UNDERSTANDING PAIN Also by Naheed Ali Understanding Lung Cancer: An Introduction for Patients and Caregivers Understanding Celiac Disease: An Introduction for Patients and Caregivers Understanding Fibromyalgia: An Introduction for Patients and Caregivers Understanding Chronic Fatigue Syndrome: An Introduction for Patients and Caregivers Understanding Alzheimer’s: An Introduction for Patients and Caregivers Understanding Parkinson’s Disease: An Introduction for Patients and Caregivers Arthritis and You: A Comprehensive Digest for Patients and Caregivers Diabetes and You: A Comprehensive, Holistic Approach The Obesity Reality: A Comprehensive Approach to a Growing Problem UNDERSTANDING PAIN An Introduction for Patients and Caregivers Naheed Ali and Moshe Lewis ROWMAN & LITTLEFIELD Lanham • Boulder • New York • London Published by Rowman & Littlefield A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www.rowman.com Unit A, Whitacre Mews, 26-34 Stannary Street, London SE11 4AB Copyright © 2015 by Rowman & Littlefield All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retriev- al systems, without written permission from the publisher, except by a reviewer who may quote passages in a review. British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Ali, Naheed, 1981– , author. Understanding pain : an introduction for patients and caregivers / Naheed Ali and Moshe Lewis. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4422-3360-7 (cloth : alk. paper)—ISBN 978-1-4422-3361-4 (electronic) I. Lewis, Moshe, 1968– , author. II. Title. [DNLM: 1. Pain—Popular Works. 2. Age Factors— Popular Works. 3. Attitude to Health—Popular Works. 4. Pain Management—Popular Works. WL 704] Proudly sourced and uploaded by [StormRG] RB127 Kickass Torrents | TPB | ET | h33t 616'.0472—dc23 2014042262 TM The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992. Printed in the United States of America Understanding Pain is dedicated to our readers, to people in pain, and to all who provided encouragement and support for this work. CONTENTS Preface ix I: GROUNDWORK 1 Introduction to Pain 3 2 Introduction to the Nervous System 9 3 Physiology of the Nervous System 23 4 Occurrence of Pain 33 5 History of Pain 43 6 Different Interpretations of Pain 51 7 The Changing Culture of Pain 61 II: CLINICAL PICTURE 8 Pathology of Pain 73 9 Diagnostics of Pain 87 10 Causes of Pain 95 11 Damaging Effects 107 12 Role of Internists and Family Practice Physicians 115 13 Role of Physical Medicine and Rehab in Pain Care 125 14 Role of the Pain Management Specialist 137 III: MANY FACES OF PAIN 15 Congenital Insensitivity to Pain 147 16 Acute vs. Chronic Pain 157 17 Occupational Pain 169 vii viii CONTENTS 18 Sports-Related Pain 179 19 Pain from Excessive Movement 187 20 Pain from Sedentary Lifestyle 195 21 Age-Related Pain 199 IV: RESOLUTIONS 22 Troubleshooting Pain 213 23 Natural Approaches to Pain 223 24 Diets for Pain Relief 235 25 Exercises for Pain Relief 245 26 Addressing the Mental Aspects 255 27 Surgery and Other Nonpharmacological Approaches 263 28 Pharmacological Approaches 277 V: WRAP-UP 29 Second Opinions 293 30 Conclusion 301 Appendix A: Pain Related Links 307 Appendix B: Research and Training 309 Appendix C: Pain Organizations 317 Appendix D: Nationally Recognized Pain Clinics 323 Appendix E: For Further Reading 329 Glossary 331 Notes 337 Bibliography 379 Index 389 About the Authors 401 PREFACE When someone is suffering from an injury, an illness, or severe men- tal or emotional distress, he or she is basically feeling pain. A widely agreed-upon definition of pain is that pain is an unpleasant sensory and emotional feeling associated with potential or real tissue damage, or is explained in terms of this damage.1 Three facets of this definition must be well understood. First, pain is a physical and emotional experience that isn’t always entirely in the body or in the mind. Second, the pain is in response to actual or potential tissue damage, so there may or may not be abnormal lab or radiography reports in spite of the presence of real pain. Third, pain is described in terms of such damage. This final component is aligned with an often-recommended definition of pain: Pain is whatever an individual suffering from it claims it is, surfacing whenever he says it does.2 So why does pain exist? According to many theories, the true func- tion of pain is to persuade the individual who experiences it to withdraw from harmful situations and to prevent such experiences from occurring in the future.3 When it comes to injuries, pain may help prevent further harm. A child who touches a hot stove pulls his hand away before a serious burn occurs. Pain that is (1) sudden and of any intensity, (2) anticipated or unpredictable, or (3) of a duration of less than six months is said to be