man in pain

After hundreds of years of studying pain, the medical community’s view of pain is changing. Once thought of as just a symptom of other conditions, experts now define pain as disease in itself. Even the federal government has shifted its thinking. Since 2018 the Department of Veterans Affairs has been awarding disability ratings to veterans for their pain alone without needing an underlying diagnosis to make it compensable. (Service connection still needs to be established by showing the VA that an in-service event, injury, or illness caused the pain, and the veteran’s pain must cause some type of functional impairment or loss. For more on this topic see the next article in this newsletter.)

If you are coping with pain, you are not alone. Consider these pain statistics:

  • In the U.S. 76.5 million people over the age of 20 (about 26% of the population) suffer from chronic pain.
  • About 80% of all Americans will experience some form of back pain during their lifetime.
  • 42 million Americans say that pain interrupts their sleep several times a week.
  • Only 58% of patients say prescription painkillers effectively treat their pain, according to the American Academy of Pain Medicine. 

In its broadest classification, there are two types of pain: acute pain and chronic pain.  Acute pain is short-lived pain caused by broken bones, surgery, cuts, burns, and similar causes. “Acute pain may last a few seconds (a pinch), a few days (a paper cut) or weeks to months (broken bone or sprain)”, Nationwide Children’s Hospital says. “Acute pain goes away when your body has healed to the best of its ability and the danger is gone.” When the pain does not go away in about three months or less, it is classified as chronic pain. If you have chronic pain your body is exhibiting a sensitive response that is no longer harmful. Nationwide Children’s Hospital explains that “some chronic pain conditions have a well-known cause, but most chronic pain goes on with no clear reason. In both cases, the body’s response is more intense than it should be.”
“You would have every right to be offended if someone said your pain was all in your head, “ the Arthritis Foundation says. “But the truth is, pain is constructed entirely in the brain. This doesn’t mean your pain is any less real – it’s just that your brain literally creates what your body feels, and in cases of chronic pain, your brain helps perpetuate it.”

Medical researchers are starting to understand how our emotions play a leading role in pain. Pain and emotion circuits overlap in the brain. Negative emotions like anger, worry, sadness, and depression can increase pain. Obesity, too, can worsen chronic pain. Studies have shown that depressed people are three to four times more likely to suffer from chronic pain than those who aren’t depressed. “Negative emotions are like gasoline thrown on the fire of pain, not only making chronic pain much worse, but even causing it in some cases”, says Beth Darnall, PhD, a pain psychologist and associate professor at Stanford University.

“The opposite is also true,” says the Arthritis Foundation. “Positive emotions can significantly lower pain when patients stop focusing on how bad they feel. Many with chronic pain agree, noting that when they’re ‘in a worse place emotionally,’ they’re less motivated to exercise and see friends and family. These are essential to changing pain patterns because they help break the pattern of ruminating on pain and they trigger the release of feel-good endorphins.”

There was a time when there were hundreds of pain clinics across America. The introduction of opioids in the 1990s resulted in the shuttering of most of these clinics. Now that we know about the terrible addictive effects of opioids, pain clinics are making a comeback to help patients manage their pain without drugs. “Instead, people learn to manage pain by modifying or changing what their brain tells them. Many say this approach relieves pain without drugs – in some cases it’s the first time they’ve gotten relief,” the Arthritis Foundation reports. Pain-management protocols these days involve intense sessions using exercise, occupational therapy, psychotherapy, and meditation to deal with pain issues.

 

Sean D. Cuddigan
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SSA and VA Disability Attorney in Omaha, Nebraska
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