Chronic Pain, Part II

Thank you for all the kind and supportive comments yesterday.

Do you think you can make it through one more, very important, serious post on this topic?

In yesterday's post, I wrote about my experience with varying pain levels since my car accident.  I also attempted to explain why people should not be so quick to judge and/or blame chronic pain sufferers.

I also might have called a few people assholes, in an inadvertent sort of way.

It's sad people are so quick to make up their minds about things they don't fully understand, but they are.  I guess people like to feel superior and being judgmental gives them a boost.  (And no, I'm not directing that comment at any ONE person.)

Today, I want to write about aspects of chronic pain I haven't really addressed here before. 

For instance, did you know scientists have documented numerous physical changes which occur in patients experiencing pain over a long period of time?  Yes, pain actually causes physical changes in a person's body.

In fact, the more frequently a nerve "fires" pain signals, the more efficient it gets – to the point of being hyperactive/hypersensitive and creating even MORE pain.  Pain also "rewrites" or alters a person's central nervous system.

And not in a good way.

People with high pain levels also tend to have high blood pressure and lower life expectancies.  I've also recently been told I'm severely lacking in Vitamin D, in spite of my outdoor lifestyle in the California sunshine.  

It turns out low levels of Vitamin D are tied to high pain levels.

Who would have thought?

I could go on and on and on with a list of all the physical changes chronic pain causes.

The list would be extensive.

Several brain chemicals, including the much talked about serotonin, decrease in patients with high pain levels also.

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Low serotonin levels are a result of high pain.  Low serotonin levels are also tied to depression.  That's why you'll see so many pain patients suffering from BOTH pain and clinical depression.

As if ongoing pain isn't depressing enough, it screws with your brain chemistry at the same time.

Serotonin is believed to help STOP the movement of pain signals in the brain.  Obviously, if you're experiencing a lot of pain, having MORE serotonin would be beneficial.  Decreasing it (as pain does) only exacerbates the situation.

I was fortunate to have a doctor put me on a low dose antidepressant right before surgery #3.  He explained my serotonin levels would be dropping in conjunction with yet another surgery and he wanted me to stay on it until I got through my recovery.  He thought it would help with pain management.

Was I clinically depressed at the time?

No.

Would I have become clinically depressed if he didn't put me on something?

Who can say?

Did it help with my pain?

I don't think so.  

At the time, I told myself the pain would probably be worse without it but I also wondered how it could possibly be worse than it was.  (Surgeries #3 – #5 were the worst time period in my post accident years.)  

Later, Dr. Painless informed me the dose I had been given was too low to be effective as a pain management tool.  He also informed me the antidepressant the doctor had chosen wasn't the best choice for pain treatment.  (The doctor's intentions had been good, but he wasn't a pain specialist.)  However, having some extra seratonin in my body was probably better than not having it.  

Dr. Painless changed my medication to Cymbalta which is the only drug in its class having received FDA approval specifically as a treatment for pain.  (It increases serotonin and norepinephrine – both decrease pain signals in the brain.) 

I didn't really want to go on it (I'm very anti-drug), but the pain I was in was terrible and I was desperate enough to try anything.  

Has it worked for me?

Well, this is what I know …

I'm now doing more than I ever have since the accident.  I'm living my life more fully in spite of my pain/injuries/disability.  Part of that is the result of the bionics in my arm.  Part of it is due to the muscle relaxers I take every night to control the horrible spasming I get in the muscles surrounding my arm/shoulder/neck.  (Dr. Painless put me on those too after taking one look at my continually spasming muscles.)  Part of it is probably Cymbalta calming down the pain signals in my brain.

Am I anywhere near "normal?"

No.

Am I better than I was a year ago?

Yes, absolutely. 

(Remember yesterday when I mentioned I now live in the 6 – 8 zone on the pain chart most of the time now, vs. the 9 or 10 zone?  And yes, I still experience bad pain flare ups but they occur less often.)

Before I close, I want to bring up one more very important topic.

Did you know very few chronic pain patients ever become addicted to pain narcotics?  

The media would have us believe MOST chronic pain patients are addicts and complaining of continuing pain just to receive narcotics.  In reality, pain patients without prior addiction problems have an extremely low level of addiction (0.19%).

My biggest regret in my first three years post car accident is not having taken MORE pain meds.  Everyone I knew, doctors included, scared me to death at the thought of taking them.  I was so afraid of becoming addicted, I would discontinue the use of meds as soon as possible after each surgery.

