My chronic pain experience
I have lived with chronic pain for more than 20 years. It started with a tick bite and got worse after pregnancies. After my first pregnancy I got a sacroiliac joint dysfunction (SPD) and developed a sitting disability. Sacroiliac joint dysfunction is called pelvic girdle pain (PGP) in England.
I worked while lying down for many years afterwards. I could walk and run cross-country skiing, but I could not sit for more than a short time. I had chronic pain without any known reason for many years. I didn't hear about sacroiliac joint dysfunction until long after second pregnancy.
After second pregnancy I developed disabling upper back pain, while still suffering from my sacroiliac joint problem. Some years later my back pain was so bad I couldn't walk more than a few minutes at a time. I had to give up my work as a lawyer.
When my home was connected to the Internet, I looked for people in the same situation as myself. I soon started Friends International support group for people living with chronic pain. The group has grown to an active Cyber community for people around the world. The board is a joint effort of volunteers that provides support and updated information about chronic pain, including Fibromyalgia and back pain.
Promising treatment for tendonoses at Stanford University in California
Dr. Allan Mishra is the founder of a network called "Total Tendon" in California. He has developed a new nonsurgical treatment for tendenoses. The new treatment called Platelet Rich Plasma (PRP) is a portion of your blood that contains concentrated growth factors. These growth factors have been shown to enhance proliferation of a variety of cell types. Visit their Research Blog for the most up to date information and to view a video of PRP Basic Science.
You are welcome to discuss tendonoses and different treatment options at our support group!
Sacroiliac joint dysfunction (SPD)
The sacroiliac joint, due to its anatomic aspect, is a very particular joint. The following information is taken from an excellent article by dr.Sady Ribeiro and his colleges dr. Andre Prato Schmidt and dr. Peter van der Wurff.
Sacroiliac Dysfunction seems to be a biomechanical dysfunction of this joint and could be a cause of chronic back pain. History and physical exam, due to poor specificity, might not be enough to make this diagnosis. Imaging studies are not very helpful either Anesthetics block, guided by fluoroscopy, CT, or MRI is considered the "gold standard" test, which proves that pain originates from the joint.
When conservative treatment fails, invasive therapeutic modalities can be used, but their efficacy has not yet been proven. Arthrodesis should be reserved for the very disabling cases that did not respond to the less aggressive approaches. Opioids may be the last hope for some patients.
Disorders of the sacroiliac joint sometimes can be a challenge regarding diagnosis and treatment. Since the joint is deeply located, proper assessment is difficult. Its anatomy is complex and unique with a syndesmotic superior compartment and synovial inferior one. The iliac bone presents a thin fibrocartilagionous cartilage and the sacral bone is covered by a thicker hyaline cartilage, which makes the iliac side more vulnerable to any pathology that might affect the joint.
Chronic pain - a disease?
Research shows that chronic pain can be a disease. Unlike ordinary or acute pain, which is a function of a healthy nervous system, chronic pain resembles a disease, a pathology of the nervous system that produces abnormal changes in the brain and spinal cord. New technology, like functional imaging, which is generating the first portraits of brains in action, is revealing the nature of pain's pathology.
Pain was not previously not that well understood. The medical profession used to believe that pain is always a manifestation of an underlying injury or disease. Doctors focused on treating the underlying cause of the pain, with the belief that once the injury or disease was cured the chronic pain would then disappear.
The medical community is starting to understand that if pain is no longer a function of a healthy nervous system (signaling that there is a disease or underlying injury), then the chronic pain itself becomes the problem and needs to be treated as the primary pathology. Read more about this in Spine-health.com.
Pain turns out to be harmful to the body. Pain unleashes a cascade of negative hormones like cortisol that adversely affect the immune system and kidney function. Patients treated with morphine heal more quickly after surgery. A recent study suggests that adequate cancer-pain treatment may influence the prospects for survival: rats with tumors given morphine actually live longer than those that do not receive it.
The general lack of understanding of how persistent pain becomes magnified and ingrained prevents many patients from receiving the level of care that they need to regain control of their lives and resume normal activities.
Our genes may affect pain
A new NIH (National Institutes of Health)-funded study shows that a specific gene variant in humans affects both sensitivity to short-term (acute) pain in healthy volunteers and the risk of developing chronic pain after one kind of back surgery. Blocking increased activity of this gene after nerve injury or inflammation in animals prevented development of chronic pain.
The gene in this study, GCH1, codes for an enzyme called GTP cyclohydrolase. The study suggests that inhibiting GTP cyclohydrolase activity might help to prevent or treat chronic pain, which affects as many as 50 million people in the United States. Doctors also may be able to screen people for the gene variant to predict their risk of chronic post-surgical pain before they undergo surgery. The results appear in the October 22, 2006, advance online publication of Nature Medicine.
"This is a completely new pathway that contributes to the development of pain," says Clifford J. Woolf, M.D., of Massachusetts General Hospital and Harvard Medical School in Boston, who led the research. "The study shows that we inherit the extent to which we feel pain, both under normal conditions and after damage to the nervous system."
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services.
