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Posts Tagged ‘pain intensity’

For many decades we have been using electricity to control pain. Actually we could go back several centuries to the oft repeated use of electric eels for gout pain. The patient would put the painful part in a bucket of eels and obtain pain relief from the shock of the eels. This is our first recorded use of electricity for pain control. It does not matter whether the pain is chronic or acute as the process of sensory input for the pain sensation is practically identical. Historically tens units have been used outside the clinic for the patient to wear and adjust during their daily activities to accommodate the pain being felt. If the pain is very severe, acute onset, or the patient has moments when the pain intensity is too great for them to bear, then interferential is used in the clinical setting. In rare situations a dorsal column stimulator (DCS) will be used and in the most severe a deep brain stimulator (DBS) will be used. I’ll explain each of these farther along in this email.

Physiology:

Pain is symptomatic of a problem somewhere in your body. The pain signal triggers your brain to respond to the harmful stimulus, such as touching a hot pan, by rapidly withdrawing your hand. If the hand was harmed, tissue damaged, then a new process is started by the brain to make sure there is no infectious agents such as bacteria, germs etc. in the body where the pain was experienced. The brain will signal the release of T-cells ( natural antibiotics ) to the site and will precede the t – cells with histamines so they can break through the capillaries to the area the bacteria is and kill it. The brain will cause many physiological and biological changes with the latter two being a small part of the process.

The pain stimulus is sent to the spinal column to go to the brain. It is an electrical signal that imbalances certain nerves and the resulting actions by the nerves insure the pain message is received so no further harm is done. All of this is good until the message going to the brain is continuous or more frequent than is needed and unnecessary. It is at this point when the message is constant that the patient has a problem. Now the issue is not protecting the body but preventing further harm by the constant pain message which limits the patient’s abilities to be functional. The pain impulse becomes an inhibitor to health. One comment you will hear often is the pain ” is all in your head”. Very accurate statement as all pain is in the head as that is where it is perceived so nothing new here. The danger of it not being in your head is most evident in a patient with diabetic neuropathy or other diseases where the sensory input is lost. That patient may have a cut, or burn to their foot/legs, and never know about it until infection has set in. The impairment of the sensory input to the patient’s brain results in far more serious injury often resulting in systemic infection, amputation or in some cases death. For those patients the lack of pain being in their “head” can be tragic.

How Electrical Signals To The Body Work:

With chronic pain the nerves that are transmitting the pain signal are activated by minimal input. When the pain nerve going to the spinal cord is stimulated a message is sent and the spinal cord can only accept and transmit a limited number of messages to the brain. The messages to the brain come in from different types of nerves referred to as “A”, “B”, “C” fibers. These fibers carry different messages such as pressure, heat etc. so the fibers have different duties (jobs) to keep the brain informed of what our body is experiencing. Because there are more nerve fibers coming to the spine than there are pathways to the brain then some messages do not get transmitted. When that message is the pain message from the C fiber, then if not transmitted, obviously there can be no pain.

If not in the brain then no pain.

With electricity for the chronic pain patient we use devices to stimulate the “non pain” fibers.

For visualization I like to compare this process to the old fashion telephone system where you had an operator who physically routed phone calls to their destination. The operator might only have access to 10 outgoing lines so when there were 20 calls coming into the central system the operator had to decide which of the 10 were most important and allow them through while letting the other 10 know to wait or call back when less busy. This is similar to the process our spine goes through on deciding what messages are allowed or not allowed.

In order to prioritize non pain messages so the spinal cord will transmit that message, rather than the pain message, we use electricity to stimulate the non-pain fibers. The electrical impulse stimulates ( causing physical/chemical changes ) to the nerve fibers and therefore the input from the non pain fibers are transmitted and the pain message is not. When using electrical inputs the patient experiences non pain sensations since that sensation is what is being transmitted to the brain for our perception. The pain signal goes away or is never transmitted therefore no pain.

At this point a word of clarification on the “blocking” of the pain message. Naturally one would assume that by blocking the impulse the patient runs risk of real injury yet it would not be perceived. That is not the case with controlled electrical input from a device. The amount of electrical stimulus in the painful area is produced based upon the existing level of pain at the time the electrical stimulus is set up. If the electrical stimulus is too great then that stimulus itself will cause the patient to have pain. The patient would react by simply saying that the electricity is now painful so the level of the intensity would be lowered so the patient experiences no pain. If after the electrical stimulus is set up and the patient now has a new injury then the pain stimulus from the new injury will override the existing settings and the new painful stimulus will override and the new injury will be just that, a more powerful stimulus that is transmitted to the brain and the patient knows of a new injury and the body reacts accordingly. This is most common in the use of electrical devices for athletes. A football player wearing a unit during a game who has suffered a “hip pointer” or “sprained ankle” would still feel any new injury or stimulus such as re-injuring the ankle. The pain from the new injury is perceived, not overridden by the electrical device.

Devices to Stop The Pain Message

Listed below are the type electrical devices normally used to stop chronic pain:

1. TENS ( Transcutaneous Electrical Nerve Stimulator ) – A small portable device worn by the patient operating from generally a 9 volt battery. Device is worn constantly, or when pain present, and can be worn 24/7 if necessary. Characterized electrically by having range of 1 – 150 pulses per second ( PPS) of electricity. PPS simply means the machine comes off and on 150 times a second. Tens have no carryover pain relief which means if the unit is turned off then the pain immediately returns. TENS are covered by most insurance companies, including Medicare.

