Pain is an individual experience. Pain is unpredictable, and a very personal experience. He comes in many forms. He can be relentless and cruel, or an occasional irritant in an individual's life. Pain can disable, and oddly, pain can enable. Pain is an equal opportunity entity. An opportunity to come and go at any time. An opportunity to disrupt, and a place of the Devils design. Pain should not exist. Or should it? Pain alerts us, pain protects us. Any healer that works with those suffering from pain understands there is one barrier to improvement in those suffering from pain. Pain must exist. We must have pain to live. But we don't have to suffer from pain. We will begin understanding pain by knowing its language.
Pain has a name
Allodynia– This type of pain is a cruel beast. It might be a simple brush against the skin, or a bump in a crowded restaurant. What shouldn't hurt now really hurts. This type of pain is a nervous system type pain, and is a very difficult pain to both comprehend, and treat.
Hyperalgesia– Hyperalgesia is often misunderstood. This type of pain isn't increased sensitivity, and can be brought on by a number of different problems. It may be as simple as a paper cut, or is complex as an evolving complication from surgery. This is the "don't touch me there" crowd. It is treatable, and a very common problem.
Nociception– Nociception is normal. Nociception says "I hurt". A nociceptor is normal if it hurts. A heightened level of nociception may induce pain. Not always, but commonly. There are 2 types of nociceptors. There is a- delta, which is a fast electric-like pain, and a C- fiber nociceptor, which is dull and achy. That is like "bone break, bone hurt." These 2 nociceptor's, or pain progressive pathways, are treated very differently. They rarely stand alone. Remember, nociceptor protection can be a good. This is why we ask so many questions. ""Is it dull, aching, throbbing" (C), or is it fast, electric, and burning(a-delta).
Dysesthesia-Dysesthesia means something is just not right. If you break it down in Greek that's exactly what it means. It may be tingling, it may be burning, may be painful, may not be anything. It may be numb. It may come and go, but is just not right. This term dysesthesia is applied to many nervous system problems.
Arthritis is a throw away term, unless you have it. It is an inflammatory condition, that usually affects joints, but can be seen in many disease states throughout body.
Most of us are familiar with osteoarthritis,and 'crippling arthritis', medically known as rheumatoid. There actually dozens of forms of arthritis. Everybody gets some form of arthritis. There is psoriasis, ankylosing spondylitis, gout and pseudogout, Sjogren's disease, sarcoidosis, and the list goes on and on.
Usually the disease is manageable, and treated with medications. There may be pain, muscle tenderness, redness or erythema, or fluid accumulations in the joint itself. Advanced forms of rheumatoid disease have typical characteristics such as Swan deformity of the hands. Other osteoarthritic conditions such as those knee, may change the outward appearance of that joint.
Treatment varies, and many different types of providers are appropriate to treat these disorders. Sarcoid for example, may require cardiology, pulmonology, rheumatology, and a pain specialist. Most arthritic conditions are self-limited, and more of an annoyance than a disability.
A nociceptor is normal if it hurts. A nociceptor tells us that something is wrong. There are two types of nociceptors that are important to us. There is A delta, and C fiber nociception. A delta is fast electric type pain, stub your toe, ouch, put your hand on a hot oven, ouch, and quick retrieval. It's a protective type of pain that helps keep us alive.
The C fiber nociception is a different type of system, that is dull, achy, bone broke, bone hurt type pain. It is a primitive type of pain. So what I'm saying here is A delta and C fiber nociception, I'm telling you there are two pathways for pain. This is important. A delta nociceptive type of pain is resistant to opioids, to a degree. C fiber nociception, dull, achy and throbbing pain is responsive. It tends to be less localized. When you have a needle prick under your finger, you know it. There's a whole bunch of pain fibers at the end of your finger that help you understand what you are touching. Of course it has the sensitivity to understand heat and pressure, but the point is, there's different types of pain. When we're describing pain to our provider, we are trying to understand what type of pain we have. Let's take for example neuropathy. Neuropathic pain is a tingling type of pain, and an electric type that is a little more leaning toward A delta. It is more resistant to narcotics, and more responsive to nonnarcotic medication alternatives, such as gabapentinoids. It tends to be a central nervous system problem, although it feels like its pain outside in, it's really inside out. We are going to describe pain this way. Inside out versus outside in. This is the neurobiology of pain. Sounds complicated, but it's really not.
Life experience is as individualized as our unique genetic being. We are alike, and not. 23 chromosomes, DNA, and a complicated dance of physiology. Go to the brain. Inside out, it all starts in the central nervous system. It regulates all, and fuels everything. That primitive part of the brain behind the ear is a remarkably similar to a rat brain. A sagittal section here is pretty close to a human brain (not the prefrontal cortex, that's the smart part). This part of the brain is emotional, craving, and can be hurt. Match that with the limbic system (real emotional), and you've got an important common denominator with the five rules of pain. This part of the brain is the inside out.
Post The Rules.
Treater-clinician, any level. Receiving-the disrupted.
1. Pain is a description, not an entity. Again, it can't be seen felt or measured. Description is our best discovery.
2. You must have a diagnosis. No, low back pain is not a diagnosis. Why do you call them that. Because fibro is a nontraditional disease. Sometimes nontraditional healers count. Low back pain is a symptom. Fibro shares these positives and negatives. It is a syndrome, a group of problems, often only defined by descriptors. Herein lies the flawed fibro construct. We will get to that.
3. If you don't believe in a problem, or think it entirely psychosomatic, refer it out.
This is for the treater not the receiver. If the receiver feels the treater is not a believer, move on.
4. Know thy drugs.
Speaker 1: Five classes, five drugs. Repeat next month. For the treater. Stay up. Get the pharmacodynamics and kinetics. Pick your five classes. Benzo (ick), NSAID (ick), Opiod (hummmmm), Gabapentnoid (yes), that's G-A-B-A-P-E-N-T-N-O-I-D Gabapentnoid, Muscle Relaxant (useless) etcetera. Pick five drugs. Learn them, own them.
5. From a compassionate standpoint I want to relieve your pain, but a realistic standpoint is we need to improve your function.
Peaceful command returns. Disruption dissolves, the chaos of fibromyalgia evolves not devolves. If a treater believes in peaceful command, by their style, you've found a believer. Your chances of that evolving into a positive clinical outcome as reality has just jumped.