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by Dennis Turk, Ph.D. University of Washington School of Medicine
August 1, 2001
Editor’s Note: This article is excerpted from the syllabus of the FAME 2001 Conference and is used with permission.
Living effectively and adapting to Fibromyalgia is possible but it begins with knowledge about pain, stress, and yourself. Knowledge, however, is not sufficient. In addition, you need (1) effort, (2) practice, and (3) perseverance even when progress is slower than you would like…Effort, practice, and perseverance depend on you.
Costs of Pain
As you have probably realized over the course of your experience with Fibromyalgia (FM) and all that it involves, FM is not a simple problem. The pain, fatigue, irritability, or depression that you feel is not merely caused by stress and not merely caused by tissue damage. Chronic pain can affect what you do, what you think, your environment, your relationships, and many other factors in your life. Similarly, what you do, what you think, the environment and many other factors in your life can affect the pain. Take a moment and explore how your pain has affected your life, mood, activities, physical responses, relationships and jobs. Don’t be surprised if this exercise causes some sadness, anger or anxiety. It will help you to assess the full cost of the pain experience and help you to recognize some important areas of your life that can be improved.
Acute Vs. Chronic Pain
It is important to differentiate between acute and chronic pain conditions because their treatments differ. In an acute condition, pain is typically a symptom of a recent injury. After the injury has been identified, treatment is directed towards the injury itself and pain medications are used only for symptom relief. Appropriate treatments may include immobilization of the injured part (for example, a broken leg placed in a cast). Even in acute pain situations, however, research points to the advantage of limited rest for the injured person (that is, after surgery or acute back injury), and early, gradual remobilization.
In the chronic pain condition, the injury may be unidentifiable or tissue healing may be complete, even if things don’t feel exactly as they did before the injury or disorder. In chronic pain conditions, long-standing immobilization or bed rest can result in more pain because of atrophy and shortening of the muscles and ligaments. Thus, appropriate treatments for chronic pain conditions include physical therapy to help endurance and strength. Chronic pain is not a warning signal that activity will result in harm to the body. In fact, healthcare providers who treat people with chronic pain encourage them to “work through the pain”, that is, to exercise and participate in normal activities despite their pain.
The Gate Control Theory of Pain
Why is it that acute and chronic pain should be so different? Nearly all people consider pain to be a highly unpleasant and uncomfortable condition. To that end, it is often said that all pain is stressful. IN acute pain conditions, tissue healing and pain reduction are expected, and even thought severe, it can be treated with medication, Knowing that the pain will end at some point leads to hope and optimism. The longer the pain goes on, however, the greater the potential for other factors such as frustration, discouragement, depression, and lack of participation in normal activities to become important secondary problems.
All types of pain, whether acute or chronic, are affected by a multitude of factors. Have you ever wondered why professional athletes who are injured during a game often don’t “feel” pain until the game is over? Or why some people seem to have a high “tolerance” for pain while other people have a low pain “tolerance”? Some of the answers to these questions are explained by the gate control theory of pain, first proposed 30 years ago by Ronald Melzack and Patrick Wall.
Drs. Melzak and Wall have proposed that as pin messages travel toward the brain, they pass through a number of “gates” that, when open, allow the pain signal through the brain. When these pain gates are closed, pain signals may be blocked. Thus, the experience of pain can be modified at a number of different places as the pain message is relayed from the site of the problem to the brain. Pain relieving medications, distraction, hypnosis and relaxation are examples of things that can close the pain gates and block pain.
Pain transmission from tissue injury can be shut off (gates closed) not only by painkillers, but also by stimulation of certain non-pain nerve fibers. For example, rubbing a sore area can sometimes alleviate pain. Certain parts of the brain can also alter pain transmission through production of specific morphine-like chemicals called endorphins that act to reduce pain. Endorphin production has been used to explain the “runners high” or feelings of elevated mood (euphoria) that runners report experiencing. The context or environment in which pain occurs and one’s personal explanation of the meaning of the specific pain can also greatly affect the amount of pain experienced. Thus, the pain gates can be opened by things such as worry or anxiety, feeling blue or depressed, overwhelming life situations, chronic pain, feeling tired or run down, and beliefs that the pain indicates something serious or threatening.
Next Week: Dr. Turk’s suggestions for pain relief through various relaxation techniques
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