Chronic Pain

Debunking Common Myths About Chronic Pain

Many Americans downplay pain as an annoying part of getting older. In fact, one recent study found that we rank pain at the bottom of a list of health concerns including cancer, obesity, heart disease, alcohol and drug abuse, and AIDS. According to multiple studies, it’s estimated that between 20-30% of people in this country suffer from what the CDC terms “high-impact chronic pain.” Pain severe enough that it frequently limits life or work activities. The numbers are probably higher since it didn’t include all those who suffer but don’t meet these guidelines.

As such, chronic pain is steeped in myths:

Pain is a natural part of getting older: Sometimes it can be. As we age, some “nuisance pain” from physical wear and tear is normal. That differs from chronic pain which is often perceived as an age-related condition. Older adults who suffer from osteoarthritis often reported in interviews  the belief that their pain was just a normal part of life. As one patient put it, “That’s how you know you’re alive … you ache.” In the same study, physicians often agreed, viewing pain as an inevitable part of the aging process, telling patients “What do you expect? You’re just getting older.” That is not true, pain is not inevitable. A National Center for Health Statistics report found that 29% of adults between the ages of 45 and 64 years vs 21% of those 65 or older reported pain lasting >24 hours in the month before the survey. Population-based studies have found a lower prevalence of low back, neck, and face pain among older adults compared with their younger counterparts. Other epidemiological studies suggest that the prevalence of musculoskeletal pain generally declines with advancing age. These findings refute the stereotype that advancing age inexorably involves pain, and challenges the notion that pain in later life is normal and to be expected.

Chronic pain isn’t that bad you get used to it: Chronic pain always hurts. Have you ever had a tooth ache? You know, that gnawing ache you seem to feel in your bones? How do you get used to that? You adapt, change your lifestyle, learn to live with it, find options that help it, but that doesn’t change the fact you’re always in pain. No one gets used to pain. But we do have to accept it. Constantly looking for answers that will result in a cure can just increase frustration and anger that nothing worked.

It’s better to tough it out and just live with pain: Ignoring pain can have serious consequences, especially if you choose to self-medicate in unhealthy ways rather than see a healthcare professional. Too often, patients assume they know the source of their pain and avoid seeking treatment. By ignoring it, more issues can arise, such as performing activities that may exacerbate or worsen the underlying condition. I had always assumed my neck pain was due to stress. Once evaluated, severe osteoarthritis was found. Had I known this years earlier, I would’ve stopped all impact sports i.e. jogging and carrying heavy, large purses that constantly put pressure on my neck. I’ll never know whether this knowledge would’ve stopped my multiple fusions, but it certainly couldn’t have hurt. Many times patients, providers, fiends, family see the inability to deal with pain as a sign of weakness, when it’s the opposite- living with chronic pain takes tremendous strength.  Don’t diminish your needs. You wouldn’t ignore care for diabetes, high blood pressure, or pneumonia. . . don’t ignore your pain.

You can injure yourself further if you exercise when in pain:  Exercise is a vital key to living with chronic pain. As I’ve said so many times, exercise is one of the main ways I live with pain. That’s why I show a different exercise each week. But the old adage no pain, no gain does not apply. Experts have shown that complete bed rest is one of the worst things you can do for any type of chronic pain. You may need to reduce your regular exercise program during flair-ups – but try to stay active and do as many of your typical activities as you can. Be safe, have a specialist such as a physical therapist show you how to mobilize safely. No matter what, keep moving!

Chronic pain can kill you: No, but it can have a profound effect on your quality of life. Certain severe situations may prompt suicidal feelings if pain seems unbearable. Research suggests that anywhere from 30-50% of people with chronic pain also struggle with depression or anxiety.

Chronic pain isn’t just a physical condition—it’s an emotional one that has tremendous influence over a person’s thoughts and moods. People with chronic pain may isolate from others or be unable to achieve the mobility they once had. Chronic pain isn’t just associated with physical injuries either, it can stem from conditions like heart disease, arthritis, migraines, or diabetes. Sometimes it can be difficult to assess whether chronic pain has led to depression, or vice versa. People with chronic pain are three times more likely to develop symptoms of depression or anxiety, and people with depression are three times more likely to develop chronic pain. These influences can create a cycle that is hard to break. It’s critical to seek help from a pain management professional before despair sets in. You. Are. Not. Alone. There is help. Look into all your options.

Weather doesn’t really impact pain: Ask just about any chronic pain sufferer, and they’ll tell you that there are seasons when their pain is worse, and they relate to the weather. Extreme cold, extreme heat, changes in barometric pressure – it’s not your imagination. People with arthritis often claim they can predict the weather, based on their joint pain level, and with good reason. Studies show a variety of weather factors can increase pain, especially changes in barometric pressures and temperature. A 2007 study from Tufts University found that every 10-degree drop in temperature corresponded with an incremental increase in arthritis pain. In addition, relatively low barometric pressure, low temperatures and precipitation can increase pain. Researchers aren’t sure why this happens but they suspect it’s due to increased swelling in the joint capsule due to atmospheric changes. I know my pain is much worse when I’m cold. Given the option, I’ll take heat over cold anytime.

