Health and Pain Mind

Chronic pain affects all aspects of life. It affects your quality of life as it limits your physical functioning, your ability to perform activities of daily living, and your ability to work. It has social consequences for your marital and family relationships, it may limit intimacy with your partner, and it may prevent interaction with friends. Chronic pain has societal consequences in terms of increased health care costs, increased disability costs, and lost productivity that is a consequence of missed workdays.

Given the pervasiveness of pain, it’s no wonder that chronic pain affects your psychological well-being as well.3 Research indicates that as number and severity of a patient’s physical symptoms increase, the number and severity of psychological complaints increase.4 In other words, the more places you feel pain and the more severe the pain, the more likely you are to have a depression or problems such as difficulty sleeping or anxiety and the more severe these symptoms are. Some of the signs and symptoms related to depression reported by chronic pain patients treated at pain clinics include:

• physical deconditioning,
• sleep disturbance,
• reduced sexual activities,
• family stress,
• work issues,
• legal issues,
• financial concerns,
• decreased self-esteem,
• fear of injury, and
• altered mood, including irritability, anxiety, and depression.5

Why do pain and depression co-exist so often? Scientists have been studying this relationship through neurosciences and epidemiology and have made important discoveries. First of all, both depression and the suffering of pain are located in the same area of the brain.6 Second, the same chemical messengers are involved in regulating pain and mood.7 What are the mechanisms that affect these parts of the brain and these chemical systems? We find that depression runs in families, so that the stress of having pain may trigger the chemical changes in the brain leading to depression in persons who may be vulnerable because of a family tendency (genetic) to depressive illness. More commonly, however, a person has no family vulnerability to depression, but may get “worn down” by all the stress, losses and problems encountered by having pain over many months.8 Either way, this “wearing down” is biochemical, such that certain important chemicals (similar to vitamins) that are responsible for regulating both pain and mood appear to be functionally depleted. This is why the same medications that are helpful in depression may also effectively treat pain, because they enhance the pain and mood regulating effects of these chemical systems in your brain.

Approximately 40% to 60% of patients being treated at pain clinics report experiencing symptoms of depression.9 Unfortunately, people experiencing pain do not always receive the treatment they need to combat their depression and their pain, especially if they do not see physicians with the training and background to treat both together (eg, pain medicine specialists, psychiatrists, or primary care physicians with this training). Given the nature of today’s health care system, most Americans receive mental health care by visiting their primary care physician, but research studies indicate that 50% of patients who are clinically depressed are not diagnosed by their primary care physicians.10 So be on the lookout for depression in yourself and loved ones and seek treatment before the negative effects occur.

Pain and depression are inexorably linked in a complex way. Pain causes depression—depression causes pain. About 30% of patients with persistent pain conditions suffer from clinical depression related to their pain, and almost all persons will experience some mood changes. 75% of patients with clinical depression present to their doctors because of physical symptoms, including pain.1 People in pain who have symptoms of depression experience more impairment associated with pain than those who do not have depressive symptoms.2

To successfully treat your chronic pain, you and your physician need to examine the emotional factors that may influence your pain level and physical disability. One of the first steps to treating pain is recognizing that depression often accompanies pain and that increases in pain or widespread pain (ie, pain in many areas of your body) can be a symptom of depression. Understanding this aspect of your pain experience may help you identify your own symptoms and seek the care you need to lessen your pain.

Pain so often is accompanied by loss—loss of function, loss of employment, loss of money, loss of friends and relationships to name just a few—it’s no wonder that people in chronic pain have an increased incidence of depression, anxiety, and sleep disturbances. It is natural to feel emotions ranging from fear, anger, denial, disappointment, guilt, and loneliness to hope and optimism. Every person reacts differently to pain at different times, which can make relationships and pain control difficult. The effect emotions and psychosocial well being have on pain cannot be ignored as emotions have a direct effect on your health. Taking care of the emotional aspects of chronic pain is necessary to treat your overall pain condition.

 minimally conscious state (MCS) is different than a persistent vegetative state (PVS), which involves wakefulness without awareness of self or surroundings. MCS patients do show some evidence of awareness of self and their surroundings.

“Increased understanding of the neural processing that can take place in the absence of the conscious awareness, and the patterns of neural activity that are associated with volitional action and conscious experience will undoubtedly shed light on the mechanistic differences among the highly heterogeneous, but functionally restricted, population of patients with disorders of consciousness,” Dr. John Whyte, of the Moss Rehabilitation Research Institute in Elkins Park, Pa., wrote in an accompanying comment.

