Recently, my eye was caught by a study that went into detail about the complications that arise when pain is not addressed well. It was a relief just to see that some doctors acknowledge that pain itself can cause the body to deteriorate, even though it wasn’t fun to see all the potential problems.
Here are selections from the original study I found (it’s worth reading all of it):
Complications of Uncontrolled, Persistent Pain
Persistent, unremitting pain may adversely affect the body’s endocrine, cardiovascular, immune, neurologic and musculo-skeletal systems and require aggressive treatment of the pain as well as the resulting complications.
...The most unappreciated clinical feature of persistent pain, however, is the plethora of complications that may result — particularly if the pain is constant and unremitting.
Many recent and emerging studies clearly document that persistent pain exerts profound impacts on the body’s endocrine, cardiovascular, immune, neurologic and musculo-skeletal systems.7 Presented here is a review and classification of some of persistent pain’s complications to give the practitioner a basic understanding that persistent pain may produce a symptom complex or syndrome that must be recognized at the clinical level.1 Even though our understanding of the occurrence and mechanisms of the persistent pain syndrome are still quite limited, it is clear that the diagnosis and treatment of persistent pain’s complications must be simultaneous with pain treatment.
...Any area of the anatomic body that experiences severe persistent pain will soon “decondition.” This area will cease normal, symmetric, coordinated movement, and the patient will simply self-splint, immobilize, and decondition the area. This leads to a number of complications including muscle atrophy, neuropathies, and in late stages, contractures. Muscle, nerve, and joint weakness, and deterioration result. It is not uncommon to see the patient with severe, uncontrolled pain progressively deteriorate due to muscle atrophy and contractures and go from cane to walker to wheelchair.
...A single painful location on the body soon begets some others. Much of this is the “overload and overuse syndrome.” To make up for a weak, painful area, joints, nerves, and muscles elsewhere in the anatomy will attempt to compensate and work overtime. Unfortunately, chronic overuse and overload may lead to tissue degeneration at secondary pain sites causing arthropathies, myopathies and neuropathies.
...Based on emerging research data, it appears that uncontrolled persistent pain may affect about every endocrine system in the body….The impact of persistent pain on the hypothalmic-pituitary-adrenal-axis is profound and paramount to understanding the complications of persistent pain.7,15-18 Severe pain is a potent stressor — perhaps the most potent — that stimulates this system.7 Persistent pain initially produces excess secretion and high serum concentrations of catecholamines and glucocorticoids as the body attempts to control pain and prevent damage.
...Persistent pain generates excess electrical activity in peripheral nerves, spinal cord, and brain. This “hot wire” effect appears to cause degeneration of nerve tissue — particularly in the dorsal horn of the spinal column.24 A recent controlled study shows that low back pain patients may develop cerebral atrophy.25 It follows that dementia and other organic brain syndromes may result.
The problems of insomnia, depression, suicide, attention deficit, memory loss, and cognitive deficiencies are extremely common in persistent pain patients
(As an interesting aside, this author also penned an article suggesting that Howard Hughes might have become a recluse because of intractable pain from severe injuries suffered at age 46:
Howard Hughes and Pseudoaddiction
..He would possibly today be given the diagnosis of Reflex Sympathetic Dystrophy or Chronic Regional Pain Syndrome. At times, his pain was reported to be so severe that a simple touch or the touching of bed clothes produced pain. His renowned refusal to brush his teeth, cut his toe and finger nails, or wear shoes may have been related to the fact that these actions may have caused increased pain.
Although at the end of the article, the author backs off and says there’s no proof; just gives a list of the severe injuries and how he was treated for them… but certainly seems like that would drive him into seclusion!)
From there, I checked on some other sources, because this is a topic of much importance to me personally. My pain isn’t the intense, mind-numbing, all-consuming pain that many report (at least, not while I have medications that help), but the ups and downs of how the government classifies pain and its treatment have me on continual tenterhooks. So I”m always looking for evidence that I could use if my doctor started to doubt my pain or disability. Getting back to the first article, I tried to find other studies that list these side effects. Far too many studies I read repeat the assumption that there is no “real” effects of chronic pain — that patients might just be “emotional”:
Integrating Pain Management in Clinical Practice
...There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain.
...The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (Pengel, Maher, & Refshauge, 2002). This definition recognizes that pain is an emotional as well as a sensory phenomenon.
Fortunately, some doctors are writing about their patients, and the effects of chronic pain. This one is a tragic story of a young man whose pain hastened his death:
Chronic Persistent Pain Can Kill
A 39 year-old white male was referred to my office by his attorney for an evaluation of injuries he sustained while working on a barge... The patient told me that he could not tolerate some of the [PT] modalities because it caused increased pain while adequate analgesia was never attained...The patient was quite miserable. His activities of daily living were severely affected.
...an autopsy revealed that he had died of “acute coronary thrombosis.” The report further stated that this “was a complication of arterial sclerotic and hypertensive cardiovascular disease.” The medical examiner further wrote that this patient “...most likely would have been able to control his diabetes and hypertension by working out as he used to do before he suffered his devastating injuries. The physical and emotional stress caused by the injuries he sustained...played a significant role in leading to his death...”
This case serves as a reminder that chronic persistent pain, under-treated and uncontrolled, can result in tragedy. This patient was 37 years old prior to his accident. He was gainfully employed and enjoying a good quality of life. Chronic pain can be a tremendous stressor and can affect virtually every organ system of the body.
Here’s another, but I couldn’t get the whole article due to a paywall. There are many interesting references listed, though:
Suffering: the contributions of persistent pain
...At a physiological level, chronic pain promotes an extended and destructive stress response characterised by neuroendocrine dysregulation, fatigue, dysphoria, myalgia, and impaired mental and physical performance. This constellation of discomforts and functional limitations can foster negative thinking and create a vicious cycle of stress and disability. The idea that one's pain is uncontrollable in itself leads to stress.
So — how can we advocate for ourselves, if the medical practitioners aren’t as clued in? Perhaps by pointing out some of these co-morbidities which can be tested for (like the adrenal and endocrine side effects). Perhaps by finding these articles and sharing them with our doctors. And also by writing to thank those medical practitioners who are speaking out, online and in articles, validating what many of us have come to understand: that pain untreated can lead to more serious complications.
And now, on a slightly related subject — the Poll: too often we have to spend a lot of time dealing with our pain/illness. Do you have something that takes your mind off it, even for a while? If Yes, please share what it is, in the comments.
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