And not getting ill at all. Chronic pain like all chronic ailments, is to some extent preventable. That's what this site is largely about, I hope.
Why does pain become chronic? The cause is presumably still operating, or has been supplanted by a new cause.
People talk a lot about wind-up or sensitization in the pain perception mechanisms of our brain, spinal cord and peripheral nerves.
These chemical and functional changes are secondary to some continuing primary cause. Conventional medicine often fails to find the cause or treat it (or them) adequately. Really important areas thus neglected include food intolerances and vertebral joint derangements.
If you have what looks like becoming chronic pain, seeing a chiropractor and a clinical ecologist could be very worth while.
(Having said all that, there is a contrary view. We have very efficient brains, capable of complicated learned automated behaviour such as car driving. It is proposed that in chronic pain, the process of pain perception, interpretation and behaviour can become automated in the same way and so self perpetuating.)
Our genes do different things in different circumstances, and changing the supply of nutrients can alter their action. My naturopath mentor was mostly able to relieve peoples' pain this way.
I didn't learn enough from him, to do this. Most naturopaths cannot, but it is possible.
Pain management always needs much more than nutrients. There's room for everything here, as long as expectations are reasonable and everyone concerned is honest.
I've seen quite convincing home movies of a Filipino psychic surgeon doing operations with bare hands. I've personally benefited from Reiki hands-on healing. One of my dogs benefited from absent healing without meeting the healer (and without my knowing the healing was to be sent.)Cherche le Guérisseur - every place has its' local healers.
One is not aiming at total pain relief. I was quite surprised when I first heard pain management specialists say they aimed for 30-50% relief of pain. I would have thought it would be more like 80%
Their reason for limiting to this, is that experience has shown aiming for more relief causes too many side effects.
Even with my particular interest in pain, I would dearly love to have more access to help and advice from pain specialists.
Such specialists are few and far between however, with long waiting times before someone is seen.
If you suffer from chronic pain, you will probably have experienced unsatisfactory relief at times. When you have the energy, consider lobbying your government representatives for higher priority for this area.
Its' overall cost to society is second only to cardiovascular disease, and greater than cancer.The small number of doctors in this field, have little political clout. This needs large numbers of people to have any effect, so please consider adding your voice.
Trial and error, or suck it and see - any new treatment of any sort is always an experiment. The massive advances in the field of genomics will reduce this uncertainty in the future, but for now it is just give it a go and see if you feel better.
It's best to start one drug at a time, at the lowest dose initially so any "side effects" (toxicity) will be less severe and their cause correctly identified. Ideally the dose should be increased until adequate relief is felt or side effects become a bother.
Only then another drug can be added or substituted for the first.
The dose increments (increases) and the time interval between them, will be different for each drug, so ask your doctor for these details and be sure you're seen often enough to discuss how it is going.
No one drug works in everyone. One way to express this is by the number of people needed to be treated, to achieve one useful result.
Similarly one can express safety or otherwise by a number needed to harm.
Here are some results (figures rounded)...Tricyclic antidepressants (eg amitriptyline)
Short acting opioids are inappropriate for long term treatment of persistent pain.
It is also possible that they may actually increase pain. The perception of pain is only possible by comparison with our past experiences of comfort or pleasure. Sudden intense analgesia can make the subsequent return of pain harder to put up with.
Years ago I was talking with a local surgeon and commented that with the arrival of effective medical treatment for ulcers, I assumed that he was doing fewer gastrectomy operations. He replied that on the contrary, more people wanted the operation, now that they had experienced what it was like to be without pain on the cimetidine tablets. They wanted a permanent fix.
Your pain may come from some injury or illness stimulating (not damaging) the peripheral nerve endings which are there for that purpose, to indicate noxious conditions. This is called nociceptive pain.
Some conditions result in pain arising from actual damage to the nerves, or in the central nervous system where they lead to. This is called neuropathic pain. It becomes more common as pain becomes more chronic, due to the "wind up" mentioned earlier.
The quality of pain may indicate a neuropathic component. Burning or electric shock like stabs of pain are typical. Abnormal sensations are often felt as well, such as pins and needles and numbness. Even the touch of clothing can be uncomfortable. Creeping, tickling and pressure feelings can occur without apparent cause.
This type of pain is often worse at night and can wake one from sleep.
The reason we are interested is that analgesic drug treatments may be different depending on this distinction. Acetaminophen (paracetamol) and ibuprofen don't usually work here.
The journal "Pain Medicine" published a study on this, by Turner et al, in November 2008.
Vitamin D deficient pain sufferers needed twice the dose of opiate medications, and had needed this for nearly twice as long. They felt less well and functioned less well.
It's hard to know which came first, the chicken or the egg. People in chronic pain probably don't get out in the sun as much.
Despite this uncertainty, it's very sensible to get your vitamin D tested and to take it if indicated. If this improves your pain, write in and tell everyone.
Tolerance is the need to increase the dose to achieve the same result, as the body gradually gets used to a particular drug over a long time of use.
NMDA is a neurotransmitter - a chemical which passes messages between brain cells.Serotonin, noradrenaline and dopamine are other neurotransmitters called monoamines.