05 Dec Chronic Pain and the Cycle of Suffering
South Pacific Private recently interviewed Dr. Mel Pohl, Vice President of Medical Affairs and Medical Director of Las Vegas Recovery Centre (LVRC) about the experience of chronic pain, addiction and the cycle of suffering.
Why is chronic pain so prevalent and such a problem? As we get older as a culture, there is more time to sustain injuries and illness that result in chronic pain. The prevailing attitude about pain in this country is that is must be taken away – resulting in some very negative results. Specifically, chronic pain results in opioid use and overuse, dependence and addiction. Also, in the quest for pain relief and in our attempts to AVOID pain – we often create more.
Describe the cycle of suffering Pain exists. It is subject to interpretation by each individual and is based on experience, upbringing, belief systems, mood, and physical conditions. Our attitudes about pain dictate how each person suffers. If pain is regarded as awful, the enemy – or the beast – we expend energy to get away from the experience. Our brain creates worry, fear, anger, sadness and stress – this all makes the pain worse.
What are the first things a person can do if in chronic pain? The key to healing begins with acceptance, you must allow the pain to exist – coexist, if you will, with your being. This can start, simply, with a deep breath. Next is to begin exercising through the soreness to allow the body’s natural clearance system to help get rid of toxins. Next, look at what’s coming into your body- food, fluids, and medications. Nourishing and hydrating the body are paramount for good health – opiates, if they are used can result in serious problems and should be examined with the help of an understanding health practitioner. Lastly, be open to different methods that are nontraditional can benefit a person in chronic pain.
How does chronic pain turn into a “syndrome”? Not everyone with chronic pain develops chronic pain syndrome – perhaps some are constitutionally (or genetically) predisposed to have problems dealing with chronic pain – more than others. As a consequence, progressive searching for pain relief leads to increasing problems. People with chronic pain syndrome treat emotional and physical pain with medications, typically opioids. They tend to search for a cure and continue to pursue this end with a variety of doctors and procedures.
Does gender play a role in how we experience pain? Studies have shown that several areas of male and female brains reacted differently when given the same pain stimulus. The female brain showed greater activity in limbic regions, which are emotion-based centres. In men, the cognitive regions, or analytical centres, showed greater activity. Studies also show that women report pain more often than men do, and in more body regions. They also have more severe and more persistent pain. When women and men are given the same pain stimuli in laboratory studies–gradually increasing heat, for instance–women say “ouch!” before men do. Women discriminate better between types of pain. Despite their greater pain burden, women handle pain better than men do. Women use more coping strategies, honed perhaps by their more frequent encounters with pain, in menstruation and in labour and childbirth. Women prepare better for pain. They plan tactics to handle it. Men more often say, “I’ll deal with it when I have to.”
What are the two groups of pain medications? There are a large number of non-opioid pain medications including anti-inflammatory medications (ibuprofen-like), Tylenol, muscle relaxants, ant-seizure medicines, antidepressants and topical preparations, all of which enhance pain relief. The mainstay of treatment for chronic pain has always been the opioids – habit-forming pain killers (or narcotics) that are effective in diminishing pain but which can cause side effects and result in physical dependency, in some cases addiction, and sometimes worse pain with continued use of the opioids (opioid induced hyperalgesia).
How does someone get addicted to pain medications? If someone becomes addicted to pain medications, they had a predisposition because of their brain chemistry from an early age. Many are born with this tendency. It seems like the key is that when someone with this predisposition takes a drug, in this case, an opioid, they feel something unique and almost “magical” an effect on their brain that causes them to feel good – out of pain, both physical and emotional. The cycle of addiction occurs when, in an attempt to re-experience these feelings, the person uses more and more of the drug, with increasing problems as a result of using. Eventually they will experience loss of control and craving which drives them to continue to use despite negative consequences.
Why do chronic pain and addiction often go hand in hand? Pain comes in emotional and physical forms. For many who use opioids, they achieve relief of both types of pain as well as suffering in the short run. The brain regions where pain is experienced and where opioids work are tied to the region where reward is experienced – hence, by taking opioid medications for pain relief, some inadvertently trigger the pleasure centre as well – when the drug wears off, they are drawn to repeat the experience again and again at higher and higher doses, often finding they cannot stop the drug.
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