Atlanta Doctor Chronic Pain Relief

The Facts About Pain

Pain effects MORE Americans than diabetes, heart disease and cancer combined!

Pain – 76.2 million people, National Centers for Health Statistics
Diabetes – 20.8 million people, American Diabetes Association
Coronary Heart Disease and Stroke – 18.7 million people, American Heart Association
Cancer – 1.4 million people, American Cancer Society

Our present way of treating CHRONIC PAIN is not working.

Pain of any type is the most frequent reason for physician consultation in the United States, prompting half of all Americans to seek medical care annually.

Most doctors and patients do not understand chronic pain.

In 80% of cases the cause of pain cannot be established
Quebec Task Force on Spinal Disorders: Spine 1987; 12:S1-S59

85% of pain patients lack a specific diagnosis.
Deyo et al: JAMA 1992;268:760-765

Insanity: doing the same thing over and over again and expecting different results. - Albert Einstein

- According to a European Journal of Pain report, chronic pain affects over 19 percent of the European population.

- Back pain disables as many as 4 million persons in the United States per year.

- An estimated 20% of American adults (42 million people) report that pain or physical discomfort disrupts their sleep one night a week or more.

- An estimated 46 million adults have been told by a doctor that they have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia.

- More than 26 million Americans between the ages of 20-64 experience frequent back pain.

- The annual cost of chronic pain in the United States, including healthcare expenses, lost income, and lost productivity, is estimated to be $100 billion.

- Back pain is responsible for an average of 12% of all sick leave, rivaling the common cold as a leading cause of absenteeism from work.

- Back pain results in the loss of more than 93 million work days each year, resulting in decreased productivity and increased expenses.

- Direct and indirect losses from chronic pain in the United States costs billions of dollars each year.

- Back pain is the leading cause of disability in Americans under 45 years old.

Chronic pain is major public health problem, and is now of epidemic proportions.

Medicare, social security, disability programs, workers’ compensation programs, and the private healthcare system all struggle to keep up with the never ending cost of chronic pain patients. Resulting in higher insurance premiums, loss of worker productivity, increased burdens on state and federal governments and a decrease in quality of life.

Now that you know that you are not alone in your suffering with pain. I want you to understand why the past treatments, diagnostic test, medications and doctors visits have been relatively ineffective. It is because they all were based on the false idea that there always has to be a structural problem to cause the pain and that if there is no structural problem there should be no pain. This premise is okay if you hit your thumb with the hammer and it hurts. Pain is much more complicated than previously thought.

The New Science of Pain

This is the New Science of Pain, The pain sensory (nociceptive) system is not just a system for the conduction of pain impulses from the periphery to the brain. We now know that plastic changes can take place in the periphery, the spinal cord and also in higher brain centers following injury, inflammation and other events. These changes may increase the magnitude of the perceived pain and may contribute to the development of chronic pain syndromes and increased pain sensitivity.

Repetition is the mother of all learning.

Our nervous system controls or has a part in every function of our body. Neuroplasticity is generally very good for us; we learn a trade or career, we develop balance, we learn math, we learn to play baseball or the piano, and thousands of other functions we do everyday and do not even think about it. There is also a bad side of Neuroplasticity that deals with bad habits, addictions, certain diseases and in many cases pain.

The good thing is that as Stephen Covey says, "between stimulus and response, one has the freedom to choose." It is also a good thing for us that we have a part of the brain called the prefrontal cortex (but you'll learn more about that later).

Neuroplastic Pain: Refers to pain cause by or increased pain because of changes within the nervous system. These structural and functional changes can occur at every level of the nervous system.

Pain, what others say.

Over the generations many wise and successful individuals have summarized complex topics into brief yet specific statements. "A world to the wise is enough", means that you only have to hint something to wise people in order to get them to understand it; they don’t need to have everything explained to them at great length. Please read the below and think about what the author is trying to relate, also look for a deeper meaning.

