I HAVE A LITTLE ANECDOTE I like to tell my patients when they first come to see me: Iâve got some good news and some bad news for you. First the bad news: Youâre in pain. Now the good news: Youâre in pain.
Sounds ridiculous? It does to my patients as well, that is until I give them the same information Iâm about to give you. By the time youâre done reading this chapter, you will begin to look at pain differently and see it for what it really is: a teacher guiding you to a complete and accurate accounting of what problems are occurring in your body.
Pain is not your enemy. In fact, it is one of your greatest allies. The simple truth is that pain is natureâs perfect alarm system, designed to alert you that something is wrong. When this alarm goes off, you are being sent an unmistakable message that something happening inside or to your body is causing you harm. Why is it so imperative for you to see pain in this light? Because misconstruing or ignoring what your body is trying to tell you can have grave, even crippling, consequences. I am going to teach you how to recognize and interpret the signals of pain so that you may heed the sirens of this built-in warning system.
I know it may be hard to perceive pain as anything but bad, especially when you or someone you know is suffering. And a whole lot of people are suffering. Pain does not discriminate. It can strike whether you are a young adult or of advanced age, male or female, rich or poor. It doesnât matter if you are a high-performance athlete or a couch potato, a yogi or a mommy. I am well aware from my own experiences how much being in pain reduces your zest for living. It robs you of the ability to be up for all the challenges and good times that life has to offer and seems to hurt much more than it can ever possibly help. And to a certain extent thatâs true, especially if youâre talking about the kind of pain that just wonât go away. However, I am not suggesting that I think itâs a good thing to stay in pain. In fact, I wrote this book so that you could live your life pain free. I want to help you develop a deeper relationship and connection with your body than youâve ever had before. When you make a friend of pain, you will be acknowledging and respecting the intricacies and nuances of your bodyâs design. Thus the first step toward living a pain-free life is understanding that the good news about pain is that you can feel it.
Without the ability to feel pain, you would be unable to survive. (Until recently, children who were born lacking this faculty had an extremely diminished life expectancy.)1 It is one of creationâs great paradoxes that you incur pain in order to avert pain. Think about it. Pain makes it possible to navigate your way through the perils that are often a part of daily life. For instance, when you touch a hot stove, the pain you feel demands that you pull your hand away to avoid any additional harm. If you suffer an injury, such as a fractured leg, the pain prohibits any further use of the limb until it has healed. Likewise, if you develop a disease or suffer a major trauma, the body responds by sending a clear directive to your brain: Pay attention and take action now.
Not all pain is created equal. Although it may feel the same, there are actually different kinds of pain. They are generally broken down into two categories: acute pain (sharp, intense, immediate) and chronic pain (recurrent, persistent, long-lasting). In the preceding paragraph, all of the examples illustrated acute pain. This type of pain is characterized as an instantaneous symptom of a specific injury triggered by some form of tissue damage. Acute pain can be mild, such as from a splinter, or it can be severe, such as when you have a tooth pulled. Its duration can vary from a matter of seconds, such as from a stubbed toe, or to several months, such as from a bad burn. The important distinguishing factor is that there is a direct correlation between cause (injury) and effect (pain). In addition, there is a reasonable, almost predictable amount of time between effect (pain) and recovery (no pain). Treating acute pain is also fairly predictable because the injury itself informs you of what needs to be done to remedy the problem. Whether you can manage this treatment yourself, such as by putting a Band-Aid on a minor cut, or require medical assistance, such as needing stitches for a severe cut, there are some obvious steps that will eventually lead to the alleviation of your pain. In other words, when you fix whatâs wrong, the pain goes away. All of these factors make it easy to see why feeling acute pain is so vital to our existence. However, things become a lot less clear when we start talking about the main focus of this book: chronic musculoskeletal pain.
A Journey Down Painâs Pathway
Your ability to say âouch!â is preceded by a complex series of electrochemical impulses triggered when your body suffers an unpleasant or harmful stimulus. You donât really âfeelâ pain until your brain receives these impulses, sent from the injured tissue by peripheral nerves through your spinal cord, and interprets them as messages of warning. Your peripheral nerves are a network of fibers that branch throughout your body. At the end of some of these fibers are nociceptors, whose function is to sense tissue damage and other danger. Millions of nociceptors in your skin, joints, muscles, bones, and around your internal organs send electrical impulses along the peripheral nerves. When these impulses reach your spinal cord, they are filtered and sorted. Severe injuries are given high priority and sent on instantaneously; less severe injuries take a little longer to reach their destination, the brain. Once they are there, a series of involuntary and voluntary actions are initiated to rectify the situation that caused the pain.
