Q&A on Chronic Pain with Karl Hurst-Wicker

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#1 - What Causes Chronic Pain?

Chronic pain is caused by many things and may be treated with injections, medication, surgery, or other modalities. The tough thing for patients and physicians is realizing the human body is a complex organism. As such, we don’t have all the answers. Some pain is due to something we don’t fully understand, and therefore, don’t have great treatments.

We need to find the cause, instead of masking the symptom.

#2 - Does Stress and Sleep Make Chronic Pain Worse?

Stress has an effect on pain because it changes the levels of neurologic hormones that amplify pain. The hypothalamus, a stress-event command center, activates when our brain perceives a threat. It sends signals to the adrenal glands to pump adrenaline into our bloodstream. Our heart beats faster, our lungs expand, and our airways open up. Our eyes and ears become more alert and those centers in our brain become more active. The amount of glucose (sugar) in our bloodstream goes up so we have the fuel necessary to activate our muscles quickly. Oxygen to our brain increases so it can recognize, process, and respond to the threat.

Lack of sleep interferes with the restorative process of healing, and increases physical and mental stress. Regular exercise reduces stress and promotes better sleep habits.

Patients can help themselves by indentifying their stressors, eliminate those that they can, and find better ways to deal with those they must.

#3 - What Are Nociception and Antinociception?

Nociception is to sense and process painful stimuli. Nerves along some portion of pain sensory pathways in the brain and/or spinal cord are activated. As an example, when we put our hand on a hot stove, the process of registering that the stove is dangerously hot is nociception.

Anti-nociception is the process of reducing our sensitivity or reaction to painful stimuli. We do this by stimulating other sensory neurons in the pain area, like rubbing our knee after bumping it.

Meditation and deep breathing exercises is also helpful in reducing our sensitivity to pain.

#4 - Some People Experience Chronic Pain and Others Don’t, Why?

The transition from acute to chronic pain has a variety of contributing factors. Sometimes the underlying problem can’t be fixed, like a bad joint that can’t be replaced because the patient is too sick for surgery. In other cases, people can develop central sensitization, thus perpetuating the pain even after the initial problem is fixed. Genetic factors may explain why some people experience chronic pain and others don’t. Certain pain medications could initiate central sensitization, increasing the likelihood of chronic pain.

I’m not sure we will develop a quick or simple way to figure out what patient is most likely to develop chronic pain because it is too complex to determine right away, but we continue to learn more year after year.

#5 – Does Brain Matter Change?

Structural changes occur in the brain and spinal cord of people with chronic pain. The brain’s grey matter, primarily made up of neuron cell bodies, is decreased. So the question arises, “Is reduced grey matter due to chronic pain, or is pain caused from reduction of grey matter?” Reduction in grey matter could be a result of persistent exposure to pain stimuli. It’s been found that patients who experience successful treatment of their chronic pain have an increase in their grey matter volume.

The brain is far more dynamic than we initially thought. We are finding that cells we previously thought to be uninvolved in the process of sensation and modeling are quite involved and have an impact on the way we perceive pain and respond to it and other stimuli.

#6 – What is Neuroplasticity?

Neuroplasticity refers to changes that occur in our brain and how brain cells interact with each other based on exposure to stimuli or learned behaviors. Neuroplasticity can be a good phenomenon, like the changes that occur in our language center when we learn a new language. But sometimes these changes can be bad for us, such as the case in chronic pain. The reduction of grey matter in the brains of chronic pain patients is one such example of neuroplasticity.

#7 - Is There Hope for Treatment and Management of Chronic Pain

A better understanding of chronic pain through research will improve management as a whole. We’re learning more every day about the pathology and inner workings of different pain states, which is leading to development of better medications and devices that are well suited to treating underlying problems. As we learn more about how the nervous system works, we will develop more tools in the fight against chronic pain.

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[Karl S. Hurst-Wicker, MD, is a board certified anesthesiologist practicing pain management at the Desert Pain Institute. He graduated from Columbia University College of Physicians and Surgeons and completed his residency in anesthesiology at the University of Utah.]