You can get a heart attack from taking COX-2 inhibitors for pain:  While Vioxx got all the publicity, it turns out that all the NSAIDs (i.e. Naproxen or Aleve, ibuprofen or Motrin) appear to increase cardiac risk at roughly the same rate but heart attacks and other vascular problems occur in only a fraction. For people who are at increased cardiovascular risk, NSAIDs should be used at the lowest effective dose for the shortest possible period of time. Anyone with hypertension must be aware that NSAIDs can increase blood pressure and reduce the effectiveness of anti-hypertensive treatments. Anyone taking aspirin for prophylaxis against cardiac disease should avoid NSAIDs whenever possible. As should those with certain conditions such as gastrointestinal ulcers, indigestion, or if they are on blood thinning agents. The benefits may outweigh the risks for some chronic pain patients, but always discuss with your healthcare provider before starting.

The pain is in your head: Anytime you suffer from pain it’s very real. Whether anyone can define it or resolve it, no can or should claim you’re not feeling  pain. Dwelling on it can certainly make you more miserable and serve to emphasize the pain but it does not make it any less real. Decades ago a book was published and touted by celebrities as “curing ” their pain. In it, the author define all pain as coming from anger. “Deal with your anger and the pain will go away”. I couldn’t help thinking- if I beat the crap out of the author to release my anger because of his despicable claim, would I feel better? If not at least he’d finally realize what real pain feels like!

Doctors will fix it: We don’t have a magic wand. Believe me, if I did I would share it. We can thoroughly evaluate and rule out issues that have specific interventions such as surgery. But when all concerns have been thoroughly evaluated and pain continues, there is no quick fix. Eradicating your pain is not the goal. I can’t remember the last time I was pain free. The goal is to manage, not cure, the pain with a multitude of treatment options available today. To learn how to live a fuller, more productive life despite the pain. Healthcare provides are only one piece of the puzzle, you are the biggest part. As I’ve discussed in past posts- sleep, exercise, diet, and weight management are imperative to a healthier, happier life.

Alternative treatments are ineffective: Often, those without the pain condition are the first to criticize alternative treatments—from acupuncture to massage to essential oils. In reality, alternatives or integrative therapies can be an excellent complement to mainstream treatments. Many chronic pain sufferers have gotten short and long-term relief from these alternatives. Keep in mind that these alternative treatments aren’t for everyone – so speak with your physician about whether or not they are right for you and get cleared before trying.

You can become addicted to pain killers if you take them too long: Let’s start by understanding the difference between dependence and addiction. Most who take opiates for a long time develop a chemical dependence on the medication. The body gets used to it and has an expectation for it to be there. So when the medication is stopped, the body experiences withdrawals. This is not addiction. With addiction, a patient craves the medication itself and misuses it in order to get a “high”. The vast majority of chronic pain patients are seeking relief not a high. Rarely is enough given to eradicate the pain, just lower it enough to function. News reports of an epidemic of prescription opioid addictions and fatalities, including the assertion that opioids are replacing heroin as the primary drug of choice on the street, may reinforce concerns. While rates of aberrant opioid use vary widely depending on the context, one consistent theme is that older age is associated with decreased risk. In one retrospective study of older patients who had recently been started on an opioid medication for the treatment of chronic pain, only 3% showed evidence of behaviors associated with abuse or misuse. Decades of research have found that, although opioid medications can cause physiological dependence, addiction is rare in patients treated with them. (To learn more, read “Diagnosing And Treating Opioid Dependence)

To deny use without honoring each patient’s situation is unreasonable. I recently spoke to a rheumatologist I use frequently and deeply respect. He was horrified that an 82 year-old lady with debilitating and crippling arthritis was in tears when her family demanded she quit her pain pills “before they addict or kill her.” For years these medicines, along with a myriad of other treatments, had allowed her to walk and interact with friends and family. Yes, there’s an issue that must be taken seriously and monitored diligently. But when used appropriately, under a providers direction, they can be another tool in a long line of options to help manage chronic pain.

dsc_0323    –Dr. Courtney

Sources:

-painpathways.org/7-chronic-pain-myths/

-ncbi.nlm.nih.gov/pmc/articles/PMC4356472/

-health.clevelandclinic.org/7-common-myths-of-chronic-pain/

-psycom.net/depression.central.chronic.pain.html

-theacpa.org/wp-content/uploads/2017/08/chronicle_fall06_82806.pdf

-arthritis.org/living-with-arthritis/tools-resources/weather/

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