I hear and I forget. I see and I remember. I do and I understand. Confucius

I cannot teach anybody anything, I can only make them think. Socrates

Teachers open the door, but you must enter by yourself. Chinese Proverb

An investment in knowledge always pays the best interest. Benjamin Franklin
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The way you think, the way you behave, the way you eat, can influence your life by 30 to 50 years. Deepak Chopra

Health is the result of thinking and acting in a certain way. Wallace D Wattles

The doctor of the future will give no medicine, but will interest his patients in the care of the human frame and in the cause and prevention of disease. Thomas Edison

Pain is more than a hurt; it is to all too many a way of life. C. Norman Shealy, MD
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Sometimes the truth hurts. And sometimes it feels real good. Henry Rollins

Life is like a sewer. What you get out of it depends on what you put into it. Tom Lehrer

Insanity: doing the same thing over and over again and expecting different results. Albert Einstein

Any fool can criticize, condemn, and complain - and most fools do. Dale Carnegie
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Healing comes from inside, not outside. Andrew Weil, MD

It's supposed to be a secret, but I'll tell you anyway. We doctors do nothing. We only help and encourage the doctor within. Albert Schweitzer, M.D.

Nature performs the cure, the physician takes the fee. Benjamin Franklin

Science without religion is lame, religion without science is blind. Albert Einstein
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We are what we repeatedly do. Excellence, then, is not an act, but a habit. Aristotle

The brain remains a dynamic structure that alters from year-to-year, day-to-day, even moment-to-moment over our lifespan. Richard Restak, MD.

The greatest discovery of my generation is that human beings can alter their lives by altering their attributes of mind. William James

True knowledge exists in knowing that you know nothing. And in knowing that you know nothing, that makes you the smartest of all. Socrates
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The best way to escape from your problem is to solve it. Robert Anthony

Insanity: doing the same thing over and over again and expecting different results. Albert Einstein

Disc Herniation

A disc may herniate because of sudden trauma; anything from a fall on an icy sidewalk, to an athletic injury, or by simply lifting the wrong bag of groceries in the wrong way at the wrong time. Disc herniation may also be caused simply by the cumulative long term effects of what doctors like to call poor body mechanics - a lifetime of too much bending and twisting, and too many awkward positions. Herniations in the lumbar and cervical spine occur with increased frequency in middle aged patients (30-50 years old). This is because the relatively flexibility and regenerative ability of youth is slowly replaced with the stiffness and disc degeneration of progressive age.

Depending on where the herniation occurs, and the degree to which nerves entering the spine, or the spine itself, are affected, a wide range of symptoms are possible. In addition to pain around the site of the herniation, many disc patients also experience significant pain somewhere other than where the disc is because the discs ooze and bulge into spaces occupied by nerves. The nerves carry impulses from different parts of he body to the spine and then to the brain. The pain is experienced as if it were occurring in the area from where the nerve originates.

In herniations of discs in the neck, pain may appear in the shoulder, neck, outer part of he upper arm, or the inside of the forearm.

Herniations in the neck often reveal sensory deficits and weaknesses in the muscles of the arms, the thumb and some of the fingers, depending on the location of the affected disc. Several kinds of imaging tests, including x-rays, CT scans, MRI's and other more exotic imaging tests can confirm and elucidate the findings of a physical exam. In general, bulging discs are rarely a diagnostic mystery.

Treatment is a different story. To be honest, doctors often disagree about the treatment of disc disease. The fact is, there are many different kinds of treatments available;and just as different doctors often approach the same problem in different ways, different patients sometimes respond to the same treatment in very different ways.

Most doctors at least agree, that initially, conservative treatment is best, unless there is clear evidence of severe nerve involvement, significant loss of sensation, partial paralysis, or bowel or bladder dysfunction. Conservative therapy includes such things as bed rest, mild stretching exercises, heat or ice, massage, and drugs to reduce pain, relax muscles and reduce inflammation. Cervical traction, ultrasound therapy and electronic nerve stimulation are also options.

For discs that do not respond to conservative treatment, there is a surgical option. Actually, the truth is there is more than one surgical option, and this is where most of the controversy in the treatment of disc disease originates.

