and are less likely to do something that causes pain (although later, as we explain addiction, you will see that this is not true in all cases).
Chronic pain continues beyond three to six months and has outlived any useful function. It should have gone away, but persists. It is the exaggerated response of the nervous system to damage, as in Jim’s case, but also to other conditions and situations that occur in the brain, as Amy experiences. It is often pain out of proportion to the prior injury or damage. Sometimes a condition will develop for no apparent reason, and there is not even a clear physical basis for the protracted pain. This is not to say that the pain is in any way unreal or imagined, which was the crux of the problem for Chris, who just didn’t buy that Amy’s pain was real. In actuality, Amy’s body simply responded differently over time to certain conditions, damage, or injury. The result is pain that won’t quit.
Pain, as we experience it, is the net effect of tissue disturbance, transmission to and from the brain, and extensive processing and modifying of the pain signal. With chronic pain, the signal and its transmission are often distorted. So, despite the fact that Jim’s broken back had healed and the “need” for pain (protection, withdrawal, avoiding further injury) had passed, he still was hurting.
Chronic pain is usually neuropathic, meaning associated with disturbances of the nervous system. Often the character of chronic pain differs from that of acute pain (called nociceptive pain), which is usually sharp, aching, or throbbing, and comes from sprains, fractures, burns, bruises, or other forms of tissue damage. Jim experienced a burning sensation and troublesome numbness, especially traveling into his right leg. Neuropathic pain can have a lightning-bolt sensation or an electrical quality. With neuropathic pain, people may experience allodynia, which is pain from something that normally doesn’t cause pain, such as light touch or a breeze across the skin. Also associated with neuropathic pain is hyperalgesia, meaning more pain than would normally be caused by a stimulus. This kind of pain may be difficult to localize, and the source of the pain may be widespread or changing. Amy had excruciating tenderness at certain trigger points, a hallmark of fibromyalgia.
Chronic pain is pain that continues beyond three to six months, has outlived any useful function, and may or may not have a clear physical basis.
Amy’s pain, as with many others who experience chronic pain, was a part of a phenomenon called central pain. This is the result of poorly understood changes in the nervous system’s perception of pain. With central pain, the “volume knob” for the perception of pain is turned up higher than normal. It is the increased “volume” that causes a normally light-touch sensation to be an awful sensation for Amy.
The worst news about chronic pain is that—though it may wax and wane—in most cases it doesn’t go away. Chronic pain is one of the major reasons people go to doctors and is said to be the most costly health care problem in America. Countless others like Chris, Mary, Mandi, and Ross are affected by living in a household with or caring for someone with chronic pain. Obviously, if you are reading this book, your life has been affected significantly by chronic pain.
{exercise} 1.1
Who Is Your Person with Pain? __________________________________
You are probably reading this with a specific person, perhaps more than one person, in mind. Identify the person in your life who has chronic pain and describe your relationship with him/her/them.
From this point on, where you see _______________, write in the name of the person(s) you identified in this exercise.
{exercise} 1.2
Types of Chronic Pain _________________________________________
Here is just a partial list of the many potential causes of chronic pain. Find the cause(s) of _______________’s pain and check it/them off or write them in the space provided if the causes are not listed.
____ Back, neck, and joint pain, which can result from tension, muscle injury, nerve damage, disc disease, or arthritis.
____ Burn pain, which can continue long after a burn wound has healed.
____ Chronic pelvic pain, which refers to any pain in your pelvic region (the area between your belly button and your hips) from tumors, infections, or scar tissue.
____ Cancer pain, which can result from the growth of a tumor with pressure on nerves, from treatment of the disease (chemotherapy or radiation treatments), or from other effects on the body.
____ Infections that didn’t respond to treatment, which can occur almost anywhere in the body.
____ Chronic abdominal pain (with or without physical explanation or findings), ulcers, gallbladder disease, pancreatitis, and gastroesophageal reflux disease (GERD).
____ Inflammatory bowel disease, irritable bowel syndrome, or other intestinal problems.
____ Bursitis, which can affect any joint, most commonly knees, shoulders, hips, elbows, or wrists.
____ Head and facial pain, which can be caused by dental problems, temporomandibular joint (TMJ) disorders, trigeminal neuralgia, or conditions affecting the nerves in the face.
____ Chronic headaches, such as migraines, cluster headaches, and tension headaches.
____ Multiple sclerosis, which can include numbness, aching, or pain.
____ Angina or chest pain from heart disease.
____ Uterine fibroid tumors (growths in the womb that can be associated with bleeding).
____ Chronic obstructive pulmonary disease (COPD) or emphysema.
____ Peripheral vascular disease (inadequate blood circulation to arms and legs).
____ Ankylosing spondylitis (severe arthritis with restriction of spinal movement).
____ Myofascial pain syndromes (heightened experience of pain coming from the brain, which impacts soft tissue and muscles). This includes fibromyalgia, which is characterized by tenderness in multiple trigger points, widespread muscle pain, fatigue, and stiffness.
____ Whiplash that doesn’t go away after an accident.
____ Broken bones that healed incompletely or in the wrong position.
____ Arthritis (rheumatoid, osteo, or other forms), which can affect any joint, including hips, knees, neck, back, fingers, wrists, and feet.
____ Neuropathy from a variety of conditions, including HIV/AIDS, injury, and cancer.
____ Other: ________________________________________________
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