Whenever I’m faced with a patient suffering chronic pain, I’m trying to discern if the origin of pain is muscular, joint-based or neuropathic (nerve based). However, sometimes pain doesn’t fall into any of these three categories.
We’re then into the realm of more unusual causes of chronic pain….
1) Chemicals/ Irritants
Consumption or exposure to chemicals can cause pain. Excessive alcohol consumption can lead to alcoholic neuropathy, where toxic alcohol damages nerves and blocks the uptake of essential vitamins, resulting in numbness, tingling and pain.
Likewise, tobacco. Short term inhalation of nicotine induces relaxation and eases pain. Long term use reduces blood oxygenation levels. Your body tissues receive less oxygen, are more susceptible to pain and less likely to repair.
Just as exposure to certain substances can cause pain, a lack of nutrients, such as vitamin B12, can damage nerves and cause pain.
2) Chronic Disease
Chronically high blood/ sugar levels caused by poorly managed diabetes can damage nerves and lead to numbness, loss of sensation and pain.
Auto immune diseases can cause the body’s own defences to turn on itself and cause inflammation. Examples are diseases such as lupus, multiple sclerosis, rheumatoid arthritis. Blood tests can be used to check for high levels of inflammation. Different test results tell a different story and suggests a different disease. Normally if pain is widespread throughout the body, moving and responding poorly to acupuncture treatment I suspect some level of systemic involvement such as an auto-immune disease.
Psychological factors doesn’t mean the pain is “all in your head”. Negative states of mind can turn up the volume on pain. It’s a fact that depression can magnify pain. Certain events or behaviours can predispose patients to pain. A difficult childhood, with absent, abusive or disinterested parents can lead to a child, then adult, eager to please. Always wanting to do things or achieve for others, this type of person may have difficulties ever saying “no”, because to upset others is to court potential separation. Marching on through life, rarely saying no, at some point the body may say “no” with a catastrophic crash resulting in either chronic illness or chronic pain.
Sleep is critical in any well-functioning organism. During sleep the immune system does its work and the body repairs damage to tissue. There are numerous studies demonstrating the link between poor sleep, inflammation and chronic pain.
Grey matter and prefrontal cortex
Pain has been shown to shrink the prefrontal cortex, the part of the brain responsible for executive function. When pain stimuli has been removed, pre frontal grey matter increases, this leads to the tantalising suggestion of a marker for pain. Less grey matter = likelihood of more pain.
Research on this is still in its infancy, but it would take subjectivity out of pain management and perhaps lead to less diagnoses of malingering or “it’s all in their head”.
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