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You Have to Learn to Live with the Pain

You have to learn to live with the pain. Have you ever heard these words? If you are a chronic pain sufferer and you've been told this, you know how frustrating it is. Twenty-eight years ago, Penney Cowan, the founder of the American Chronic Pain Association heard these words and chose to do something about her pain. She had become physically deconditioned after back pain from a car accident left her in pain, fearful, and unable to work. Six years after her accident, she was still expecting some medical doctor somewhere to figure out what was wrong with her back and fix it.

But, as with many cases of nonspecific low back pain, even when there's a known cause (car accident), tests are negative and no known anatomical reason exists for the pain that continues past the time of healing. If that's your situation, then it's time to take action. What Penney Cowan found out was that she could learn to manage her pain, reduce the sense of suffering, and understand her pain, rather than fear it. She did this through a multidisciplinary program of pain management, physical therapy, cognitive behavioral therapy, counseling, and activity.

Entering a comprehensive pain-management program gave her the tools she needed to get back control of her life and improve her quality of life. Does she still have pain? Yes, but it no longer dictates what she can and can't do. She has learned how to live with her pain and remain active. She credits herself with changing from a passive patient waiting for a cure that was never going to come to a person with improved quality of life and a desire to continue learning in spite of her pain.

You may wonder why some people come out of car accidents with back pain that never quits and others walk away unaffected. Scientists don't know all the answers to that dilemma. But research has shown that there are certain risk factors that contribute to this type of response. Trauma of any kind can play a role. A past (or current) history of physical or sexual abuse or trauma is a key factor. It's estimated that as many as half of all patients with chronic back pain have some type of abuse history.

Although the pain itself might not be the result of posttraumatic stress disorder (PTSD; also known as posttraumatic stress syndrome or PTSS), the level of pain intensity and chronic duration seem to be linked with PTSD/PTSS. PTSD/PTSS seems to affect severity of symptoms, level of disability, and depth of depression. One other psychologic factor that seems to be part of the picture with chronic pain is pain catastrophizing.

Pain catastrophizing refers to a negative view of the pain experience. It is exaggerated or blown out of proportion. Sometimes it refers to a patient who actually has pain already. In other cases the person isn't even in pain yet -- he or she is still just anticipating it might happen. A person who tends to catastrophize sees things as worse than they really are. Studies show that without intervention these behaviors can lead to chronic pain and disability over time. Catastrophizing or expecting the worst to happen increases pain. Catastrophizing boosts anxiety and worry. These negative emotions stimulate neural systems that produce increased sensitivity to pain. It can become a vicious cycle.

No one doubts that patients with chronic low back pain have pain and even an underlying cause for that pain. The three most common causes for chronic low back pain are disc disorders (degenerative discs, disc herniation), back disorders (arthritis, spinal stenosis), and back injuries. Scientists and doctors just don't know the exact neural mechanism that sets up the pain signals. There's some evidence that pain signals disrupt normal brain structure, processing, and function related to thinking and feeling. Until we know more and can find a way to turn those signals off without drugs, the best medicine is a focus on pain management through exercise, activity, and counseling.

People like Penney Cowan can get back to work, walk three miles a day without being limited by pain, raise a family, stay active, and remain a contributing member of society. But just like it takes a village to raise a child, it can take a coordinated plan through a community of health care providers to provide all the tools needed to manage chronic pain. If you suffer from chronic low back pain, don't let it have a negative impact on your quality of life and level of function. See the American Chronic Pain Association (www.theacpa.org/) for more information concerning services, conditions and pain management issues.


Allen Lebovits, PhD, et al. Struck From Behind: Maintaining Quality of Life with Chronic Low Back Pain. In The Journal of Pain. September 2009. Vol. 10. No. 9. Pp. 927-931.

09/24/2009

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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