Chronic Pain: The Inside Story
No two words put together back to back inspire more fear, spark as much controversy, and cause as much confusion as âchronic pain.â You cannot turn on the television, listen to the radio, open a newspaper, or surf the Internet without being bombarded by a plethora of information on this subject. I have found a lot of this information unnecessarily complex, often conflicting, and sometimes even highly inaccurate. Everyone, it seems, is talking about chronic pain because everyone, it seems, is in it. And thatâs no exaggeration. It has, quite literally, become an epidemic. The statistics in the United States alone are staggering:
- More than 100 million people suffer from chronic pain.2
- 90 percent of the population will experience back pain during their lives.3
- 70 million workdays are lost from pain a year, costing industry more than $100 billion a year in lost wages and insurance.4
- 50 million people are partially or totally disabled by their chronic or long-term pain.5
- 45 million people have severe and chronic headaches.6
- 40 million people suffer from arthritis, 26 million of them women.7
- 20 million people experience jaw and lower-facial pain.8
- 10 million children under the age of 18 suffer from chronic pain.9
- 6 million people suffer from fibromyalgia, a general diagnosis for the myriad aches and pains afflicting muscles, joints, and tendons.10
You may be reading this book because you are already one of these statistics. Or you may be reading it because you donât want to become one of them. Either way, the information in this book will provide you with the help youâre looking for. Iâm going to let you in on a little secret: In nearly 100 percent of these cases of chronic musculoskeletal pain, the symptoms can be rapidly relieved and the conditions themselves prevented.
The word âchronicâ comes from the Greek word for âtime.â Generally speaking, chronic pain could be characterized as any pain that recurs or persists over an indeterminate period of time. Like acute pain, chronic pain can run the gamut from mild to severe; and the duration of each bout can last from minutes to months, even years. What distinguishes the two is that while the source of acute pain can be attributed to an obvious injury or illness, many who suffer from chronic pain (barring the chronic pain associated with disease, such as cancer, or trauma, such as the chronic pain associated with nerve damage) do so seemingly in the absence of an injury. For instance, how many times have you experienced pain that seemed to just pop up out of nowhere? How many times have you said that âwithout warningâ you couldnât move your neck or that âsuddenlyâ your back went out? If these experiences are true for you, youâre not alone. Millions of people around the world have reported the same thing. Likewise, whereas the recovery from acute pain seems to follow logically from the treatment of the injury itself, chronic pain persists in spite of, sometimes even because of, treatment. In fact, quite often there seems to be no logic at all; no discernible direct link between cause, effect, and temporary recovery. Chronic pain seems to come as mysteriously as it goes. Of course, there is a reason for the sudden onset and dissipation of chronic pain, as I am about to show you, but the lack of objective evidence pinpointing an actual injury has led to a great debate in the medical community on the very nature of chronic pain.
Because of its vexing and ambiguous qualities, many health professionals have been reluctant to even acknowledge chronic pain as a real ailment. I cannot tell you how many patients have come to me over the years after their doctors told them that their pain was imaginary, a manifestation of hypochondria, or a desperate ploy for attention. Although I am always appalled when I hear this, I am never surprised. Western medicine is dependent upon the tangible for analysis and careâseeing, cutting, poking, and prodding. But chronic pain is intangible and cannot be quantified by most extrinsic standards, except that the patient is clearly feeling something. Because many of the empirical methods commonly used today for diagnosing chronic pain, such as CAT scans, MRIs, X-rays, and blood tests, are inadequate for formulating proper treatment, many doctors feel frustrated and impotent in the face of the growing crisis. Some have even dismissed it altogether. The situation has become as critical as it has in large part from widespread misdiagnosis, mistreatment, and ignorance.
The failure on the part of many health professionals to adequately deal with chronic pain exacts a devastating psychological toll on its sufferers. To be in physical pain is bad enough; to be given little support and offered no solution only leaves one feeling utterly helpless and depressed. The severity of this emotional trauma cannot be overestimated. Fifty percent of suicides give pain as motivation.11 Changing the approach to chronic pain has literally become a matter of life or death. Lately, the medical community has acknowledged an urgent need to reassess their position, and slowly a new attitude and understanding is emerging. Not long ago I was reading an article in Newsweek that stated:
Of course, chronic pain is real. But even coming up with a singular and coherent definition has proved difficult. Itâs not that there isnât one; in fact, there are too many. It reminds me of the old joke: âWhat do you get when you ask three doctors a question? Five answers and a second opinion.â Most health professionals agree that chronic pain is pain that reappears over and over. I can tell you that defining it that way is simply not enough. While it may be accurate, it does not sufficiently convey a complete picture of the condition. Why? Mainly because of what it leaves out. For instance, what causes pain to reappear? What causes it to disappear? Is there a cause in the first place? There is, of course, a more precise definition. After spending more than 30 years in clinical practice, research, and teaching, my definition is this: Chronic pain (outside the realm of disease or trauma) is recurrent and persistent pain related to the biomechanical dysfunction of muscles and joints. Understanding why this is so, from a physiological point of view, will be explored more fully in Chapter 3, although I will touch upon it here. The important concept of this chapter is what this pain is telling you, and how this information can be correctly applied toward maintaining and maximizing your all-around health.
Conditions That Cause Chronic Pain
Chronic pain, like acute pain, is a warning sign that something is wrong. Whereas acute pain is indicative of an overt problem, chronic pain is indicative of an underlying one. More specifically, it is an indication that the mechanical function of your musculoskeletal system has been compromised in some way. When you have a headache or a backache, when your hip hurts or your neck is tight, you are being sent a clear message that the muscles and joints in that area are, to varying degrees of severity, impaired. Chronic pain is, therefore, a direct result of injury. Whereas acute pain is the result of a singular, often perceptible injury in which the tissue is damaged, chronic pain is the result of multiple imperceptible injuries in which the tissue is irritated. In some instances chronic pain can trace its source to an illness or a catastrophic event, but it mostly occurs as a consequence of an infinite series of benign actions...