Neuroplastic Pain - Chronic Pain

Neuroplastic Pain: Refers to pain cause by OR pain increased because of changes within the nervous system. These structural and functional changes can occur at every level of the nervous system.

Neuroplasticity: refers to the ability of the nervous system to alter its structure and function. Neuroplasticity (also deals with brain plasticity, cortical plasticity and cortical re-mapping) refers to changes that occur in the organization of the brain and entire nervous system as a result of experiences. "Plasticity" relates to the learning by adding or removing connections, or cells.

Neuroplastic changes related to pain can occur at multiple levels of the nervous system. More pain receptors may be in an area, the area of the brain that feels pain increases, the pain sensory system becomes more efficient, and the brain can learn pain.

"Neuroplasticity can make it easier for you to feel tissue damage (acute) pain."

HOW ARE YOU WIRED?

We take for granted that we will feel good most of the time. When pain strikes, we feel bad. Pain interrupts our work, our recreation, and our relationships with our families. Comfort, that is, not being in pain, is one of your goals if you are sick and should be one of the goals of treatment for the doctor who is treating you for any illness, but especially for an illness associated with chronic pain.

Once the cause of your pain is found and proper treatment is started, the pain may serve the useful function of keeping you at rest so that the injury or illness can heal. But if the pain comes from an illness that is incurable and will never heal, the pain loses its usefulness and becomes harmful. This type of pain keeps you from normal activity, and inactivity decreases your strength.

Types of Pain

Non-nociceptive pain (NO tissue damage but pain is present)
Pain comes from within the nervous system.
A. Neuropathic
B. Neuroplastic

A. Neuropathic Pain
Examples: RSD, MS, CRPS, Carpal Tunnel Syndrome, Neuroma, Tumor, or Herniated Disc

Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system, rather than stimulation of pain receptors. With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. Originating from either the peripheral nervous system (the nerves in the area between the tissue and the spinal cord) or the central nervous system (the nerve connecting the spinal cord to the brain).

Neuropathic pain can be caused by a multitude of reasons, such as nerve inflammation, nerve degeneration (examples include stokes and multiple sclerosis), nerve pressure, and nerve infection. If ignored, neuropathy can lead to numbness, pain, weakness and incoordination. There are more than 100 known types of peripheral neuropathy, each with its own characteristic symptoms, pattern of development, and prognosis. Approximately 30% of neuropathy cases are linked to diabetes. Other common causes of neuropathy include autoimmune disorders, tumors, hereditary conditions, nutritional imbalances, infections or toxins. Another 30% of neuropathies are termed “idiopathic” when the cause is unknown.These damaged nerve fibers send incorrect signals to other pain centers.

B. Neuroplastic Pain
Changes occur within the nervous system that result in pain with little or no tissue damage. This type of pain is neurologically progressive and can become independent of the original pathology that caused pain.

Your pain warning system is not just a system for the con­duction of pain impulses from the periphery to the brain. Scientists now know that changes can take place in the receptors, nerves, the spinal cord and in the higher brain cen­ters following injury, inflammation, continued use of the pain system, disuse of inhibiting factors and learned behaviors. These changes can increase the likelihood that pain is perceived and may contribute to the development of "chronic pain". Therefore, "chronic pain" can in some cases be considered a separate disease, independent of the pathology that initially set off the pain warning system.

The nociceptive (pain) system is not just a system for the conduction of pain impulses from the periphery to the brain. We now know that plastic changes can take place in the periphery, the spinal cord and also in higher brain centers following injury or inflammation. These changes may increase the magnitude of the perceived pain and may contribute to the development of chronic pain syndromes. SWISS MED WKLY 2002;132:273– 278

There is good evidence that chronic pain is associated with changes in brain function. It is possi­ble that these brain changes compound chronic pain and future agents may be able to prevent such complica­tions. German J Psychiatry 2003; 6: 8-15

Neuroplastic Pain

Neuroplastic Pain: Refers to pain cause by OR pain increased because of changes within the nervous system. These structural and functional changes can occur at every level of the nervous system.

