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Pain and pain management
What is Pain
Some describe it as an unpleasant sensation...and like all senses, it is interpreted in the Brain. It is a "vital" input and feedback that allows our Brain to interpret our external environment and monitor our internal body.
Our Brain - I am
A French philosopher once said, "I think, therefore I am". A nice summation of our Brain, where resides our feelings, mood, memories, thoughts, beliefs, personalities, and identity.
Sensation
Our senses tells us-our brain, where our body is in our world as well as how it is functioning inside. With your eyes close, you know the position of your hips, knees and ankles. You can feel the light touch of your clothing. You can feel the cellphone vibrate in your pocket. You can feel the cool breeze on your skin. You can feel the sharp sensation of a tack under your foot, or the dull pain of rock under your toes. Without these sensations, you would not be able to move about, and literally your joints would erode and self-destruct. Pain is a necessary and important message for us to protect our body in a dangerous world, as well as an important message to self-monitor our body systems.
Acute Pain
Pain can be a mild or slight message, lasting only a brief moment. An electric shock when we touch a live wire, our arm quickly withdraws without a thought. A reflex. Touching a hot burner with your finger, another quick reaction to your mouth, and still a water blister develops. With this, there may be an associated irritation of the persistent pain, but there is acceptance knowing the episode will pass soon in hours or days. Pain is a lesson to our Brain to avoid that previous action or behavior. And if we have been injured, pain tells our Brain that we need to rest our injured part until it heals. If you sprain a knee, then pain occurs with movement. You favor your injured knee, not putting as much weight on it. Your knee stays bent. The muscles become weaker. Pain forces you to rest that knee, so you give it the necessary time to heal.
Chronic Pain
But what happens when that pain persists, and lasts not just days or weeks, but months and years? The pain, as measured by its frequency and intensity, floods the Brain. And now, in addition to your injured knee, you now have a second problem--a Pain Problem. It affects the other functions in your Brain-your personality, your mood, your feelings, your personality, your concentration, your identity. A Chronic Pain syndrome is frequently associated with depression, poor mood, poor sleep, irritability, decreased focus and concentration, and mental and physical fatigue. As your Brain is affected, so in turn, does your body function changes.
Evaluating Pain
The problem with evaluating Pain is that there are no easy and reliable objective measures. As a result, we quantify pain from zero to 10. From no pain, to mild pain, then slight pain, moderate pain, severe pain, and incapacitating pain. This is still self-reporting and subjective. Further complicating, different people have different sensitivities to interpreting and handling pain. The reality is that as Physician, we must accept the patient's subjective complaints as real and factual (assuming no secondary gain), to the extent that the Pain interferes with the patient's daily activities and functioning, and mental health.
The Problem with Pain
There lies two main problems with Pain: Disability and Addiction.
Disability from Pain
Pain is a major cause of Disability, along with its corollary Depression. With restriction in motion and activity, disability is a direct consequence. With this inactivity, weakness increases, physiologic functions fail, and Pain increases further. Decrease activity and isolation impacts our Brain, increasing feelings of Depression and Anxiety. Situational stresses occur in the home, with family and friends, self-worth, work, and recreation.
Addiction
In the last hundred years, with the advancement in pharmacology and surgery, analgesics and narcotics have been an important step in the advancement of Medicine. To replace the biting bullet and bottle of whiskey, anesthesia and pain control was a necessity especially during war. Medications have provided comfort and saved lives in the battlefield, and this knowledge has been transferred to our country's hospitals and trauma centers. Today, specialized care is required to control Chronic Pain, because opiates and opioids result in physical dependence and tolerance, and for some, addiction. In addition, Addictive persons with no pain problems use narcotic medications not for pain but for their effects of improving mood, giving a high sensation of brief euphoria that may counter their own psychological problems, or simply partying. Unfortunately, because of physical dependence and development of tolerance, irregular and uncontrolled dosing, impure drugs mixed with powerful drugs like fentanyl, and polydrug use mixed with alcohol, overdoses and deaths have reached epidemic numbers.
Pain Management
At Vital Pain Management, our multispecialty medical group includes specialists in Pain, Emergency Medicine, Neurology, Physical Medicine and Rehabilitation, and Osteopathy. Our goals are to evaluate and manage the conditions that cause Chronic Pain, manage the Pain with appropriate Pain Medications and dosing to minize side-effects, provide alternative therapies, improve coping strategies and mental health, and improve daily activities and functioning, For patients that present to our office taking an improper or dangerous amount of medications, we can provide transition to alternative relatively safer pain medications like Buprenorphine or Suboxone, or taper the dosage of medications to a safer level.