understand ‘what is broken’ and then attempting to make the best of fixing it. When I see a patient with EDS, I need to figure out what are the issues. Sometimes it is a shoulder dislocation, knee pain, hip pain or neck pain that may be the primary issue. Besides the pain, there is the issue of intense fatigue, brain fog, weakness and stomach issues. It is not always about chronic pain only but other problems that add to the challenges of managing EDS. All of these together make it difficult for a difficult to function. Putting all this together and connecting the dots is a very laborious job and it takes an enormous amount of time.

Sometime back, I had the opportunity to present a webinar on connecting the dots in EDS. The webinar was hosted by EDS Awareness. It is free for all. I did it in 2 parts of roughly 3 hours each. You can listen to the webinar by clicking on this link or by copying and pasting it into your browser.

Dr. Chopra’s webinar on EDS

Its easier to view the link on a desktop computer. If you use a mobile device, the link may take you to the correct website but may not display Dr. Chopra’s webinar. In that case click on ‘view full site’. Still trying to figure out how websites work.

There is so much more that I am discovering about managing EDS every day, feel free to either sign up (no, we do not share email addresses) or check back regularly.

Disclaimer

NOT to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the blog. Under no circumstances shall Pradeep Chopra, SNAPA any contributors to the blog, or any employees, associates, or affiliates be responsible for damages arising from the use of the blog.

This blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the blog.

this changes, this will be spelled out directly via a post to the blog/website.

The contents of this blog are all copyrighted. All blog posts, videos that are distributed to the public for free can be re-distributed via hard copy or electronic copy for free ONLY.

CRPS / RSD

Forms – your first visit

January 6, 2018January 6, 2018
by Pradeep Chopra, M.D.

It is much more efficient if you can spend some time to fill out the forms prior to coming in. Please bring the forms with you after you have filled them out. Considering the complexity of the pain conditions that Dr. Chopra treats, it helps him understand your condition better.

It is a good idea to write a timeline (a detailed one would be better) of your or your child’s condition. Dr. Chopra actually does review it and it also helps you remember accurately how your condition changed, treatment tried in past and the results of the treatment. Please download and print the forms and fill them out the best of your ability.

Demographic sheet December 2009
Release of medical records – SNAPA
Karnofsky scale
033 Questionnaire (ver 6-6-16)
031 The Epworth Sleepiness Scale and fatigue scale
030 Body pain indicator
029 Brief Pain Inventory
Timeline – in your words

EDS

Ehlers Danlos Syndrome Part 2 – Pradeep Chopra MD

December 26, 2017January 6, 2018
by Pradeep Chopra, M.D.

Pradeep Chopra MD – Ehlers Danlos Syndrome Part 2

Continuing our quest to understand Ehlers Danlos Syndrome (EDS). In March 2017, the classification of EDS was updated to include some rare forms of EDS that had been discovered recently. As of now, there are 13 subtypes of EDS. Of the 13 subtypes, only two of them are considered common. Let’s crunch some numbers to see how common or rare EDS is.

The combined prevalence of all types of EDS is at least 1 in 5000 individuals worldwide. But, remember that EDS is rarely diagnosed and often missed, this means that the prevalence is likely to be more than 1 in 5000. I doubt if EDS is over diagnosed, it’s more likely to be a missed diagnosis.

The most common types of EDS are the Hypermobile (hEDS) and the Classical (cEDS) types.

The hypermobile type affects 1 in 5000 (0.02%) to 1 in 20,000 (0.005%) people.

The classical type affects 1 in 20,000 to 1 in 40,000 people.

The value of looking at any statistics makes sense when compared to a number that we all understand.

The worldwide prevalence of

EDS	0.02 %
Multiple sclerosis	0.14 %
Rheumatoid arthritis	1%

Although EDS is listed officially as a rare disease, physicians are starting to realize that it is not as rare as it was initially thought to be. This misconception may have risen from the fact that most cases of EDS are missed, undiagnosed or misdiagnosed. Medical students and physicians have many other things to remember and document (such as if a patient has smoke detectors or guns in their house). When they are told a condition is rare, they assume that they are not likely to see a case of EDS and so do not need to learn about it. What is worse is that after a person gets diagnosed with EDS, they are told by their doctors that they are “born with it, and nothing can be done about it.” That is an inherently untrue statement that only a lazy health care provider would make. Cystic fibrosis and diabetes are conditions that people are born with, yet we brush them off with a ‘nothing can be done about it.’ A lot of things can be done for people with EDS to get them a good quality of life and be more functional.

