Robert A. Lavin - Navigating Life with Chronic Pain

Editor-in-Chief, Neurology Now Books Series

Fellow of the American Academy of Neurology

Professor of Neurology

The Eugenia Brin Professor in Parkinsons Disease and Movement Disorders

The Rosalyn Newman Distinguished Scholar in Parkinsons Disease

Director, University of Maryland Parkinsons Disease and Movement

Disorders Center

University of Maryland School of Medicine

Baltimore, MD

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In this section you will learn about how your body and your mind respond to pain and how it can affect all aspects of your life. You will discover that you are not alone and that pain is frequently misunderstood. In this section you will also learn how you can make the most of your medical visits and work with your doctor to develop a personalized pain plan that is best for you. You will understand how to control your pain by combining a variety of medical and behavioral therapies and physical exercise treatments that are most appropriate for you. You will also learn about the limitations of some pain medications and procedures. While it is unlikely that your pain will completely go away, this section will emphasize self-management skills that allow you to live with your pain by controlling it.

In this chapter you will learn

That you are not alone because pain affects millions of people.

The differences between acute and chronic pain and how the nervous system can amplify pain so that it becomes disabling.

How to take control of your chronic pain and how to reduce pain by learning about tools to self-manage your pain.

Most experts agree that there are two types of pain. Acute pain is pain that has occurred for less than three months, and chronic pain is pain that lasts longer than three months. However, aside from the amount of time that a person has been in pain, there are other important differences between acute and chronic pain. Lets discuss each separately to understand the difference.

We have all experienced acute pain. It occurs when there is an injuryanything from a scraped knee to a broken bone. The body responds to the injury with painsometimes so much pain that nearby muscles will contract in intense spasms so that it is difficult to even move. This is obviously painful, but acute pain actually serves a purpose because it teaches us to avoid painful situations in the future. It is also protective because the pain prevents us from moving an injured body part so it has a chance to heal. After a period of time, the pain improves as the injury heals. Finally, the term acute refers to the fact that the pain resolves within three months after an injury or surgery. Acute has nothing to do with the severity of the pain because both acute and chronic pain can be severe.

In contrast, chronic pain does not go away after three months, and it does not serve any useful purpose. Unlike acute pain, chronic pain continues long after the injury has healed. This book focuses on chronic pain.

Chronic pain can be disabling because it interferes with common activities of daily living (ADLs) that we take for granted. ADLs include tasks like dressing, bathing, walking, getting up from a chair, and even sleeping. Because of the prolonged and exhausting experience of unrelenting pain, many people with chronic pain feel sad and hopeless. Understandably, they may become depressed, anxious, irritable, withdrawn, and even suicidal. These psychological and emotional responses to constant, unrelieved pain are what really makes chronic pain different and more complex than the acute pain that occurs when you scrape your knee.

Joe fell and broke his hip at work. He had surgery to repair the injured hip and was informed that the pain he felt was part of the normal healing process and would go away with time. He used pain medication and attended physical therapy as directed by his doctor. After many months, he was still experiencing the pain, long after his doctor told him that his fracture had healed. The pain interfered with his ability to sleep, work, play with his kids, do chores around the house, and even perform simple activities like pulling up his pants, showering, and getting on and off the toilet. The constant pain had taken over his world. He was no longer the breadwinner for his family, and he was dependent on others for his most basic needs. He felt isolated and stuck in his home. He was no longer able to do things that he enjoyed, like seeing his friends, playing sports, and walking around the neighborhood. It also affected his relationship with his wife and children because he tried to avoid people and frequently got upset over minor things that never used to bother him. Furthermore, sexual relations with his wife were impossible due to the pain. He started to feel depressed, angry, anxious, and lonely.