Healing Pain: The Innovative,
Breakthrough Plan to Overcome Your Physical Pain & Emotional
By Ann Berger, MSN, MD, and C. B.
that pain is understood by anyone and that everyone feels it a bit differently.
Overall, pain is an unpleasant sensation that occurs in varying degrees of
severity and is a consequence of a number of processes. In order to manage
pain, doctors discern its intensity and frequency and the circumstance from
which it springs.
typically categorized into two broad areas: acute and chronic. Acute pain is easier to diagnose
and treat than chronic pain. It usually occurs after an injury, and people in
this state look like they're in pain. This type of pain usually disappears when
the injury heals. If you break your nose in a fall or cut yourself in your
workroom, you probably feel the pain pulsing like a silent alarm throughout
your body. With acute pain, your heart rate, respiratory rate, fight-or-flight
response, and sweating increase. While acute pain is severe, the good news is
that it lasts a relatively short time.
is a lot more complex.
Closer Look at Chronic Pain
An article on
chronic pain in the Journal of the American
Medical Association noted that chronic pain is expensive, mainly
because of the resulting disability and absence from work. In recent studies,
researchers say, "more attention has been paid to the impact of chronic pain on
daily living." And what an impact it has.
What is chronic pain? A typical definition says
that chronic pain is not one thing, but a condition that varies depending on
the person. The variables include where the pain is, what its cause is, and how
an injury heals. In some cases, the pain is simply inexplicable. However, one
description is consistently applicable: All chronic pain is long-term pain that
persists even after healing has occurred or when the condition that's causing
the pain does not go away. This is pain beyond what doctors expect to see from
a condition or injury that does clear up.
with endometriosis have worse symptoms during their cycles, while others begin
feeling pain a week before that. When these women describe their pain as
chronic, it's because they're uncomfortable for at least 2 weeks of the month.
People who get bad migraines usually experience them intermittently rather than
every day. So in that way, you may perceive your migraines as not actually
being chronic, but recurring. I also get migraines once a month, but I don't
consider the condition chronic. Healing starts here! Chronic pain cannot have
power over your thinking when you at least partly define it as something you
will not allow to affect how you function.
in the throes of acute pain, patients with chronic pain often do not appear to
be in pain -- but indeed they are! Research done with chronic pain sufferers
shows that some exhibit greater brain activity than healthy people when
subjected to pain. This may be why they experience pain more severely. Yet,
they've gotten good at "getting through" and soldiering on. Rather than seeing
an elevated change in vital signs, like increased heart rate, one usually sees
vegetative signs, and, not to be dismissed, such a person may appear depressed.
chronic pain tell me that they have sleep disturbances, decreased libido,
anhedonia (an inability to feel pleasure), constipation, lethargy, and
personality change; lose their appetites; and sometimes are preoccupied with
their bodies. These are all classic symptoms of chronic pain. But why the pain?
Often, it's due to a disease, while at other times, it's the treatment of the
disease that produces the pain. When a person has any type of surgery, they can
be left with a long-term pain problem secondary to scarring, or even permanent
persistent pain may range from mild to severe, and it is present to some degree
for long periods of time. Some people with chronic pain that is controlled by
medication can have "breakthrough pain," which occurs when the medication does
not work and moderate to severe pain breaks through or is felt for a short
time. This can occur several times a day, even when the proper dose of medicine
chronic pain, it's important to understand the different potential types and
mechanisms of pain.
Referred pain is felt some
distance from where the pain actually originates. In other words, the site of
the pain is not necessarily the source. Osteoarthritis of the hip, for example,
causes pain to be experienced in the knee. In acupuncture, a form of Chinese
medicine, kidney problems can be indicated by pain in the knees.
Phantom pain occurs when
you have had a limb, breast, or other body part removed by surgery. People
describe the pain or unpleasant sensations as if they were coming from the
absent body part, but phantom pain is real and not in patients' minds.
Somatic pain is caused by
activation of a pain receptor. Remember, pain nerve endings, called
nociceptors, are programmed to respond to various stimuli, such as heat, cold,
and other physical sensations. The characteristics of the pain are very well
localized aching, throbbing, and a gnawing feeling. Examples include joint and
bone pain. This type of pain is generally very responsive to nonsteroidal
anti-inflammatory drugs (NSAIDS) like aspirin, and when they are no longer
helpful, one can use opiate medications to treat this type of pain.
Visceral pain is also
caused by activation of a pain receptor. The patient often feels achy, vaguely
localized pain. It commonly originates in the abdomen or the chest, it does not
feel as if it is limited to only one area. A good example of visceral pain is
chest pain due to a heart attack. In this case, the pain occurs in the chest,
but it can go up the neck and down the arm, too. This type of pain is a little
more difficult to treat, but it can respond to opiates and adjuvant
Neuropathic pain is caused by
destruction of a nerve in either the peripheral or central nervous system.
Neuropathy can be best thought of as a seizure of a nerve. People often
describe a severe, sharp, shooting, or stabbing pain or a burning, numb, or
Myofascial pain is muscle
pain that occurs in conjunction with other pains. The trigger point is a
localized, highly irritable spot in a taut band of skeletal muscle. Palpation
of these trigger points will alter the pain, causing it to increase or radiate.
You may feel as if you are having a muscle spasm.
Pain: The Innovative Breakthrough Plan to Overcome Your Physical Pain and
Emotional Suffering by Ann Berger, MSN, MD and C. B. deSwaan
© 2006 Ann Berger and C. B. deSwaan. (March 2006; 1-59486-012-2)
Permission granted by Rodale, Inc., Emmaus, PA
wherever books are sold or directly from the publisher by calling (800)
848-4735 or visit their website at www.rodalestore.com.
Ann Berger, MSN, MD, is one of the foremost
specialists in pain management in the nation. A medical oncologist specializing
in pain treatment, she has written and edited numerous books on pain and
palliative care for patients and health-care providers. Dr. Berger is also
senior editor of the most widely used textbook on palliative care, Principles and Practice of Palliative Care and
Supportive Oncology. She currently resides in Darnestown,
C. B. deSwaan is a New
York City-based freelance writer specializing in nonfiction. She has written 20
books with expert collaborators, including the best-selling Men Are Just Desserts and Smart Cookies Don't
Pain: The Innovative, Breakthrough Plan to Overcome Your Physical Pain and