Raj N. Sureja, MD
Every day in my medical practice, I encounter patients who experience pain on an on-going basis. Their pain may be caused by an injury that happened to them, a diagnosed disease or for a completely unknown reason, called idiopathic pain. For most people, the pain that they feel is recognized but is handled in a fairly matter-of-fact way. They have pain, they get treatment and they go on with their lives, continuing to live and work despite the pain. Other individuals experience pain and it dominates their lives, causing them to stop work, shun social activities, and ignore their family due to the pain they feel. Why is pain felt so differently?
Chronic Pain is one of the most researched conditions in medicine today. Pain evolved as a way to protect us from danger. Yet, despite all of the study, we don’t know that much about it or how to eliminate it. We do know that the brain is responsible for the pain that we feel, but we don’t understand why some people are better able to cope with intense pain and others are more sensitive to pain. Since pain is subjective, it is hard to apply a standard of measurement that holds true for all people.
Without the brain, there is no pain. That is a pretty simplistic way of looking at it, but the brain takes all sensory feedback it receives from the body, sorts through it and decides if we need to take action. In other words, pain is a signal that we need to do something. Sometimes, it could be to move our hand away from a hot stovetop. Other times, we don’t have an injury or danger present, like a hot stovetop or a broken toe, but we feel pain anyway. For reasons we don’t yet understand, the brain has decided that it is to our advantage to feel pain.
People who have horrific accidents, such as getting a leg blown off on the battlefield, sometimes report no pain at all, until long after the emergency has passed. How can that be? Apparently the brain decides that pain will just make the problem worse in that type of emergency and does not send pain signals. Yet, people who have lost a limb years ago will still feel pain in the non-existent limb, called phantom pain. Does the brain think that this is feeling will add value or benefit the person in some way? We don’t know the answer to these questions.
Research tells us that there are people who have overactive central nervous systems which can make them more susceptible to feeling pain, even when the stimulus which causes the pain is very mild or barely there. It also tells us that people who are sensitive to pain have more activity in the brain areas responsible for identifying pain. It is also well known that certain emotional traumas, such as depression, abuse, anger or anxiety can contribute to the severity of pain experienced.
With all that we know and don’t know about pain, physicians work with patients to uncover all of the issues that may be contributing to their pain experience. It is like being a detective, and we peel the layers back, one by one, and try to address each causative factor in the best way we can. Obviously, if a person has a physical reason for their pain, I try to diagnose and treat that problem. That could involve physical therapy, gentle exercise, medications, cognitive behavioral therapy, an interventional procedure, or surgery. Likewise, if a person suffers from emotional issues that cause their pain to be more severe, I send them to our Medical Psychologist for evaluation and treatment. Treating the mind and body in coordination with medical therapy has proven to be the best way to effect change for the better in patients who suffer from chronic pain.