We don’t seem to understand it.  We are not that good at controlling it.  We are becoming better at addressing it.  We have a long way to go.

OxyContinPicture from  Info Video

There was a post on My Lymphoma Journey addressing this issue and it really got me thinking.

We are just leaving the declared decade of pain control and research.  So, where are we?  Pain is now the fifth vital sign.  Hospitals, doctors, and drug companies are now more attentive to the issue and attempt to relieve their patients’ agony.  There are still areas for awareness improvement.  For example: Medicare reimbursement, at some levels, is dependent on functional improvement.  Sleep and pain are not considered functional.  Therefore, a person can have 9/10 pain while trying to get dressed (after a sleepless night) but as long as they can get dressed independently they do not need treatment.

Opioid insanity

click for

There are some great new medicines on the market to help with pain control.  There are some to help neurogenic pain, such as Neurontin and Lyrica. (Hard to miss all the Lyrica commercials).  These are not opiate based.  Rather they seem to have their roots in seizure control medicines.  They do have their own side effects but can be very helpful.

Drugs, such as oxycodone, are being used to treat everything from acute (new) pain to chronic (long term) pain.  It is very powerful and has a pretty high street value.  Due to the abuse and over prescribing by many individuals, states are beginning to crack down on its use.  This includes more paperwork for doctors.  While making sure medicines are used ethically and as intended is very important, especially with narcotics, the increased paperwork and investigations have meant a new barrier to access.  Some doctors stopped prescribing it in order to avoid the whole issue.  Some pharmacists try to avoid it for the same reason.  Who wants to go to jail or lose their license because they did not research their patients’ lives enough.  I witnessed a doctor in the hospital accusing a patient of being a wimp and a “clock watcher”.  Only to discover later, he just did not like all the paperwork that he had to do every time he prescribed pain medicine.

An issue of particular importance for chronic pain patients is opioid-induced hyperalgesia.

This phenomena involves the person becoming more sensitive.  They perceive pain from events and stimuli that normally do not cause pain.  Because they feel more pain, they take more medicine.  This can make the situation escalate and can be very debilitating.  The treatment seems to be to stop the medicines entirely and look at other medicines and non-medicine therapies.  There is a brief and good article here.  There are some centers that are using a team approach to help these patients.  Here is one I found in case you are interested.

What we do not know

What causes pain?  I will not go into the science of the chemical and mechanical reasons for it.  I am sure that there are whole books on the subject.  What is intriguing is that there are people who have x-rays proving advanced arthritis that have no pain.  There are people with negative x-rays that are in severe pain.  There was a study awhile back that took random people with no complaints of back pain and found that many of them had bulging disks on MRI studies.  There have been more studies with similar findings.

So what determines who has pain and who does not?  There is so much more that we need to learn.

Best Pain Scale with a twist


31 thoughts on “Pain

  1. Great topic, and you’re right–there is so much more to learn. As always, conditions that lack objective findings can be so difficult to pin down, and many people suffer in pain as a result.

    • The strength and courage it must take to keep moving forward everyday with pain is inconceivable. Good on him and you. Hopefully someone will figure it out, and soon.

  2. It’s so true that often pain cannot be diagnosed and so then the severity is doubted I think…I’m going through trying to find out why I have pain in my hands at night…and tests do not come up with an answer…so I am only left to surmise that it has to do with my MS but they can’t prove that either…so only left with the option of when necessary pain meds…Diane

  3. Pain is often relative. To me pain is a signal. A signal that we are out of balance somewhere. Or a reason to nurture a wounded aspect of ourselves more. Often people viewing things from a spiritual perspective have less “perceived pain” then otherwise. =)

    • Yes, another dynamic to the pain cycle. Pain is a signal that should not be ignored. Sometimes the problem may be the interpretation of what the signal means. People with chronic pain are often well read on the subject in an attempt to find a solution. If the signal cannot be interpreted correctly, the person has to live counterintuitively, ignoring the pain to get through the day. Please forgive the long response; your comment sparked another level of thinking on the subject. Thank you for that!

  4. Thanks Katie! The article confirmed what I’ve observed in recovering friends of mine. I wish I could help them see what they’re doing to themselves. Their lives have become inactive cycles of pill popping that perpetuates itself, when they could be healthy, active people, if only they could break the cycle. I know that I don’t know exactly what it’s like to walk in their shoes, but it’s clear that at least some of their pain is created by the very attempt to alleviate the pain. How sad!

  5. Nice timing on this post. I’ve been in SOOO much pain lately. Have a pinched nerve in my shoulder blade and just getting out of bed is a chore. This was good info though

  6. Great post. I have Fibromyalgia and when I talk to others with the condition and hear the kinds of pain medicines that they are own it surprises me. My Rhumo and I have made it a point to use as little pain meds as possible with me only using Lyrica and when needed A mild backup. Don’t get me wrong I do have a emergency Rx for when I feel like I want to take a flying leap because the pain is so bad, but it is not my go to and/or everyday. I feel that once you go down that path, there is no return…

    • It sounds like you and your doctor are a great team-able to develop a plan that works for you. I wish you the best on this journey. I wish for more people to be able to construct good plans with their physicians. I wish for a research break through. I wish I never run out of wishes. Have a beautiful weekend!

  7. great post and thank you for posting. personally, i think doctor/patient relationships are based on the individual doctor and patient. some doctors shouldn’t be anywhere near patients or medication while on the other hand you have plenty of patients who misuse and abuse.

    human nature, overall genetics, as well as everything else we are riddled with make it difficult to move forward with everyone’s best intentions in mind. so whats my point? i agree when you say we have so much more to learn!

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