"Chronic pain is rarely accompanied by sympathetic nervous system arousal. Lack of objective signs may prompt the inexperienced clinician to say that the patient does not look like he or she is in pain"

American Pain Society 1999 P.4

 

Pain through the eyes of observers throughout time:

 

"Pain upsets and destroys the nature of the person who feels it"

Aristotle

 

"Perhaps few persons who are not physicians realize the influence of which long-continued and unendurable pain have upon both body and mind"

Weir Mitchell 1864

"Pain is an experience subject to modification by many factors. Wounds received during strenuous physical exercise, during the excitement of games, often go unnoticed. The same is true of wounds received during fighting, during anger. Strong emotion can block pain".

Lt Col. H Beecher 1946

"Pain is a consummate mind-body event where sensation and emotion become inextricably intertwined; it is impossible to say where the realm of physical pain ends and psychic suffering begins".

Fishman, S MD The War on Pain Harper Collins 2000 p. 2

 

"There is no single accepted pain experience--no one feels it the same".

Fishman p. 7

 

"Unrelenting pain can alter the way neurons handle information,it can make sensation more intense, twist its character, create additional sensations like stabbing pain, or set off other neurological events common with stress"....

"Lasting pain can produce a cycle of chemical and electrical action and reaction that becomes an automatic feedback loop--a chronic self-perpetuation hurting that persists long after the original trauma has healed."

"Pain can reconfigure the architecture of the nervous system it invades. It can be stamped so deeply as to make a permanent impression."

p. 85-6 Fishman

 

"The mind-body connection can either magnify or demagnify pain or push it from the center of your consciousness...." We have the ability to transform pain into either less pain or more pain"..."Too much sensation can magnify pain".

Fishman S MD p.10

_____

Chronic pain linked to spinal cord protein

Wind blowing on skin or touch of a shirt is extremely painful

Discovery will help sufferers rebuffed for lack of physical signs

ELAINE CAREY HEALTH REPORTER

Toronto Star Dec 15, 2005.

Canadian scientists have discovered a protein that plays a key role in causing debilitating, chronic pain that until now has never been understood. "Some people can't wear shirts or they're not able to go out because the touch of a breeze gives them lightning-like pain," said Dr. Michael Salter, who heads the University of Toronto Centre for the Study of Pain. "The worst part is that there's often no physical sign that something's wrong. They're suffering intensely, they get no relief from medications and their family and friends don't understand." The discovery paves the way for developing new ways of detecting and treating the chronic pain that affects thousands of Canadians, says a study published yesterday in the scientific journal Nature. Chronic or neuropathic pain is caused by nerve damage brought on by an injury or illnesses such as cancer, HIV-AIDS or diabetes, which causes changes in spinal cord cells called microglia.

"Once damaged, the scientists discovered that microglia release a protein called brain-derived neurotrophic factor which causes spinal neurons to send an abnormal signal to the pain-processing networks in the brain. Microglia normally act to suppress pain signals to the brain and spinal cord but the protein converts it into a mechanism that amplifies them,"

said Salter, co-principal investigator with Dr. Yves De Koninck of Laval University and a senior scientist at Sick Kids Hospital.

"One of the messages from this paper ... is that after these kinds of injuries to nerves in your arm or leg or hand, you can have changes in your spinal cord that can perpetuate pain and actually intensify it long after the injury has healed," he said.

"This is an important discovery for the millions of Canadians who suffer from debilitating chronic pain that cannot currently be treated," said Michael Wilson, chair of NeuroScience Canada, one of the funders of the research through the Brain Repair Program.

'If pain was spelled flu, it would already be considered an epidemic in this country' Barry Ulmer, Chronic Pain Association

The discovery "represents an important shift that could soon provide patients with effective treatments and allow them to be active again in our society," Wilson said. Chronic pain is "a touchy subject" because there are no obvious physical symptoms and sufferers are often told they are making it up or faking it, Salter said. Even strong painkillers don't suppress the pain because they work on only some of the large pain-processing networks but not all of them, he said. "Typically people with neuropathic pain get very little pain relief from traditional painkillers like morphine or Aspirin or acetaminophen," he said. For some people the pain is so acute that even common events like wind blowing on the skin or the touch of a shirt is extremely painful. When neuropathic pain attacks children with cancer who are undergoing chemotherapy, the pain is so excruciating the treatment has to be stopped.

The discovery of how microglia communicate with nerve cells in the pain- processing networks should help in developing drugs to treat it, Salter said. And it could lead to a diagnostic test to identify it. "You could go and have a test and show your physician: `Look, there really is something wrong with me,'" he said. That is a bigger issue in the United States where many chronic pain sufferers can't get any health care benefits.

Barry Ulmer, executive director of the Chronic Pain Association of Canada, said the findings were encouraging but were still only at the laboratory stage and "it's got a long way to go. "If pain was spelled flu, it would already be considered an epidemic in this country," said Ulmer, whose wife suffers from chronic pain. "Anything that comes forward that takes away from the subjective nature of pain is helpful," he said. "Most people are stigmatized because of it. Anything positive that comes along has to be a bonus."

If you change the way you look at something Something you look at will change.

SOURCE: Toronto Star 2005. Thanks for permission.

 

 

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