For more information, Please check

http://www.nlm.nih.gov/medlineplus/news/fullstory_70160.html

Pain may be acute or chronic. Acute pain begins suddenly and usually does not last long. Chronic pain lasts for weeks or months. Usually, pain is considered chronic if it does one of the following:

• Lasts for more than 1 month longer than expected based on the illness or injury
• Recurs off and on for months or years
• Is associated with a chronic disorder (such as cancer, arthritis, diabetes, or fibromyalgia) or an injury that does not heal

When severe, acute pain may cause anxiety, a rapid heart rate, an increased breathing rate, elevated blood pressure, sweating, and dilated pupils. Usually, chronic pain does not have these effects, but it may result in other problems, such as depression, disturbed sleep, decreased energy, a poor appetite, weight loss, decreased sex drive, and loss of interest in activities.

During treatment for chronic pain, many people experience a brief, often severe flare-up of pain. It is called breakthrough pain because it breaks through in spite of regularly scheduled pain treatment. Typically, breakthrough pain begins suddenly, lasts up to 1 hour, and feels much like the original chronic pain except it is more severe. Breakthrough pain may differ from person to person and is often unpredictable.

Chronic pain can make the nervous system more sensitive to pain. For example, chronic pain repeatedly stimulates the nerve fibers and cells that detect, send, and receive pain signals. Repeated stimulation can change the structure of nerve fibers and cells or make them more active and can thus increase pain transmission to the spinal cord and brain. As a result, pain may result from stimulation that might not ordinarily be painful, or painful stimuli may be felt as more severe.

When pain occurs repeatedly, people may anticipate it by becoming fearful and anxious. These emotions can stimulate the body to produce substances that make pain feel more intense. An example is prostaglandins, which make nerve cells more likely to respond to pain signals. Fear and anxiety can also reduce the production of substances that reduce the sensitivity of nerve cells to pain. An example is endorphins, the body’s natural pain relievers. Fatigue can have the same effects on pain as fear and anxiety.

These changes in pain sensitivity partly account for pain that persists after its cause resolves and for pain that feels more severe than expected.

Pain is common among older people. However, as people age, they complain less of pain. The reason may be a decrease in the body’s sensitivity to pain or a more stoical attitude toward pain. Some older people mistakenly think that pain is an unavoidable part of aging and thus minimize it or do not report it.

The most common cause is a musculoskeletal disorder. However, many older people have chronic pain, which may have many causes.

Effects of pain may be more serious for older people:

• Chronic pain can make them less able to function and more dependent on other people.
• They may lose sleep and become exhausted.
• They may lose their appetite, resulting in undernutrition.
• Pain may prevent people from interacting with others and from going out. As a result, they can become isolated and depressed.
• Pain can make people less active. Lack of activity can lead to loss of muscle strength and flexibility, making activity even more difficult and increasing the risk of falls.

Older people are more likely than younger people to have side effects from pain relievers (analgesics), and some side effects are more likely to be severe. These drugs may stay in the body longer, and older people may be more sensitive to them. Many older people take several drugs, increasing the chances that a drug will interact with the analgesic, reducing the effectiveness of one of the drugs or increasing the risk of side effects.

Older people are more likely to have disorders that increase the risk of side effects from analgesics. Having a heart or blood vessel (cardiovascular) disorder or risk factors for these disorders increases the risk of heart attack, stroke, blood clots in the legs, and heart failure when NSAIDs are taken. Having a kidney disorder, heart failure, or a liver disorder makes people more vulnerable to kidney damage from NSAIDs and less able to handle the fluid retention caused by the drugs.

To reduce the risk of side effects, particularly when prescribing opioids, doctors give older people a low dose at first. The dose is increased slowly as needed, and its effects are monitored. Doctors also choose analgesics less likely to have side effects in older people. For example, acetaminophen Some Trade Names
TYLENOLis usually preferred to NSAIDs for treating chronic mild to moderate pain without inflammation. Certain NSAIDs ( indomethacin Some Trade Names INDOCIN and ketorolac Some Trade Names TORADOL) and certain opioids (such as pentazocine Some Trade Names TALWIN) are usually not given to older people because of the risk of side effects.

Nondrug treatments and support from caregivers and family members can sometimes help older people manage pain and reduce the need for analgesics.

Pain is the most common reason people visit their doctor. Pain may be sharp or dull, intermittent or constant, or throbbing or steady. Sometimes pain is very difficult to describe. Pain may be felt at a single site or over a large area. The intensity of pain can vary from mild to intolerable.

People differ remarkably in their ability to tolerate pain. One person cannot tolerate the pain of a small cut or bruise, but another person can tolerate pain caused by a major accident or knife wound with little complaint. The ability to withstand pain varies according to mood, personality, and circumstance. In a moment of excitement during an athletic match, an athlete may not notice a severe bruise but is likely to be very aware of the pain after the match, particularly if the team lost.