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Chronic Pain, Pain Syndrome
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chronic pain

What Is Chronic Pain? Chronic pain is an uncomfortable feeling that tells you something may be wrong in your body. It is a very personal response that is both physical and emotional. Chronic pain ranges from mild to severe. It may be constant or recurring. It is defined by how long it. There are 2 types of pain: 1.acute and 2.chronic.

Acute pain doesn't last long and usually goes away as your body heals. Chronic pain lasts at least 6 months after your body has healed. Sometimes, when people have chronic pain they don't know what is causing it. Along with discomfort, chronic pain can cause low self-esteem, depression and anger, and it can interfere with your daily activitieslasts. While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage.

Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).

Importance of pain control Taking care of chronic pain is very important. We want you to be as comfortable as possible. This will help you eat well, sleep well, and be involved with your family and daily activities.

Measuring your pain You are the best judge of your own pain. Your physicians and nurses need your help to find out about your pain. This will help them provide the best treatment.

Here are some of the questions your doctor may ask you:

  • Where is your pain? Point to any area on your body where there is pain.
  • What does the pain feel like? Use your own words to describe your pain. Examples of words that may help you describe what you are feeling are: cramping, pressure, burning, tingly, numb, shooting, sharp, aching, or throbbing.
  • How much does it hurt? You will be asked to describe or rate your pain using one of the following three methods: Number scale that uses numbers from 0-10; Word scale that uses words; Face scale that uses pictures.
  • What makes your pain worse? What makes it better?
  • Do certain activities increase your pain?
  • Do certain positions make your pain worse?
  • How well does your pain medication work?
  • Let us know if any home remedies or other treatments worked well for you.
  • Does your pain interfere with your daily life?
  • Does pain interrupt your sleep?
  • Does it hurt when you bathe?
  • Has your pain interrupted your activities with family and friends?
  • Keep a pain diary Some people find it helpful to write about their pain in a diary or journal. This may help us understand your pain and improve your pain treatment.
Pain Scales: Number Scale Describe your pain using a number from 0 to 10: 0= No Pain and 10= The worst pain you've ever had. Word Scale Describe the pain using the words that best tell us how much you hurt: No pain, Mild, Moderate, Severe, Very severe, or Worst possible pain.

Treating your chronic pain with medication: Chronic pain is usually treated with pain medication. Pain medications are given either as needed or scheduled. Usually, if you only have pain part of the day, you will take your medications as you need them. If you have pain most of the day, you will take medications on a regular schedule.

Taking pain medication Some medications are classified as immediate-release medications. These are fast acting and last for a few hours. Slow-release medications deliver a steady amount of medication over a longer period, usually 8 to 12 hours. These medicines are taken regularly, even if you are not having pain at that moment. This may work best to manage your chronic pain. It is common for people to take both types of medications.

Sometimes certain activities make your pain worse. Taking a fast-acting pain medication before starting the activity will help. Often, a combination of pain medications  may be used to treat certain types of pain.

How are pain medications given? Pain medications may be given in several ways. The most convenient and least expensive way to take pain medicine is by mouth in pill form. Other ways to take medicine include:

  • Liquid medication (either by mouth or through a feeding tube).
  • Suppository (given rectally).
  • Injection (into a muscle, into a vein, into the spinal column, or under the skin).
  • Infusion (into a vein, into the spinal column, or under the skin).
  • Patch (allows medication to be absorbed through the skin).
About side effects:
  • Nausea, Infection - When starting pain medication, some patients may feel nauseated for two or three days. This will pass as your body adjusts. Taking your medication with food may help. Medication may be prescribed to treat the nausea.
  • Drowsiness or Tiredness- Pain medications may cause some drowsiness for the first couple of days. However, if you feel very sleepy or your speech is slurred, tell your doctor or nurse.
  • Constipation - Some pain medications, like narcotics, cause constipation. Stool softeners and laxatives will help. Take them on a regular basis.
Will the medicine stop working after I have taken it for a while? Pain medication does not stop working. Sometimes the body gets used to a certain medication. This is called tolerance. Changing the dose or the medication often helps. If you need to take pain medicines for a long time, it may be necessary to increase the dose or change to another medicine at some point to get the same amount of pain relief.

Will Become Addicted To The Medicine? Some people who take pain medication worry about becoming addicted. When you have chronic pain, your body needs the medicine to live your life more comfortably. This is quite different than taking illegal drugs to 'get high.'