acute. Chronic pain, however, is constant and recurring without anticipation and prediction and lasts greater than just a few months. We need to know about pain, its management and assessment, because complications may occur when we experience it, since the body produces a stress response in which harmful substances are released from injured tissue. These include breakdown of tissue, increased metabolic rate, impaired immune function, and negative emotions. This ix x PREFACE goes to show that pain also prevents one from participating in self-care activities. Unfortunately, pain can also bring forth feelings of helpless- ness and hopelessness. Pain management options allow one to maintain some control. The caregiving team’s responsibility is to teach the pain patient about the goals of pain management and why it’s an important part of care. When a team member disregards the patient’s report of pain, the patient will usually have a sense of not being believed. The patient may compensate by either underreporting pain—or, less commonly—anx- iously overreporting. He or she may try to hide the pain for fear of being thought of as a complainer or drug seeker. Moreover, pain is more than a symptom; it can be a high-priority problem in itself. When in excess, it presents both physiological and psychological dangers to health and recovery. Severe pain is viewed as an emergency situation deserving prompt attention from formal caregivers such as physicians.4 Pain is the most common reason patients seek medical advice. Tak- ing care of patients in pain is challenging, and it requires a systematic approach to assessment and treatment. Pain management requires careful assessment of the patient’s condition while taking into consider- ation the ethical principles that affect patient care. Accurate assessment of pain is essential to effective treatment. Without this, it’s not possible to intervene in a way that meets the patient’s needs. Effective manage- ment can help reach goals by (1) enhancing comfort, (2) minimizing side effects of medications and complications related to inadequate control, and (3) reducing the length of hospital stay. An unfamiliar environment such as a busy hospital lobby, with its noises, lights, and activity, can compound the effects of pain. In addi- tion, a person who is without family or a support network may perceive pain as severe, whereas a person who has supportive people around may perceive much less pain. Some prefer to withdraw when they’re in pain, whereas others prefer the distraction of people and activity around them. Family caregivers can be a significant support for a person in pain. With the increase in outpatient and home care, families are as- suming a greater responsibility for medical pain management. More- over, education related to the assessment and management of pain can positively affect the perceived quality of life for both the clients and their caregivers.5 Expectations of significant others can affect a person’s perception of (and responses to) pain, and sometimes, it may also be the presence of support people that changes a client’s reaction to pain. After reading through this book, the reader should understand that experiences with pain may also vary depending on the age group. An infant may respond to pain with increased sensitivity, avoiding pain by turning away or physically resisting. This can be compared with a tod- PREFACE xi dler or a preschooler who already has the ability to describe pain and its location. The toddler might respond by crying or with anger because pain appears as a threat to his security. A school-age child may try to be more resilient when facing pain but should be provided with support and nurturing from the caregiver. An adolescent could be slow to ac- knowledge or recognize pain because “giving in” may be considered weak. When an adult experiences pain, he or she might exhibit gender- based behaviors learned as a child. An adult may ignore pain because to admit it could mean weakness or failure. On the other hand, the elderly may perceive pain as part of the aging process. Studies have shown that chronic pain affects 25–50 percent of older pain clients living in the community and 45–80 percent of those in nursing homes.6 Senior citizens constitute the largest group of individu- als seeking health care services. While the prevalence of pain in the elderly population is generally higher due to both acute and chronic medical conditions, the pain threshold doesn’t appear to change with aging, although the effect of analgesics may increase due to physiologic changes related to drug metabolism and excretion (getting rid of waste).7 Sometimes, they may withhold complaints of pain because of fear of (1) treatment, (2) any lifestyle changes that may be involved, or (3) becoming dependent.