Understanding Chronic Pain

By Dr. Margaret Caudill-Slosberg

Dr. Margaret Caudill-Slosberg is a board-certified internist and diplomat of pain medicine. She's currently an instructor in medicine at Dartmouth Medical School and a Quality Scholar at the V.A. Hospital in White River Junction, Vermont.

Once largely ignored, understanding and treating patient pain is now at the forefront of modern medicine. Dr. Margaret Caudill-Slosberg, an expert in pain management and healthcare improvement, weighs in on the new findings.

First defined by the American College of Rheumatology in 1990, fibromyalgia is a complex pain problem. Sufferers complain of tender points on their arms, legs and trunk. The key symptoms include chronic widespread pain, chronic fatigue syndrome, irritable bowel syndrome and joint pain. And many people with fibromyalgia experience all four of these conditions.

Fibromyalgia can make daily tasks difficult. The pain and fatigue often lead to frustration, which, in turn, can exacerbate symptoms since physical and emotional behaviors can alter levels of pain.

Though sufferers generally feel pain in their skin and muscles, the heightened physical pain is thought to originate in the brain and spinal cord. Therefore, symptoms can be alleviated — but not cured — through medications that affect brain chemistry.

Reduce the chronic pain of this crippling disorder.

Helping Yourself
If you suffer from fibromyalgia — or any other chronic medical problems — it is important to understand the difference between what your doctor can do to help you and what you can do to help yourself. Eating balanced meals, exercising regularly, nurturing social supports and managing the stressors in your life are key self-management skills and can improve your symptoms and quality of life.

Before You See Your Doctor
Before any appointment with a healthcare provider, write down the top three issues you want to discuss. It is easy to forget what you really want to ask, especially if you feel like your doctor is rushed. If you take time to prepare for your visit, you are more likely to have your needs met.

Ready Your Answers
At your doctor's appointment, be prepared to answer the following questions.

• What is your main symptom?
• Where is it?
• When did it start and how long does it last?
• What makes it better or worse?
• What are the qualities of the sensation—sharp, stabbing, tingling, burning?
• What have you done for the symptom?
• What other symptoms do you have?

Write your responses down and bring them with you to the appointment.

Writing It Down
Keep a diary of your symptoms of sensation and emotional distress. Record three times a day at same time every day using a 0 –10 numerical system (0=no pain or distress; 10=worst pain/most distress). This can help you determine how much pain you have and how often it occurs. In this way, you can discover what are truly physical symptoms and what are frustrations associated with pain. This is important information for your doctor in monitoring new treatment effects and changes in your symptoms.

Treatment and Medication
Fibromyalgia treatments should target both brain and behavior, and can help reduce pain and improve quality of life. Because serotonin, norepinephrine and dopamine play a role in sensory processing in the brain, antidepressant medication may be more beneficial than anti-inflammatory agents and opioids. Anti-seizure medications have also been shown to be helpful.

Always keep a written or computerized list of your medications — including doses, frequency and purpose — with you at all times. Update it whenever your medication is changed.

 

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• Self-Diagnosis 101
• The amazing girl who feels no pain

 

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