EDS is a lifelong condition. Most people do well until there is a precipitating event like an infection or trauma. They are usually athletic growing up. They are good in activities such as ballet dancing, ice skating, dance, cheerleading.

Disclaimer

While I make every effort to broadcast correct information, I am still learning. I will double check all my facts but realize that medicine is a constantly changing science and art. One doctor may have a different way of doing things from another. I am simply presenting my views. I welcome any comments, suggestions, or correction of errors. I take no money from drug or device companies. By reading this blog, you agree not to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the blog. Under no circumstances shall Pradeep Chopra, SNAPA (Center for Complex Conditions), any contributors to the blog, or any employees, associates, or affiliates be responsible for damages arising from the use of the blog.

This blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the blog.

At the present time, this website and blog do not accept any advertising money. If this changes, this will be spelled out directly via a post to the blog/website.

EDS

Ehlers Danlos Syndrome (EDS) Pradeep Chopra MD

December 24, 2017February 14, 2018
by Pradeep Chopra, M.D.

Pradeep Chopra MD – Ehlers Danlos Syndrome

My area of interest has been in the management of complex chronic pain conditions. I don’t call it as ‘treating’ these conditions but more as ‘managing’ these conditions to allow patients to be functional and have a better quality of life. In medicine, we seldom ‘treat’ or ‘cure’ conditions. Physicians mostly manage these conditions. We don’t treat or cure insulin dependent diabetes mellitus or migraine headaches. At best, we manage them.

The human body is made up of cells, a bunch of these cells join hands and form connective tissue. Other substances go into making connective tissue also. In general, most of the human body is made up of cells working together to create connective tissue. Some examples of connective tissue are – ligaments, skin, muscle, tendons. Even blood is considered a connective tissue.

Before I go any further, I would like to point out that EDS is not a disease. It is another form of the human body. Much like there are tall people and short people, black-skinned and white skinned people, there are people with weak connective tissue as compared to those who do not. Certain medical conditions are more common in black skinned people such as sickle cell anemia or sarcoidosis. In the same way, people with weak connective tissue are more prone to certain medical conditions.

Ehlers Danlos Syndrome is heritable (that means it is genetic) condition. Patients with Ehlers Danlos Syndrome (EDS) tend to have the weaker connective tissue. The connective tissue in patients without Ehlers Danlos Syndrome is stronger, does not stretch easily or break easily. In EDS, the connective tissue is weaker, it can stretch easily, and if pulled too much, it may stay stretched or even break. It is a common misconception that people (note: I prefer not calling them patients, as I said EDS is not a disease – it is a form of the human body) suffer from loose skin of joint dislocations only. Many other issues come into play in EDS. I will discuss them over time.

Disclaimer

While I make every effort to broadcast correct information, I am still learning. I will double check all my facts but realize that medicine is a constantly changing science and art. One doctor may have a different way of doing things from another. I am simply presenting my views. I welcome any comments, suggestions, or correction of errors. I take no money from drug or device companies. By reading this blog, you agree not to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the blog. Under no circumstances shall Pradeep Chopra, SNAPA (Center for Complex Conditions), any contributors to the blog, or any employees, associates, or affiliates be responsible for damages arising from the use of the blog.

This blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the blog.

At the present time, this website and blog do not accept any advertising money. If this changes, this will be spelled out directly via a post to the blog/website.

CRPS / RSD

Chronic Pain – Pradeep Chopra MD’s Blog

December 22, 2017March 23, 2018
by Pradeep Chopra, M.D.

Pradeep Chopra MD’s Blog on Chronic Pain.

This blog is the first of a series of blogs on the disease of chronic pain, medicine, and truths in medicine.

Pain management has become a controversial topic in the last year or so. The controversy is based mostly on the fact that there is a single drug or therapy that can control pain. This notion has come from physicians who are not trained in pain medicine. It has come mostly from people who have never experienced the cruel, burning of chronic pain. Most people undergo short bursts of pain after a trauma (surgery, cuts, scrapes and falls) which respond to standard pain therapies.

Pain, as we know is a protective reflex. It’s pretty simple – when our body sustains an injury, we feel pain, we take measures to protect it till the damage heals. This pain will respond to standard analgesics (pain medicine). Once the injury heals, we don’t feel the pain anymore.

Chronic pain is a disease by itself. It is no longer a protective reflex. The original injury was a long time ago, but the pain has persisted. Chronic pain is no longer protective. Standard analgesics no longer provide the same relief and in most cases, no relief at all.

