ALL ABOUT CHRONIC PAIN - LATEST ARTICLES

Knowledge Is Power In Order To Rescue The Hijacked Brain

In order to achieve the best quality of life and level of functioning, people living with chronic pain must learn as much as they can about the subject of pain and what constitutes effective pain management. We know that pain is a signal that tells us there is damage or something wrong with our system. However, with some chronic pain conditions the system (including the brain) gets altered. The pain system gets turned on and cannot be turned off. I call this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping). 

A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery.  In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage. 

Opioid Use Can Also Hijack The Brain

According to research published in Annals of the New York Academy of Sciences titled Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain; states that convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids.  Such neuroplastic changes occur at both cellular and intracellular levels. Unfortunately, most pain conditions in this country are treated with opiates – research indicates that as high as 90 percent of people undergoing pain management are prescribed opiates. With so many people living with chronic pain and using opiates, these neuroplastic changes need to be better understood.

I like to use simple language and metaphors or visual images when educating my patients. Many of the people I have worked with would not understand the term Neuroplasticity so I use the metaphor of the hijacked brain. I tell them the reality or neuroplasticity science are much more complex but in essence what is happening is that the brain forms pathways (called neuro-networks) that eventually become super highways—in other words the new neuro-network becomes more complex and elaborate. 

Building Better Highways

What I believe needs to happen in chronic pain management is developing new pathways or highways to replace self-defeating pain behaviors or suffering that can lead to a reduction or elimination of pain. My Mentor and colleague Terence T. Gorski uses the example of living in a rural area with an outhouse over a hundred yards from the back door. Between the back door and the outhouse is a field of heavy vegetation that is very hard to walk through. On the first trip it takes a long time and is very difficult but some of the vegetation is getting tramped down just a little so the trip back is not quite as hard. After several trips it gets much easier.

I expand this metaphor by saying treatment is like gaining access to landscaping equipment that will assist you in putting in a paved path to your goal—effective pain management. It is crucial to develop new ways of thinking, more effective methods of managing painful emotions and new ways of behaving that will improve pain management and quality of life.  To do this, new neuro-pathways need to be generated and used over and over until the highway is built. Unfortunately, there are many obstacles that can get in the way and detour people back to the old highways and people need a strategic integrated plan to stay on the new highway. 

Utilizing Addiction-Free Pain Management® 

To assist keeping people on the new highway, I started developing The Addiction Free Pain Management® (APM) Manualized Treatment System in 1996. The APM™ System is a comprehensive method of addressing the four quadrants of suffering: biological (psychical), psychological, social, and spiritual. This system was first utilized by me in my own quest to find chronic pain relief without reliance on opioid medication and to stop suffering with my pain. 

The APM™ Treatment System is based in part on the Gorski-CENAPS® Developmental model of recovery. It also includes the best practice standards reported by the National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM) and the Substance Abuse and Mental Health Services Administration (SAMHSA) along with the leading evidence-based chronic pain management best practice standards. 

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

Over the past two decades I have seen that we as a nation have fallen victim to being sold the power of the pure bio-medical model for chronic pain treatment. Even though many research projects have all concluded that ethically, and for better outcomes, effective chronic pain management requires an integrated team approach. Unfortunately, many chronic pain patients have been denied integrated services with the payors saying that there is not enough research to validate paying for these services. 

However, this is not true. In fact, the truth is that there is no level one double blind research that demonstrates opioids are effective for chronic pain management. There are, however, many evidence-based and research-based studies that demonstrate that integrated services such as Cognitive Behavioral Therapy, Acupuncture, Equine Therapy and many others can demonstrate improved outcomes for chronic pain patients. Despite this insurance companies have authorized thousands upon thousands of opioid prescriptions that eventually led to the dire problem we are experiencing today including thousands of overdose deaths all around the United States. 

Part of the big picture is that opioids have proven very effective for acute pain management, such as broken bones, cuts, surgical procedures etc.  Many big companies spent a lot of money and produced credible outcome research that demonstrated opioids we're effective for treating acute pain. 

Some of the same big pharmaceutical companies spent millions of dollars if not more to tout using powerful opioids for chronic pain management. In one instance they purchased the right in the Journal of the American Medical Association to have the line OxyContin is not addictive, inserted. This along with the efforts of several high-powered medical doctors toured the country stating that it was a right for patience to have their chronic pain treated with opioids. At one point they spearheaded the movement to declare pain as the Fifth Vital Sign. 

During the 1990s we started to see the growth of pain clinics cropping up all over the country. Pain clinics became a very lucrative business for many physicians especially anesthesiologists.  In simple terms the bio-medical model became a combination of pills, injections, interventional pain procedures and surgeries.  This model did seem to work very well for many pain patients. Unfortunately, for over 20 percent of the population showed little or no improvement with this model. Unfortunately, in many instances the patient was blamed for it not working. 

There are many reasons why this 20 percent group of patients started over-utilizing most of the chronic pain healthcare dollars (some research shows as high as 80 percent) and they still showed little or no improvement.  Why is that? The answer is complex, but I will attempt to share why I believe this occurs.

