If you are suffering from chronic pain, you must realize that your body is always changing. Even if you were initially well controlled on pain relieving therapies, you can expect your body will adapt.
This posting is a review of 7 causes for your chronic pain worsening.
Change does not necessarily mean that your pain syndrome will worsen. Medical practices showed we that some people will get better while others get worse.
No one stays the same with their chronic pain. This is because the human body is in a dynamic interplay between your anatomy and physiology.
Even with an accurate diagnosis and optimal therapy, you may worsen. That does not necessarily mean that you are doing anything wrong (or your Doctor for that matter).
It is just the way things usually work with the human body. It is Physics…everything goes to greater and greater disorganization (called entropy).
Wrinkles are a manifestation of this process (as with other body parts that sag).
Yet and still, I had many patients that improved. Overtime their slower acting medications actually reversed the neurotransmission that was causing their pain.
In some cases, my patients made radical life style changes that resulted in the reduction of their chronic pain. Change can be positive too.
You may be asking, “What could it mean if my pain actually is getting worse (a more common finding)?” I see at least 7 reasons for why this happens in people.
Let’s review them…
7 Causes for Your Chronic Pain Worsening…
1) The Underlying Disease Process Worsens…
The most common reason for worsening of chronic pain is the unrelenting progression of the process that caused the pain to begin with.
The most common cause of low back pain is Osteoarthritis (OA).
OA is really a “wearing out” of joints, ligaments, and tendons. It would make sense that the process would continue as long as you are alive.
Because a person is diagnosed at a point in time with OA does not mean that there would not be progression. Most diseases are like this…consider heart disease, for instance.
The likelihood of a second heart attack is usually greater than the likelihood of the first when a diagnosis of heart disease has been established.
2) Your Activity Level Has Increased…
Sometimes the pain management is so effective that a patient actually increases their activity level.
Of course, one should then expect that their requirements for pain medicine would increase.
Most of patients were able to return to work when placed on effective pain management. They usually required an increase in their medicine with the increase in work activity.
If you drive your automobile with a “heavy foot” your brakes will require more frequent maintenance (and your oil changes will too). Again, it is simple physics when it comes to increased pain with increased activity.
3) Your Body Has Adapted To The Medicine…
Your body is in a never ending state of readjustment. Things that are high will eventually come low and vice versa.
It is called a “physiological feedback loop.” It is essential for the efficiency of the physiology of the body.
It is what body builders rely on for the massive gains in muscle they achieve. Your entire body biochemistry relies on this process for efficient function.
The medicines and procedures that you may utilize for pain relief may also become ineffective over time. The body adjusts naturally.
The medications and procedures haven’t changed…you have.
It is expected that your requirement for pain medicine will increase over time.
This is not necessarily addiction.
Most people need an increase in their dose of medicine every 12 to 24 months, even if they are well balanced on their medications. It is simple physiology.
4) You Have Developed Additional Causes For Your Pain…
While the primary cause for your chronic pain will likely remain, the rest of your body is subject to the destructive influences of life. Unless you were able to radically modify the primary mechanism causing your pain you will undoubtedly develop a 2nd or 3rd mechanism over time.
This is usually because the systems that were not originally dysfunctional have had additional stress put upon them. For instance, paraplegics (people with paralyzed legs) often develop Carpal Tunnel Syndrome of their wrists due to the additional weight burden placed on their arms. There is that thing called Physics again.
5) You Are On Inadequate Doses Of Pain Medicine…
The nervous system is constantly changing which is called neuroplasticity. Nerves become more efficient at conducting pain impulses if they are continually stimulated.
Under-treating pain can not only worsen the primary mechanism for a person’s pain but will enhance the ability to perceive and transmit the pain.
This is called “ramp-up.”
It has been shown in experimental studies that patients under-treated for their level of pain ultimately develop secondary symptoms and illnesses. Early adequate treatment of chronic pain reduces the development of this phenomenon.
The old adage, “just live with it” has been debunked by more recent scientific studies that showed that under-treated pain increased all cause mortality.
6) You Are On The Wrong Medicine…
All primary mechanisms for pain are not the same. Neuropathic pain is treated with different medications from inflammatory pain.
Though opiate pain medications are effective for most types of pain, their challenging side effects make them a category of medication that will always be controversial to use.
In any case, identification of the primary mechanism for a pain syndrome is essential for initiating and maintaining the best therapy. In practice of pain management, We rarely saw patients who had previously been given a good explanation for the primary mechanism of their pain.
If a patient doesn’t understand the main reason for their pain they will be less invested in the therapy. Furthermore, they will not be able to adjust their therapy regimen between visits…a situation that makes the chronic pain patient very dependent on their medical providers.
7) You Have Become Addicted…
Finally, the consideration of addiction is warranted in people who take their medications so incorrectly that they could develop bodily harm from doing so. This is a most challenging aspect of pain management as most addicts do not honestly report their non-compliance.
Even in the most compliant patients, only 60% of patients will actually take their medications as directed. Human beings are flawed as a basic principle and require a great deal of encouragement.
I do not believe that vilification of the Doctor or patient will have the best result. Our present system has created an adversarial relationship between the parties involved. It must change if we are to maintain the therapeutic relationship between Doctor and patient.
What Is The Next Step?
If you find that your pain management is not meeting your pain needs you will need a re-evaluation. My bias is for that to be done by a Doctor who believes in a “primary mechanism for pain” type of approach.
I do not believe that most pain doctors actually mentally process the therapy for a patient this way. It would appear that most pain Doctors take a more procedure oriented approach to pain management with an emphasis on the ability to demonstrate tissue injury with a diagnostic procedure.
But what if the mechanism for a person’s chronic pain does not lend itself to a diagnostic study for diagnosis? Or, what if your pain syndrome is simply not following the usual rules for diagnosis?
In the traditional model for diagnosing chronic pain, a person without a diagnostic study to explain their pain is often labeled as having “factitious pain.” In otherwords, they are considered to be lying or have a psychiatric problem.
But many disorders do not show up on a diagnostic study. Certain peripheral neuropathies, central nervous disorders, and even a herniated disc can evade detection with the usual diagnostic studies.
The diagnosis of a chronic pain syndrome should not be restricted to a diagnostic study but should be left to the discretion of the treating physician.
There Is Hope…
We spend billions of dollars on pain management yearly in the U. S. and I do not think the American public is “getting their money’s worth.” Many aspects of pain management need to improve.
Our legal system needs to change its criminalization approach to the addict. Also, Doctors must stand up for their patients and advocate for them.
Insurance companies need to finance only what works, and patients need to take more responsibility for their healthcare.
There are other issues that are beyond the scope of this brief article.
There is a subset of patients that will suffer most of their lives with chronic pain.
When I see a life-time of suffering ahead for a patient, the issue also becomes a spiritual one. I have included a final video that could be life changing if you find yourself despairing over your quality of life.
Perhaps what you need to do is consider the Lord and His involvement in your life. He knows you by name and He truly feels your pain.
The missing therapy for you may be a relationship with Him. Would you consider it if it meant an improvement in the quality of your life?
JESUS KNOWS MY NAME (sung by Kathy Hart-Bado):
If I may be of service to you or you just want to leave a comment please do so below. I would love to hear from you.
Wishing you much joy and healing.