The above concept of the difference between pain and chronic pain is something that most people do not understand (physicians included). I have met dozens of patients with severe chronic pain who have been told: “If the pain from my ankle sprain felt better after taking ibuprofen, I don’t see any reason why your chronic pain from CRPS (Complex Regional Pain Syndrome) cannot get better with ibuprofen.”

I believe the treatment of pain lies in finding what is broken and fixing it. This principle applies to acute and chronic pain. For example, if someone has a broken bone, the treatment lies in stabilizing the fracture. No amount of ibuprofen, applying creams and lotions or acupuncture is going to make the pain go away.

The same principle applies to treating chronic pain. The difference here is that finding what is broken is far more challenging. For example, if someone develops low back pain after surgery, the fix would be looking for the cause of the pain. It could be a muscle spasm, nerve damage, joint pain. Treating the muscle spasm or the joint pain would help the most. Treating it as “low back pain” with blind therapies does not make sense. Surprisingly enough there are drugs that have been approved for the treatment of low back pain. Duloxetine (CymbaltaÒ) has been one of the drugs. When it was first approved, it did not make sense. How can one medication that works on the brain treat back pain from a disc bulge or arthritis of the back or muscle spasm all the same time? What was even more baffling was that the drug would work only on the lower back. Would it not work on the upper back? What about the neck? What about pain in other parts of the body? Apparently, it works only on the lower back because that is what the FDA said and insurance companies have taken that to deny patients the medicine for other pains, including upper back and neck. Clinical experience has shown that duloxetine does not do a good job for even low back pain. More on this later.

In chronic pain finding the exact cause of the pain is challenging. One has to remember that there may be more than one cause. For example, in someone has a shoulder joint pain, the pain could be from wear and tear of the cartilage, ligament damage or muscle spasms around the joint. Once we find the cause of the pain, it may not be possible to repair it. But treatments targeting ‘what’s broken’ will get better results. Treating it blindly with acupuncture, physical therapy or electrical currents such as scrambler therapy without understanding the underlying problem will not be effective

Disclaimer

While I make every effort to broadcast correct information, I am still learning. I will double check all my facts but realize that medicine is a constantly changing science and art. One doctor may have a different way of doing things from another. I am simply presenting my views. We welcome any comments, suggestions, or correction of errors. By reading this blog, you agree not to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the blog. Under no circumstances shall Pradeep Chopra, SNAPA (Center for Complex Conditions), any contributors to the blog, or any employees, associates, or affiliates be responsible for damages arising from the use of the blog. I take no money from drug or device companies.

This blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the blog.

At the present time, this website and blog do not accept any advertising money. If this changes, this will be spelled out directly via a post to the blog/website.

Pain Management

Pain In the United States

October 2, 2017January 5, 2018
by Pradeep Chopra, M.D.

Pain in the United States

A new analysis of data from the 2012 National Health Interview Survey (NHIS) has found that most American adults have experienced some level of pain, from brief to more lasting (chronic) pain, and from relatively minor to more severe pain.

The analysis helps to unravel the complexities of a Nation in pain. It found that an estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain. Those with severe pain are also likely to have worse health status.

The analysis was funded by the National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) and was published in The Journal of Pain.

“The number of people who suffer from severe and chronic pain is striking,” said Josephine P. Briggs, M.D., director of NCCIH. “This analysis adds valuable new scope to our understanding of pain and could inform the National Pain Strategy in the areas of population research and disparities. It may help shape future research, development, and targeting of effective pain interventions, including complementary health approaches.”

Pain is one of the leading reasons Americans turn to complementary health approaches such as yoga, massage, and meditation—which may help manage pain and other symptoms that are not consistently addressed by prescription drugs and other conventional treatments. For this reason, NCCIH research priorities include the study of complementary approaches to determine their effectiveness for treating symptoms such as pain.

The NHIS is an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences. The 2012 NHIS asked participants about the frequency and intensity of pain experienced in the prior 3 months. The survey results are based on combined data from 8,781 American adults from a subsection of the larger NHIS.