The major reason I see for the biomedical model failing with the 20 percent subset of chronic pain patients is their health care providers fail to identify and/or treat the coexisting disorders. Some of the common coexisting disorders that lead to poor outcomes or even treatment failure are medication misuse abuse or even addiction; depression; anxiety disorders; unresolved trauma history such as PTSD; Eating Disorders and other mood disorders. 

Other factors that lead to poor outcomes our patients having poor family or social support. In many cases, family members have been burned out or the patient becomes so despairing they pull away and will not accept help. In other instances, friends or family members tend to enable or over do for their loved one. 

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

If you’re living with a chronic pain condition like I am you may have noticed that sometimes you are so fearful about doing even the most basic tasks of daily living, that you become immobilized. It can also manifest as overwhelming anxiety, so much so, that a phenomenon gets triggered which amplifies your perception of pain. I call this Anticipatory Pain.

Because you believe you are going to hurt by doing a certain activity, you can activate the physical pain system. Just by thinking about doing something that you believe will cause you to hurt, you will start to feel pain. This can happen before you even do whatever it is you already believe will cause physical pain. All you have to do is to start thinking about doing that thing.

Once the physical pain system is activated, the anticipatory pain reaction can make your perception of chronic pain symptoms worse. 

Whenever you feel the pain, you interpret it in a way that makes it feel worse, and you think about it in a way that actually does make it worse. You tell yourself that “this pain is awful and terrible,” and “I can’t handle it.” You convince yourself that “it’s hopeless, I’ll always hurt, and there’s nothing I can do about it.”

This way of thinking contributes to the development of emotional reactions that further intensify or amplify the pain response. The increased perception of pain causes you to keep changing your behavior in ways that create even more unnecessary limitations and mounting emotional discomfort. These reactions can make you believe you are trapped in a progressive cycle of disability.

Coping and Moving Beyond Anticipatory Pain

One of the most requested articles I wrote was titled “Coping with Anticipatory Pain. I believe it’s vital for us to support people to not just cope with anticipatory pain, but to move beyond it.

I learned a long time ago that what we expect is usually what we get which can sometimes be both helpful and harmful. When it comes to feeling pain and developing an effective chronic pain management plan, it’s crucial to understand the role of anticipatory pain. It has both biological and psychological components.

On the biological side, the cascade of effects from a pain sensation occurs on many levels and involves a variety of different areas within the nervous system. As a result, a wide variety of nervous system chemicals are produced and dumped into the blood while other brain chemicals are rapidly absorbed or depleted. Pain doesn’t just hurt — it changes the most basic neurophysiologic processes in the human body.

On the psychological side, anticipation of an expected pain level can influence the degree to which you experience your pain. In some cases, when your anticipatory level of pain expectation is lowered, your brain responds by influencing special neurons. This renders your brain less responsive to an incoming pain signal and your sensation of pain decreases. In any event, both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) will influence or modify the effects on your body.

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

I developed the information in this article to help my patients take a look at their relationship with medications. Differentiating between appropriate use of psychoactive medications with abuse or addiction potential and the beginning of abuse can sometimes be difficult for patients and their healthcare providers to determine. Some medications also have the potential for problematic use including medication dependency, medication abuse, pseudo-addiction, and finally addiction. The confusion and uncertainty of this progression can be challenging for everyone.

The Benefits and Risks of Using Medication

The benefits of medicines are the helpful outcomes people get when they use them, such as lowering blood pressure, curing infection or relieving pain. The risksof medicines are the chances that something unwanted or unexpected could happen to people when they use them. Risks could be less serious things, such as an upset stomach, or more serious things, such as liver damage or even addiction.

When a medicine’s benefits outweigh its known risks, The U.S. Food and Drug Administration (FDA) consider it safe enough to approve. But before using any medicine—as with many things that people do every day—people should be clear about what those benefits and risks are in order to make the best choices.

Some of the Risks from Medication Use

• The possibility of a harmful interaction between the medicine and a food, beverage, dietary supplement (including vitamins and herbals), or another medicine. Combinations of these products can increase the chance of interactions.
• The chance that the medicine may not work as expected.
• The possibility that the medicine may cause additional problems.

Every choice to take a medicine involves thinking through the helpful effects, as well as the possible unwanted effects. The best choice depends on someone’s personal situation. People must decide what risks people can and will accept in order to get the benefits you want. For example, if facing a life-threatening illness, people might choose to accept more risk in the hope of getting the benefits of a cure or living a longer life.

On the other hand, if people are facing a minor illness, they might decide that they want to take very little risk. I always encourage my patients to think it through and work together with their healthcare team to better manage the benefits and risks of their medicines.

Weighing the Risks—Making the Choice

Directions:  The benefit/risk decision is sometimes difficult to make. The best choice depends on a person’s particular situation. People must decide what risks they can and will accept in order to get the benefits they want. In many situations, the expert advice of peoples’ doctor, pharmacist, or other health care professional can assist them making the safest decision. Now please review the table below for some specific ways to lower the risks and obtain the full benefit from your medications. 

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.