2. Interferential Unit ( IF/IFC) – Somewhat larger than a tens unit and uses electricity from a plug in AC adaptor. The pulses per second are 8,000 – 8,150. The greater pulses per second mean an Interferential Unit can not be worn or used for any extended time period if using a battery system but needs to be plugged in to the wall. Interferential has considerable carryover pain relief and often after a 20 -30 minute treatment the pain will not return for hours/ days or weeks. Interferential is covered by some insurance companies when billed as durable medical equipment ( DME) but is regarded by Medicare as experimental.

3. Dorsal Column Stimulator ( DCS) – An external device power source that usually uses radio waves to transmit power to the receiver which is connected to wires embedded on each side of the spinal column. This is an implant requiring surgical intervention. The stimulus often results in immediate pain relief with some carryover in certain patients. Normally the surgery has to be preapproved by the insurance company and external devices have failed prior to the authorization of the implantation of a DCS.

4. Deep Brain Simulator ( DBS) – Similar to the DCS except the wires are placed into the brain. Implant done generally by a neurosurgeon and often a last resort type treatment for patients who potentially suicidal due to the severity of their chronic pain.

Author: Bob G Johnson
Article Source: EzineArticles.com
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Suffer From Chronic Pain

Each year tens of millions of Americans suffer from persistent pain known as chronic pain. Individuals with chronic pain are less able to function in daily life than those who do not suffer from chronic pain.

Chronic pain patients suffer from poor sleep quality and depressed mood rather than pain intensity, duration, or anxiety. Clinical Implications Chronic pain patients suffer from poorer quality of sleep than do healthy control subjects. Many people suffer chronic pain in the absence of any past injury or evidence of illness. Although more than one in five Americans live with chronic pain, women are more likely to suffer from chronic pain conditions than men. If you or a family member suffer from chronic pain, you know that the search for relief is an ongoing process. But some people suffer chronic pain in absence of any past injury or evidence of body damage. At least 25 percent of Americans suffer from back pain. One fourth of these individuals, back pain is chronic and unremitting.

Experience

If you’re grappling with chronic pain, one of the earliest and most wrenching emotions you experience is a deep sense of loss. In fact, a number of people with SCI experience chronic pain in areas that otherwise have no sensation. Lascelles’ experience, owners are usually more concerned about pain from surgery than pain associated with chronic conditions. The path to chronicity of pain is characterised by failed attempts to adjust and cope with an uncontrollable, frightening, and adverse experience.

Problem Of Chronic Pain

RSD or RSDS is a neurological problem and one of the symptoms is constant chronic burning pain. It is now appreciated that the phenomenon of wind-up is crucial to understanding the problem of chronic pain. Chronic pain in children is an important problem and more action is urgently required to overcome the embarrassing lack of data on childhood pain. Some believe that many factors work together to produce chronic pain, rather than a single disease or medical problem. The longer pain goes on the more susceptible it is to other influences and developing into a problem.

Source From Injury

Some people develop chronic pain out of the blue, with no injury or illness to trigger pain signals. Once chronic pain that has been caused by an injury or surgery is managed, patient recovery may be faster. an injury, and chronic pain with no identifiable pain generator (e.g. The injury transformed her into one of millions of Americans tormented by chronic pain. In stark contrast to acute pain, persists beyond the amount of time that is normal for an injury to heal. In some cases this may stem from an injury incurred during an accident or an assault.

Stress

Managing stress and managing chronic pain go hand in hand. Stress Ask most chronic pain patients what their most significant source of stress is, and they will usually tell you that it is pain. Physical, psychological, and emotional stress may worsen chronic pain. Predictors of posttraumatic stress disorder symptom severity level in chronic low back pain patients.

Prevalence

Statistical analysis The prevalence of recent pain, chronic pain, and severely disabling chronic pain were summarised as percentages of respondents with 95% confidence intervals. Croft et al [11] found the prevalence of chronic pain to be slightly lower in postal survey non-responders. A small number of previous studies have sought to collect data on the prevalence of chronic pain from non-responders. The prevalence of severely disabling chronic pain in this sample was 3.0%.

Depression

This pattern has to be changed if depression, stress, and chronic pain itself are to be conquered. This is because the consequences of chronic pain and the symptoms of depression look very similar. Depression Persons with a chronic pain problem often show decreases in meaningful and enjoyable activities. Depression is often associated with chronic pain and may need to be treated as a separate, but related, condition. Living with chronic pain can lead to loss of appetite, depression, and exhaustion. The consequences of unrelieved chronic pain in this population, similar to others, include depression, decreased socialization and sleep disturbance. Influence of chronic pain on mood and psychosocial function, utilizing age-specific scales (e.g., geriatric depression scale). Nelson and Diane…and depression in patients with chronic pain was investigated. Counselling may also be of some help in addressing the depression which so often accompanies chronic pain or illness.

Levels of anxiety, depression and self-rated health were described for respondents with severely disabling chronic pain and contrasted with respondents reporting no pain. Psychological therapy for anxiety and depression is helpful in managing the emotional consequences of chronic pain. This is not the case and if somebody has chronic pain and depression, ‘you have to treat both’, he says. Our research provides further evidence that chronic pain and depression are quite independent”, Dr Clauw said. There are many factors that affect the development of chronic pain such as age, level of disability, depression, or the presence of nerve damage. Schatzberg suspects that the presence of chronic pain should be added to this list as a symptom for assessing depression.

Please continue with Chronic Pain Syndrome And Chronic Pain Management And Treatment – Part II

Author: Richard Lim
Article Source: EzineArticles.com
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