Researchers assigned pain severity using an approach developed by the Washington Group on Disability Statistics, which provides four categories of pain. Among the findings of the analysis:

An estimated 23.4 million adults (10.3 percent) experience a lot of pain.
An estimated 126 million adults (55.7 percent) reported some type of pain in the 3 months prior to the survey.
Adults in the two most severe pain groups were likely to have worse health status, use more health care, and suffer from more disability than those with less severe pain. However, approximately half of individuals with the most severe pain still rated their overall health as good or better.
There were associations between pain severity and race, ethnicity, language preference, gender, and age. Women, older individuals, and non-Hispanics were more likely to report any pain, while Asians were less likely.
Minorities who did not choose to be interviewed in English are markedly less likely to report pain.
The impact of gender on pain varies by race and ethnicity.

“This report begins to answer calls for better national data on the nature and extent of the pain problem,” said Richard L. Nahin, Ph.D., M.P.H., lead epidemiologist for NCCIH and author of the analysis. “The experience of pain is subjective.

It’s not surprising then that the data show varied responses to pain even in those with similar levels of pain. Continuing analyses of these data may help identify sub-populations that would benefit from additional pain treatment options.”

Read more about the report – Estimates of Pain Prevalence and Severity in Adults.

Disclaimer

While I make every effort to broadcast correct information, I am still learning. I will double check all my facts but realize that medicine is a constantly changing science and art. One doctor may have a different way of doing things from another. I am simply presenting my views. I welcome any comments, suggestions, or correction of errors. I take no money from drug or device companies. By reading this blog, you agree not to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the blog. Under no circumstances shall Pradeep Chopra, SNAPA (Center for Complex Conditions), any contributors to the blog, or any employees, associates, or affiliates be responsible for damages arising from use of the blog.

At the present time this website, and blog does not accept any advertising money. If this changes, this will be spelled out directly via a post to the blog/website.

Pain Management

Pain Management History

October 2, 2017January 6, 2018
by Pradeep Chopra, M.D.

Pain Management History

from the National Institute of Health (NIH):

Early Greeks and Romans advanced the idea that the brain played a role in producing the perception of pain.
In the 19th century, physician-scientists discovered that opiates such as morphine could relieve pain and chemist Felix Hoffmann developed aspirin from a substance in willow bark. Aspirin remains the most commonly used pain reliever.
The French physician, Dr. Albert Schweitzer, proclaimed in 1931 that, “Pain is a more terrible lord of mankind than even death itself.”
In 1994, the International Association for the Study of Pain (IASP) defined pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage.”

WHAT WE’VE COME TO UNDERSTAND TODAY

Pain affects more Americans than diabetes, heart disease and cancer combined.
Pain is cited as the most common reason Americans access the health care system. It is a leading cause of disability and it is a major contributor to health care costs.
According to the National Center for Health Statistics (2006), approximately 76.2 million, one in every four Americans, have suffered from pain that lasts longer than 24 hours and millions more suffer from acute pain.
Chronic pain is the most common cause of long-term disability.
The diversity of pain conditions requires a diversity of research and treatment approaches.
Pain can be a chronic disease, a barrier to cancer treatment, and can occur alongside other diseases and conditions (e.g. depression, post-traumatic stress disorder, traumatic brain injury).
For infants and children, pain requires special attention, particularly because they are not always able to describe the type, degree, or location of pain they are experiencing.
Discoveries of differences in pain perceptions and responses to treatment by gender has have led to new directions for research on the experience and relief of pain. For example, medications called kappa-opioids provide good relief from acute pain in women, yet increase pain in men.
National Institute of Health (NIH)-supported scientists identified a gene variant of an enzyme that reduces sensitivity to acute pain and decreases the risk of chronic pain.
COX-2 (cyclooxygenase-2) is a major contributor to pain associated with inflammation. A study of genes affected by COX-2 led to the discovery of its role in connection to multiple cellular pathways that contribute to pain relief and adverse side-effects.
Behavioral interventions for pain also demonstrate promise for providing pain relief either in conjunction with or in lieu of drug interventions. For example, NIH supported research has demonstrated that individualized pain management programs may reduce cancer pain for some patients.

