Review of pain and its management – 2018 publication by Drs. Andresen and Rosenberg

[ajm222]

quote Chaunce1234:

I don’t think you are rambling at all, this is an important topic.

Pain is so incredibly complex, chronic pain perhaps even more so, and there is obvious need for extensive research to manage and treat it effectively.

You are right though, and what you describe is one of several theories about chronic pain. That is, that chronic pain may be more of a secondary mechanism or interpretation by the nervous system rather than from a new or ongoing tissue injury, whether due to the original injury or due to repeat pain signals being sent to/from the brain which eventually overly excites that particular neural pathway. Two quite different but similar mechanisms occur with eating extremely spicy food which often sensitizes to temperature and other spices, and sexual arousal which sensitizes to stimulation but in a pleasurable manner. The difference in those situations however is eventually the stimulation ends, and so does that sensitivity. With chronic pain, that stimulation and sensitivity continues, for an uncertain reason. The pain is still very real, but perhaps it is a different mechanism of pain compared to the typical “injury = pain” route.

​​​And as you allude to, that also may be why sometimes pain diminishes over time, or can be diminished over time with things like nerve blocks, medications, various brain training, and it may even be the functional mechanism for why certain other treatments can be helpful to some people. There is also a variety of working theories that medical marijuana may be effective for chronic pain for a similar reason, whether by distraction or by offerring indirect changes to brain signaling and pain interpretation. You will also find that many experienced pain management doctors will push their patients to engage in mentally challenging and mentally consuming tasks too, since the brain is clearly a major component in the pain experience, and participating in mentally difficult tasks causes changes to the brain itself, that’s essentially what learning is.

Here’s a recent interesting article on brain plasticity, and while it’s not on the direct topic of pain, you can imagine why it’s relevant:

http://news.mit.edu/2018/mit-scientists-discover-fundamental-rule-of-brain-plasticity-0622

Fascinating article, thank you!

[Chaunce1234]

quote ajm222:

Pain in general is just such an interesting topic. It seems that in some cases it’s not even that damage is occurring to cause pain but instead some sort of sensitization process begins where the nerves are simply over excited after surgery and never quite settle down. I wonder if this is how injections and conservative pain management most often leads to resolution – almost like training the brain to ignore the area and any false signaling and to relax, which eventually leads to improvement.

Anyway, I’m just rambling at this point.

I don’t think you are rambling at all, this is an important topic.

Pain is so incredibly complex, chronic pain perhaps even more so, and there is obvious need for extensive research to manage and treat it effectively.

You are right though, and what you describe is one of several theories about chronic pain. That is, that chronic pain may be more of a secondary mechanism or interpretation by the nervous system rather than from a new or ongoing tissue injury, whether due to the original injury or due to repeat pain signals being sent to/from the brain which eventually overly excites that particular neural pathway. Two quite different but similar mechanisms occur with eating extremely spicy food which often sensitizes to temperature and other spices, and sexual arousal which sensitizes to stimulation but in a pleasurable manner. The difference in those situations however is eventually the stimulation ends, and so does that sensitivity. With chronic pain, that stimulation and sensitivity continues, for an uncertain reason. The pain is still very real, but perhaps it is a different mechanism of pain compared to the typical “injury = pain” route.

​​​And as you allude to, that also may be why sometimes pain diminishes over time, or can be diminished over time with things like nerve blocks, medications, various brain training, and it may even be the functional mechanism for why certain other treatments can be helpful to some people. There is also a variety of working theories that medical marijuana may be effective for chronic pain for a similar reason, whether by distraction or by offerring indirect changes to brain signaling and pain interpretation. You will also find that many experienced pain management doctors will push their patients to engage in mentally challenging and mentally consuming tasks too, since the brain is clearly a major component in the pain experience, and participating in mentally difficult tasks causes changes to the brain itself, that’s essentially what learning is.

Here’s a recent interesting article on brain plasticity, and while it’s not on the direct topic of pain, you can imagine why it’s relevant:

http://news.mit.edu/2018/mit-scientists-discover-fundamental-rule-of-brain-plasticity-0622

[ajm222]

Interesting, thanks.

It reminds me that I was looking at the Wikipedia page for “Post herniorraphy pain syndrome” the other day, and I found the following to be very interesting:

“A followup of a randomized study of 750 laparoscopic vs. open hernia repair followed patients’ pain scores at 2 and 5 years post hernia repair via questionnaire. At 2 years, the chronic pain rate was 24.3% (lap) vs. 29.4% (open), and at 5 year follow up it was 18.1% (lap) vs. 20.1% (open). At 5 years, 4.3% in lap group and 3.7% in open group had attended a pain clinic.^[5]“

It’s almost as if for some patients the pain reduction and healing happens over much longer time scales. If true, while unfortunate that it can take so long (and clearly the pain doesn’t completely go away in all patients), the encouraging thing would be that over time things can still steadily improve even several years down the line.

I can’t read the full article so I can’t be sure those conclusions are entirely accurate. And obviously the little section posted above raises a number of questions. But I’d like to think that in some cases where the pain is not steadily increasing and not very severe initially, people can still have hope that even if they’re in pain at 6 months or 2 years, they may still experience improvement without having to consider removal.

Prior to this article I had been thinking that any consistent pain after only 3 months was a really bad sign, as many studies consider hernia pain to be chronic if not completely resolved after that amount of time.

Pain in general is just such an interesting topic. It seems that in some cases it’s not even that damage is occurring to cause pain but instead some sort of sensitization process begins where the nerves are simply over excited after surgery and never quite settle down. I wonder if this is how injections and conservative pain management most often leads to resolution – almost like training the brain to ignore the area and any false signaling and to relax, which eventually leads to improvement.

Anyway, I’m just rambling at this point.