Chronic Pain, Chronic Mystery

As a parent of children, an owner of a pet or a caretaker of others unable to fully care for themselves, you've likely had to grapple with pain that is not your own. And you have probably come to recognize the concept of pain as frustrating. It's hard to pin down, especially when it's someone else's. Where is it? How severe is it? When do you feel it? Making the situation even more ambiguous is when the child, pet or other "patient" is unable to communicate with words or even sometimes a gesture to guide us. We empathize, trying to recall similar pain we have experienced and ask a series of questions that can help us get to the cause so we can do the obvious thing: Make. It. Stop. 

Sometimes there is urgency involved, as indicated by crying, howling, screaming, writhing, or resistance to touch or soothing. If we knew what happened, what was swallowed, poked, burned, yanked, bonked or even who bit, bonked or punched we could get closer to making it stop. 

As it turns out, even when the person in pain is perfectly able to communicate the who, what, when, where and how of it, with chronic pain the actual cause can still be elusive, a chronic mystery. Even to doctors, therapists and researchers. This is one of the reasons for the deluge of pharmaceuticals in the American marketplace, developed to alleviate pain and its symptoms while navigating the tough and prolonged journey to the reason the pain is there. Are we getting close to the root cause of chronic pain and to solve the mystery?

Conventional medicine treated the singular acute issue: a broken bone, or an infection. Easy peasy. Today, however, at least in the U.S., as our population is becoming increasingly unhealthy, we're applying this same approach to disease, autoimmune disorders, and pain, which is now it's own stand-alone condition. No longer considered just a symptom of something larger, chronic pain of its own accord is a medical diagnosis. According to the Centers for Disease Control, chronic pain is a leading cause of why people seek medical care in the first place; with 30 percent of Americans (nearly 100 million people) saying they suffer from some form of chronic pain. 

As bestselling author and holistic physical therapist Kristine Koth explains, "Healthcare likes single-problem, single-solution treatments. You have a symptom, you’re given treatment for that symptom. That is not how pain works, that is not how our bodies work."

What we are facing, especially among mature adults is chronic pain from problems that cannot be detected, much less resolved. Chronic pain is difficult to place: it hurts here but there's no wound. I have a headache but nothing is wrong with my head. It hurts when I sit but not when I stand. What is wrong with us? We don't quite know – the answer lies in the root cause that continues to elude the scientific community. 

We are often told that pain is in our heads because there aren't visible symptoms, such as with fibromyalgia. We're told, in the case of back pain, that we simply can't ski, lift, cycle, garden, jog or swim anymore. People with gastro-intestinal distress are advised to stay away from certain foods, or to not eat after specific times of the day. Voila, a solution. But it's not so with chronic pain because the cause of the discomfort and sometimes agony persists, possibly advancing behind the scenes while we convalesce, avoid, restrict and medicate. 

As we age, we move from the visible injuries of youth, like bruises, scrapes, sprains, cuts and burns to the internal injuries of longevity. We begin to concede to what is sometimes called the "disquietude of aging," resigning ourselves to less activity, less joy, and ultimately just less of everything that makes life worth living. 

Whether or not there is a pain cure, via a regimented lifestyle, surgeries, medication, kale shakes and vitamins or alternatives like acupuncture – would it make a difference to all of us to better understand the cause of our misery? It might, and we're going to look at some of the underlying causes of chronic pain here.

One of the most common repeat episodes of chronic pain is lower back pain. Here, we can point to years of poor posture, a bad mattress, heavy, improper lifting, being overweight, wearing high heels. In these cases, there are some obvious solutions to relieving the pain.

For many, chronic pain might be traced to an old injury, surgery or an infection. For some, autoimmune diseases like arthritis or irritable bowel syndrome just happen and researchers are unable to pinpoint the cause, though they can detect demographic trends. Lupus and multiple sclerosis have a heredity factor, but as yet are not curable, only managed. There are more than 80 autoimmune diseases and they are a focal point of medical research.

A trending hypothesis now, is that inflammation, a symptom of myriad precursors, plays a huge role in pain. Inflammation, as we know, is the body's attempt to right something that's wrong. The "Western Diet" is a suspected cause of internal inflammation, irritable bowel syndrome being but one example of this. Gluten has come under the gun lately, as have sugar and some of the western food additives that could contribute to inflammation of intestinal tissues, which then cause ongoing pain and other symptoms such as diarrhea, cramps and irregular stools.

Nerve damage, though, is thought to be the main cause of chronic pain, and it simply cannot always be repaired. Thus, the search for alternatives in various pain relievers, all of which have varying levels of effectiveness on each sufferer.

While nerve damage is the most frequent source of chronic pain, it usually results from an injury or a surgery that never quite healed. But what if the pain is just nerve damage? What if it's just simply pain and constant discomfort without a life-altering event to explain it away? Unfortunately that is what millions of Americans are facing in their lives.

Even if we are able to pin pain to an underlying condition such as chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease or temporo-mandibular joint dysfunction, there's no roadmap to their causality. What causes those conditions is what research has been focusing on, as more and more of these cases are diagnosed. In the meantime, we are left with treating the often life-altering result, which is constant pain at some level, and at minimum, unrelenting discomfort – an unwelcome companion in our journey to and through aging.

Again, some people will be at higher risk for chronic pain or the conditions and diseases that cause it: having an injury, having surgery, being female or being overweight or obese. This information doesn't seem all that helpful as none of these are things we can avoid, except possibly becoming injured but nobody wants to live in a bubble. And hey, as we get older, we know that even everyday activities like getting into or out of a car can cause injury. 

Perhaps it's just that. Our ever-complex lifestyle challenges the ways our bodies were meant to be used. Think about how we eat, move, stress, sleep. Think about how much time we spend not doing these things or doing them too much. 

As young people, we could shrug off such things as a pulled muscle or a stiff neck, as in most such cases the miraculous human body is capable of healing itself over time. As we age, and injuries, pulled muscles, surgeries and life events compound, these conditions are no longer something to be ignored. 

Thankfully, as the medical world is taking the condition of pain more seriously, our complaints are being heard. Being heard and understood is critical in pain management, because without an actual wound, many pain sufferers have found it difficult if not impossible to be taken seriously. That is the first step. In addition to addressing the physical discomfort of chronic pain, the significant impact on lifestyle can be devastating. Our next feature on pain will explore the many ways chronic pain can literally erode a life from the inside out. Stay tuned!

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