HOPE FOR TOMORROW

The NIH is poised to make major discoveries that will improve health outcomes for individuals experiencing acute or chronic pain by applying opportunities in genomics and other technologies to improve our understanding of the fundamental causes of pain. This will be accomplished through translating basic laboratory science to new, improved pain treatments and by providing strategic support for the research community to discover more effective pain treatment strategies.
Applying genomics and other technologies to understand pain. Advances in basic and clinical genetics are making it possible to both characterize genetic factors related to pain sensitivity and develop novel therapeutic approaches.
In ongoing pain studies, scientists are using technologies such as microarray-based assays (complex genetic and molecular tests) to better understand the mechanisms of pain and analgesia, identify new targets for analgesic drugs, and test the efficacy and adverse reactions of newly developed or currently used drugs to treat pain. Researchers are currently using these technologies to discover the mechanisms by which drugs such as COX-inhibitors and neurotropins may relieve pain.
Translating basic science to improved pain treatments. Researchers will continue to focus on advancing both biological and behavioral pain management strategies from the research sphere to clinical applications.
Innovative ways to categorize and measure pain are currently being studied. For example, scientists are using computer-assisted technology to develop a novel program that will capture and quantify pain experiences. Tools such as this will be combined with existing methods to more accurately and consistently measure pain over time and across groups, diseases, and conditions.
Research will continue identifying biomarkers and biological pathways associated with painful conditions resulting from the use of drugs to treat diseases such as cancer and HIV/AIDS.
The NIH Pain Consortium an effort involving over 21 NIH Institutes, Centers, and Offices, promotes collaboration among the various NIH programs that support pain research, and provides strategic direction for accelerating advances in pain prevention, and treatment.
The Patient Protection and Affordable Care Act has established an Inter-agency Pain Research Coordinating Committee, led by the Department of Health and Human Services, to assess and coordinate pain research efforts across the Federal government.

Disclaimer

While I make every effort to broadcast correct information, I am still learning. I will double check all my facts but realize that medicine is a constantly changing science and art. One doctor may have a different way of doing things from another. I am simply presenting my views. I welcome any comments, suggestions, or correction of errors. I take no money from drug or device companies. By reading this blog, you agree not to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the blog. Under no circumstances shall Pradeep Chopra, SNAPA (Center for Complex Conditions), any contributors to the blog, or any employees, associates, or affiliates be responsible for damages arising from the use of the blog.

This blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the blog.

At the present time, this website and blog do not accept any advertising money. If this changes, this will be spelled out directly via a post to the blog/website.

CRPS / RSD

What Is Chronic Pain and Why Is It Important?

October 2, 2017January 6, 2018
by Pradeep Chopra, M.D.

What Is Chronic Pain and Why Is It Important?

Chronic pain is pain that lasts more than 3 to 6 months. It’s a very common problem. Results from the 2012 National Health Interview Survey show that:

About 25.3 million U.S. adults (11.2 percent) had pain every day for the previous 3 months.
Nearly 40 million adults (17.6 percent) had severe pain.
Individuals with severe pain had worse health, used more health care, and had more disability than those with less severe pain.

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different.

Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap — sprained back, serious infection, or there may be an ongoing cause of pain — arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage.

Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system). A person may have two or more co-existing chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.

Chronic pain becomes more common as people grow older, at least in part because health problems that can cause pain, such as osteoarthritis, become more common with advancing age. Not all people with chronic pain have a physician-diagnosed health problem, but among those who do, the most frequent conditions by far are low-back pain or osteoarthritis, according to a national survey. Other common diagnoses include rheumatoid arthritis, migraine, carpal tunnel syndrome, and fibromyalgia. The annual economic cost of chronic pain in the United States, including both treatment and lost productivity, has been estimated at nearly $635 billion.

Chronic pain may result from an underlying disease or health condition, an injury, medical treatment (such as surgery), inflammation, or a problem in the nervous system (which is called “neuropathic pain”), or sometimes the cause may be unknown. Pain can affect quality of life and productivity, and it may be accompanied by difficulty in moving around, disturbed sleep, anxiety, depression, and other problems.¹

For more information about chronic pain, visit the National Institute of Neurological Disorders and Stroke.

Many people with chronic pain can be helped if they understand all the causes of pain and the many and varied steps that can be taken to undo what chronic pain has done. Scientists believe that advances in neuroscience will lead to more and better treatments for chronic pain in the years to come.

Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.

Disclaimer

While I make every effort to broadcast correct information, I am still learning. I will double check all my facts but realize that medicine is a constantly changing science and art. One doctor may have a different way of doing things from another. I am simply presenting my views. I welcome any comments, suggestions, or correction of errors. I take no money from drug or device companies. By reading this blog, you agree not to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the blog. Under no circumstances shall Pradeep Chopra, SNAPA (Center for Complex Conditions), any contributors to the blog, or any employees, associates, or affiliates be responsible for damages arising from the use of the blog.

This blog should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the blog.

At the present time, this website and blog do not accept any advertising money. If this changes, this will be spelled out directly via a post to the blog/website.