About Other Pain Relief Methods: Sometimes chronic pain is not completely helped by medications alone. Other methods that might work for you include:

  • Massage
  • Heat or cold at the pain site
  • Physical therapy or exercise
  • Breathing exercises
  • Relaxation and/ or imagery
  • Music therapy
  • Distraction therapy
  • Biofeedback techniques
  • Transcutaneous Electronic Nerve Stimulators (TENS units)
  • Hypnosis
  • Special procedures involving certain types of anesthesia
  • Radiation therapy
  • Surgery
Chronic Abdominal Pain:
  • Chronic abdominal pain is a long-lasting, dull pain in the stomach.
  • It is usually around the bellybutton.
  • The pain happens often, usually at the same time of day. For example, your child may have stomach pain every Monday morning.
  • The pain can last hours.
  • It occurs over days, weeks, or months
  • Stomach pain is very common in children.
    Causes Of The Pain
  • The stomach pain is not usually caused by illness.
  • Many children with stomach pain are otherwise healthy. They do not have other symptoms.
  • Children really do feel the pain, even if the reason can't be found.
  • Pain may be caused by a child's feelings. For example, stress can cause stomach pain.
  • For example, a child may have stomach pain every Monday morning because the transition from home back to school is stressful for her.
    What Should I Do?
    • Keep watching your child. Call your doctor if he has stomach pain for more than 1 hour or very sharp stomach pain.
    • Take her temperature.
    • Do not force her to eat. Have her drink plenty of clear fluids if he will take them.
    • Understand that even if you can't find a reason for it, your child's pain is real.
    • Do not treat your child as if he is 'faking it.' Do not punish his for complaining of pain.
    • Show concern for you child but do not "baby" her.
    • Give your child equal attention when he is feeling better.
    • Have him lie down until he feels better.
    • A heating pad or hot water bottle might help him feel better.
    • If the pain started before a task, such as before going to school or starting a chore, have the child finish when the pain is gone. Do not make it a punishment.
    • Make sure your child has free time in the day. Do not keep him too busy.
    • Do not talk about your worries in front of your child.
    • Watch your child's diet. Does it affect her stomach pain? How so?
    • Keep track of your child's weight from month to month. Call the doctor if you are concerned.
    • Keep a diary to record your child's symptoms. It may help you, the child, and the doctor find the cause of the pain. Use the questions below as a guide.
    How Can The Pain Be Treated?
    • If you think your child's pain could be due to an illness, call the doctor.
    • The doctor may want to test your child. Be prepared to answer the following questions:
    1. Does the child have diarrhea?
    2. Fever?
    3. Weight loss?
    4. Constipation?
    5. Where is the pain?
    6. How long does it last?
    7. What seems to make it worse?
    8. When does your child get the pain?
    9. Morning?
    10. Night?
    11. Weekends?
    12. Where does it happen? School or Home.
    13. How does food and eating affect the pain?
    When Should I Call The Doctor?

    The following symptoms could be due to an urgent condition. Call your doctor if your child has:

    1. Stomach pain for more than 1 hour.
    2. Very sharp stomach pain.
    3. Diarrhea, bloating, or gas.
    4. Vomiting, especially if vomit is dark green or yellow.
    5. Few bowel movements.
    6. Sour taste in the mouth.
    7. Chest pain.
    8. Bulging in the groin or scrotum.
    9. Pain in testicle or scrotum.
    10. Fever, chills.
    11. Pain with urination, very little urine, strange colored urine.
    12. Blood in the stool or black stools
    13. Burning pain that gets better after eating
    14. Pain that starts after eating certain kinds of food.
    15. Feeling tired.
    16. Jaundice (yellow color to skin).
    17. Weight loss or poor weight gain.
    18. Child cannot stand tall. Pain makes her bend at waist.
    19. Difficulty in breathing.
    20. Call the doctor if pain gets worse.
    21. Call the doctor if you have questions or concerns about your child's condition.

    Quick Answers

    Chronic abdominal pain is a long-lasting, dull pain in the stomach.

    • Stomach pain is very common in children.
    • Many children with stomach pain are otherwise healthy. Pain may be caused by stress.
    • If your child has other symptoms with the pain, such as diarrhea, fever, or vomiting, call the doctor.
    • Understand that even if you can't find a reason for it, your child's pain is real.
    • The doctor may want to test your child to see what is causing the pain.
    • Call your doctor if your child has stomach pain for more than 1 hour or very sharp stomach pain

    Chronic Pain Treatments:

    Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants and anticonvulsants. Different types of medicines help people with different types of pain. Usually you use long-acting medicines for constant pain. Short-acting medicines treat pain that comes and goes.

    Several types of therapy can help ease your pain. Physical therapy (such as stretching and strengthening activities) and low-impact exercise (such as walking, swimming or biking) can help reduce the pain. Not doing physical activity or trying to do too much can hurt chronic pain patients. Occupational therapy teaches you how to pace yourself and how to do ordinary tasks differently so you won't hurt yourself. Behavioral therapy can reduce your pain through methods (such as meditation and yoga) that help you relax. It can also help get rid of stress.