A new definition of chronic pain
In the last decade or so, psychologists and other pain researchers are coming around to a new definition of just what is pain. Gone is the old telegraph model that served medical science for thousands of years: You put your hand in a hot fire you felt the pain of the burn until the tissue eventually healed.
In its place, some scientists are putting forward the notion that pain ricochets through the body more like the way the Internet works: The initial experience sets off a complex chain of reactions involving one's general health, genetic makeup, brain chemistry and perhaps even how one has come to think about pain in the first place.
The chronic pain that doctors seem to be seeing much more of, where even the slightest touch can send some patients into fits of agony, appears to be a function of the brain being unable to turn off its own alarm circuit. The pain signal just seems to go around and around in a high intensity loop and neither narcotics nor anti-depressive drugs appear able to shut it off.
If you have any questions or need support, join us at the message board in the forum called Coping and health problems. Also visit our board to get information about the latest treatment for chronic pain, and Fibromyalgia, including back pain. You are welcome to visit our link library. The support group is a very experienced, active and caring group of people.
Chronic pain - without any known reason
Chronic pain may develop for no apparent reason. Despite repeated examinations and tests, your doctor may not be able to link it to an identifiable physical cause or condition. This doesn't mean that the pain doesn't exist. Pain is, by its very nature, subjective. It is not tangible. X-rays and lab tests can't "see" pain.
Your pain may be associated with factors that are difficult to diagnose. It's also possible that the normal method of pain processing has been disturbed in your brain or spinal cord. For example, your pain could be similar to the phantom pain some amputees feel in their amputated limbs. Even subtle damage to nerves can cause severe pain.
Often, the cause of chronic pain isn't well understood. Years of research have failed to uncover the precise physical causes of many painful ailments.
Heightened sensitivity to pain may be a factor. People with chronic pain often have lower than normal levels of painkilling endorphins. In other cases, pain signals from injured or diseased tissue amplify or distort pain messages by activating pain circuits in the peripheral nervous system, spinal cord and brain.
New discovery in treating pain
None of the existing drugs on the market are adequate to deal with chronic pain. Cox-2 inhibitors carry severe risk of side effects, opioids are highly addictive, Tylenol (paracetamol) is ineffective for chronic pain, and other pain drugs cause significant drowsiness.
Researchers from Columbia University Medical Center have applied for a patent to develop a new class of drugs that will block chronic pain and turn off what they call "the switch" for chronic pain. Dr. Ambron and Dr. Sung have applied for a patent for the pathway that turns on the PKG, as well as several molecules that inhibit it, according to the SENIOR JOURNAL.COM.
Pain becomes chronic when the activity of first and second order neurons persists after damaged neuron heals or the tissue inflammation subsides. It's been known for years that for chronic pain to persist, a master switch must be turned on inside the peripheral neurons, though until now the identity of this switch remained a mystery. Richard Ambron, Ph.D., professor of cell biology, and Ying-Ju Sung, Ph.D., assistant professor, both in the department of Anatomy and Cell Biology, have now discovered that the switch is an enzyme called protein kinase G (PKG).
"We're very optimistic that this discovery and our continued research will ultimately lead to a novel approach to pain relief for the millions suffering from chronic pain," said Dr. Ambron.
The researchers found that upon injury or inflammation, the PKG is turned on and activated. Once activated, these molecules set off other processes that generate the pain messages. As long as the PKG remains on, the pain persists. Conversely, turning the PKG off relieves the pain, making PKG an excellent target for therapy.
Additional health conditions can develop if pain is untreated
Additional health conditions can develop as a result of unmanaged chronic pain At times chronic pain has a snowball effect, with additional symptoms piling on as the pain wears on. Two frequent co-existing symptoms are depression and insomnia. Read more in Spine-health.com excellent newsletter from September 2006.
Depression often goes hand-in-hand with chronic pain.Depending on how your life is affected by chronic pain, you may also experience stress and depression. Depression is a serious, but treatable, disease. Talking with your physician is critical, as untreated depression can worsen the pain and slow the healing rate. Denial and burying your emotions don't make the issues go away. Emotions can exacerbate pain.
Pain can lead to sleep problems, which lead to more pain. Patients with chronic back pain may also sleep poorly, which exacerbates the pain problem. Sleep disorders should be treated in conjunction with the underlying cause of the back pain—not in isolation from it. Read about effective treatment techniques in Breaking the cycle of chronic pain and insomnia.
Tendons deseases
The researchers Dr G P Riley, Professor J S H Gaston, Dr B L Hazleman, Dr G C Jones and Dr A N Corps have a long history of investigating tendon disease, and have recently generated exciting new information. The team has shown that production of an enzyme known as MMP-23 is increased in painful Achilles tendons and they plan to study its role in the development of tendon problems. MMP-23 is one member of a family of enzymes which break down the proteins that make up our connective tissues. However very little is known about the role and function of this recently discovered enzyme.
This project aims to confirm and extend their preliminary findings, to find out what this enzyme does in tendon. If their hypothesis is confirmed, drugs that block the activity of MMP-23 could one day become new treatments for these common and painful conditions.