Understanding Chronic Pain

Alzheimer, Parkinson, Lou Gehrig. All famous names, all poorly understood neurological diseases for which there is only palliative treatment. Although they represent very different problems, they share a progressive damage to the central nervous system. We don’t blame these poor souls for their predicament; we don’t chastise them for getting sick. As human beings, we feel sorry for their plight and we feel powerless to help them.

Why is it then that society treats people with chronic pain differently? Why is it that our attitude changes, for instance, when facing someone stricken with Parkinson’s as compared with someone suffering from the depression associated with chronic pain? Our behavior regarding chronic pain has been molded by society because of the many people whom we believe have pain out of proportion to their complaints, by the close association of chronic pain and mental illness, and by a certain number of malingerers and drug seekers we all have met.

More and more research reveals chronic pain as a form of neurological disorder. The process is complex and poorly understood, but we know it involves the activation of specific nerve cells, which are responsible for a type of pain super sensitivity. Moderate amounts of pain can be dealt with by the nervous system in a straightforward fashion, but severe or constant pain can lead to a barrage of impulses that the spinal cord can’t handle, and that have the potential to change nerve cells permanently. Pain impulses, which last a few milliseconds, may change certain nerve cells permanently, just like the experience of a severe trauma can lead to permanent neurological changes.

The good news is that help is available. The responsible treatment of any pain which has the potential of becoming chronic, such as shingles or long term low back pain, depends on reducing the painful stimulus that reach the spinal cord. Medication, nerve blocks, sometimes psychological intervention, and in most cases, physical therapy, are some of the tools doctors can use to slow down the painful stimulus.

The brain has an important role in subduing the arrival of pain impulses. Some people are fortunate enough to have been born with an enhanced capacity to deal with pain. Others are less able to do so and therefore suffer more than their counterparts. This is compounded by the fact that they possibly receive a lesser quality of medical care because doctors can’t tell whether they are “really hurting”, or if it’s all a figment of their imagination.

Next time you feel you’re losing your cool with someone with chronic pain, take a step back and just consider that maybe, one day, we’ll be using a big important name like Alzheimer or Parkinson to describe the condition from which they are suffering. Have patience. Gather information. There is help.

© Dr. Moacir Schnapp and Dr. Kit Mays