Neuroplasticity: refers to the ability of the nervous system to alter its structure and function. Neuroplasticity (also deals with brain plasticity, cortical plasticity and cortical re-mapping) refers to changes that occur in the organization of the brain and entire nervous system as a result of experiences. "Plasticity" relates to the learning by adding or removing connections, or cells.

Neuroplastic changes related to pain can occur at multiple levels of the nervous system. More pain receptors may be in an area, the area of the brain that feels pain increases, the pain sensory system becomes more efficient, and the brain can learn pain.

Studies suggest that pain may play a major role in determining cortical rearrangements in the adult human somatosensory system. Most studies, however, have been performed under conditions whereby pain coexists with massive deafferentation (e.g., amputations). Moreover, no information is available on whether spinal and brainstem changes contribute to pain-related reorganizational processes in humans. The absence of correlation between the amplitude of spinal, brainstem, and cortical components of SEPs suggests that enhancement of cortical activity is not a simple amplification of subcortical enhancement.

The neuroplastic phenomenon: a physiologic link between chronic pain and learning

Neuroplasticity refers to the ability of neurons to alter their structure and function. Structural changes occur at every level of the nervous system, from enlargement and reshaping of the entire neuron (with newly developed dendritic connections), to changing synaptic quanta in presynaptic fibers and alterations in the number, type and sensitivity of postsynaptic ion channels. Thus, neuroplasticity should be viewed as a dynamic process, not a particular outcome.[28]

These presynaptic and postsynaptic membrane changes occur in response to mediators which are initiated by the postsynaptic membrane. Different types of neuroplastic changes are detailed by Ganong, including: posttetanic potentiation, habituation, sensitization, long-term potentiation and long-term depression.[16] Changes in intracellular calcium ion concentration, related to the effect of the excitatory amino acid (EAA), N-methyl-D-aspartate (NMDA), seems to be the least common denominator underlying all types of neuroplastic changes.[16] The related change of intracellular calcium ion concentration produces a hyperexcitable state within the nerve.[16] The inhibitory amino acid, gamma-aminobutyric acid (GABA), normally counters the effects of NMDA and other excitatory amino acids, by exerting an effect on calcium and chloride ion channels in a way that dampens noxious stimuli.[26]

Each nerve cell employs multiple chemical signals to communicate with other cells and itself. Nerves may use entirely different combinations of chemical messengers at different times in response to changing internal and external environmental conditions. In the presence of excessive excitatory or inhibitory neurotransmitter activation, the number of excitatory receptors or inhibitory receptors decrease in density respectively.[16] The EAAs are believed responsible for the regulation of changes in synaptic plasticity, dendritic and axonal structure.

There are 3 subtypes of EAAs: NMDA, glutamate and aspartate, balanced primarily by GABA. In response to excessive excitatory activation, GABA receptors change in number and function through a phosphorylation process which allows negatively charged chloride ions to dampen the effect of synaptic hyperexcitability.[26] Excessive increases in the concentration of EAAs which are not countered by inhibitory amino acids result in neuron cellular damage and a cascade of events that increases spontaneous nerve firing, escalating EAA concentration and further adding to neuronal destruction.

The type of neuroplastic process which predominates varies with different stages of growth and development. Neuroplastic changes related to the growth of cells and the establishment of new dendritic connections occur more readily in youth because of the relative instability and rapid growth of neurons in children. This type of plasticity is associated with intelligence and creativity. With age, there is a decrease in the number of receptors and established neuroanatomical pathways (including chemical circuits), which dissolve and reform in response to environmental cues. Competing influences must be strong and repetitive for adults to change interneuronal connections and add new synapses.[20] Still, dramatic changes in the intricate circuitry and chemistry of the adult brain occur as a result of sensory, motor, behavioral, environmental or drug-related stimuli.[33] This plasticity appears to be related to changing thoughts and behaviors, and serves the purpose of promoting adaptation by allowing the person some flexibly when responding to changing environmental demands.