The pain I was in during that time period was brutal.

I told myself toughing it out was the RIGHT thing to do, because omigod I don't want to become a drug addict.

I've only learned in the last year, the chances of my becoming addicted were extremely remote and it would have been so much better for me, in every sense of the word, if I'd taken more pain meds.

All the "don't take drugs, tough it out" advice I got (and still get) was well intentioned, but incorrect.

Pain takes a horrible physical toll on a person.

Managing pain as much as possible, usually with a multi-faceted approach, is the most important thing a chronic pain patient can do to lessen that physical impact.

You can find Part I of this post by clicking here.

© Twenty Four At Heart 

14 Responses to “Chronic Pain, Part II”

  1. Jan

    My nephew is one of the few who *has* become addicted to his pain meds, most notably oxycontin, but his recovery has been more mismanaged than yours was (if that’s possible) – you wouldn’t believe all the medication he’s been taking, or the amounts. Well, maybe you would. *sigh* He’s in the hospital today having surgery – he got an infection at the surgery site for *his* bionics and according to my sister is having his spine irrigated and scraped. Just the description makes me cringe.

  2. Michelle

    I know my brain doesn’t function well when I have pain. So I can’t imagine what it would be like to be living with that. I’m glad that you are now getting good advice about your pain, and good management. And I love that you are honest with us with how you feel. And that you share your awesome photos.
    I don’t know how I would live with your pain levels, but I’m glad that you are choosing to live and fight.

  3. Erica

    I didn’t know most of this. I’m going to pass this post on.

  4. Kelly

    A lot of really good info in this post. thank you!

  5. Missy

    Thank goodness for Dr. Painless. It’s good to know that there are resources available to chronic pain suffers.

  6. Cathi

    I think you are helping more people than you know with posts like these.
    thank you!

  7. Karen in East Texas

    Huh, I didn’t know that about vitamin D, but it makes sense and now I know why my doctor but my on vitamin D last month. I also did not know about the seratonin and will be asking my doctor about that on my next visit.
    Thank you for sharing.

  8. Rachael

    The last part, about pain meds, reminds me of my sleep situation. LOOONNNGGG story short, I finally got some sleeping pills after years and years of trying everything and just dealing with a lot less sleep than most folks. Took me so long, because I was afraid to become addicted. But after my first few good nights of sleep I was over that! I took to saying,I am addicted to getting a full nights sleep! I love my little blue pills!! (I’m off them now, and sleeping normally YAY.) I totally should have done it like 20 years earlier. Doh.

  9. Nancy P

    My heart goes out to you. I just can not imagine having that kind of pain daily. It does sound like Dr. Painless has been good for you.
    Regarding the drug thing. I understand. I USED to be like that too for my depression. My only regret was not starting the meds sooner. ugh.
    You, my dear are an inspiration!

  10. ALSweetThing

    I’ve been in chronic pain for 16 years, since a terrible car accident. I’ve never been addicted to pain pills and I so agree with what you said about that. Toughing it out, as I did for years before seeing a really good pain specialist, hindered me in so many ways. I’m currently not on an antidepressant, though I have been on and off through the years. Unfortunately, Cymbalta had really severe side effects for me and made my muscle spasms worse. I might try it again later. It could have been a combination effect.
    Suzanne, thank you for these two posts. Hugs and love to you.
    Stacey

  11. Kathy

    I’m very glad you wrote this. But I have no idea where the first poster was going with her comment. Good for you for just letting her be. You are amazing!

  12. unmitigated me

    I’ve been using Cymbalta and pain meds for several years, and THEY WORK. Yet I still look forward to the day when I can stop because of some new technology or procedure that I feel sure will develop. Brava to you, 24, for sharing, and I am so happy that Dr. Painless is able to help!

  13. Lunachance

    A very informative post. I was on Cymbalta for a time being and did not notice a difference in my pain management. I finally did ask for sleep assistance and wonder why I did not ask earlier… I have always been the first to get off pain meds and think that was not the best thing for me. The only time I am ever pain free is when I am hospitalized. I had the fear of addiction also pressed my way (but figure that if I were to become addicted, it would have happened years ago). I have another surgery on Thursday and hope that it will be as minor as my surgeon is making it out to be (just two nights at the hospital). Fingers crossed it will be brief and productive.
    I enjoy the wisdom you share.
    Cheers,
    Lunachance

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