    Lifestyle changes are also an important part of treatment for chronic pain. Getting regular sleep at night and not taking daytime naps should help. Stopping smoking helps, too, because the nicotine in cigarettes can make some medicines less effective. Smokers also have more pain than nonsmokers.

    Most pain treatments will not take away all of your pain. Instead, treatment should reduce how much pain you have and how often it occurs. Talk to your doctor to learn how to best control your pain.

    What should I tell my doctor about my pain? Telling your doctor about your pain will help him or her find the right treatment for you. Tell your doctor where the pain is, how bad it is and how often your pain occurs. Also talk about what makes the pain better or worse.

    Your doctor may review other health problems (such as arthritis, breathing problems and heart conditions) you may have because these may keep you from doing some types of therapy. Your doctor may also ask if you have had any problems with sleep, mood or anxiety.

    Chronic Pain Medicines What drugs can treat chronic pain? Many medicines can decrease pain, including the ones listed below. Each one may have side effects. Some side effects can be serious. It's important to listen to your family doctor carefully when he or she tells you how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your doctor or your pharmacist.

    Acetaminophen Acetaminophen (one brand name: Tylenol) helps many kinds of chronic pain. Remember, many over-the-counter and prescription pain medicines have acetaminophen in them. If you're not careful, you could take more acetaminophen than is good for you. Taking too much acetaminophen could cause liver damage. If you often have to take more than 2 acetaminophen pills a day, tell your doctor.

    Nonsteroidal Anti-inflammatory drugs (NSAIDs): Other drugs that help with pain are called nonsteroidal anti-inflammatory drugs, or NSAIDs. Examples include aspirin, ibuprofen (two brand names: Motrin, Advil) and naproxen (two brand names: Aleve [over the counter], Naprosyn [prescription]). These medicines can be taken just when you need them, or they can be taken every day. When these medicines are taken regularly they build up in the blood to levels that fight the pain of inflammation (swelling) and also give general pain relief. Many of these medicines are available in low-dose forms without a prescription.

    If your doctor wants you to take an NSAID, always take it with food or milk because the most common side effects are related to the stomach. If you are taking other pain medicines, don't take NSAIDs without first talking to your doctor.

    Narcotics Narcotics can be addictive, so your family doctor will be careful about prescribing them. For many people with severe chronic pain, these drugs are an important part of their therapy. If your doctor prescribes narcotics for your pain, be sure to carefully follow his or her directions. Tell your doctor if you are uncomfortable with the changes that may go along with taking these medicines, such as inability to concentrate or think clearly. Do not drive when taking these medicines.

    When you're taking narcotics, it's important to remember that there is a difference between "physical dependence" and "psychological addiction." Physical dependence on a medicine means that your body gets used to that medicine and needs it to work properly. When you don't have to take the pain medicine any longer, your doctor can help you slowly and safely decrease the amount of medicine until your body no longer "needs" it.

    Psychological addiction is the desire to use a drug whether or not it's needed to relieve pain. Using a narcotic this way can be dangerous and may not help your pain. If you have a psychological addiction to a narcotic, your doctor may give you another drug to help with your psychological problems. Or your doctor might recommend that you talk to a counselor. Your doctor might also change the medicine that you are addicted to by lowering the dose, changing to another drug or stopping the medicine altogether.

    Narcotic drugs often cause constipation (difficulty having bowel movements). If you are taking a narcotic medicine, it's important to drink at least 6 to 8 glasses of water every day. Try to eat 2 to 4 servings of fresh fruits and 3 to 5 servings of vegetables every day. Be sure to tell your doctor if constipation becomes a problem for you. He or she may suggest taking laxatives to treat or prevent it.

    Other medicines Many drugs that are used to treat other illnesses can also treat pain. For example, carbamazepine (one brand name: Tegretol) is a seizure medication that can treat some kinds of pain. Amitriptyline (one brand name: Elavil) is an antidepressant that can also help with chronic pain in many people. Your doctor may want you to try one of these medicines to help control your pain. It can take several weeks before these medicines begin to work well.

    Remember -- if you are taking any pain medicine, be sure to ask your doctor or pharmacist before you take any other medicine, either prescription or over-the-counter.

    Are drugs the only way to treat chronic pain? No. Many other treatments can also decrease pain. They can actually change the body's chemicals that produce pain. Almost anything we do to relax or get our minds off our problems may help control pain. It's important to add relaxing activities to your daily life, even if you are already taking medicine for pain. You might have to use stress reduction methods for several weeks before you notice a decrease in pain. Your doctor can give you tips about stress reduction and relaxation methods.

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