~ Dr.P.S Ajrawat
Definition Of pain
Pain is common health problem. Pain afflicts one out of every two to three people in the United States and around the world at any given time. Chronic pain and acute pain are major sources of mental and physical disabilities which generally go undiagnosed and do not receive adequate attention. Pain sufferers continue to live in an enigma, and their lives becomes an endless misery.
ARE YOU A PAIN SUFFERER?
Do you suffer from agonizing pain?
Do you have sleepless nights?
Are you physically and emotionally distressed?
Is your life at a standstill because of pain?
Are you taking excessive pain medication?
Have you undergone multiple treatments?
Are you financially stressed out?
Are you missing out on life?
Were you ever told that your pain is unreal or all in your head?
Are you on a never ending Merry-Go-Round in search of pain relief?
If you have to answer 'Yes' to any of these questions, then this is the time to look at your pain from a new and better angle. In order to accomplish that, it is important that you understand the definition of pain.
Pain has been described many ways. Aristotle called it a 'negative passion of soul'. Some theologians consider it a punishment, and more than a few psychotherapists view it as an odd obsession. However, in recent years, it has come to be defined from a better perspective which is scientific and appropriate.
DEFINITION OF PAIN
According to the new Taxonomy on Pain, the most complete definition of Pain is as follows:
"Pain is an unpleasant, emotional and sensory experience associated with actual or potential tissue damage."
According to this scientific definition of pain, pain is a multidimensional and a complex process; that is, pain is a process which can affect the individual physically, emotionally, psychologically, socially, occupationally and in many other ways. This establishes a new frame of reference which allows the pain specialist to treat and the pain patient to be treated in an effective and appropriate manner. This treatment is best accomplished by the professional services of a Pain Specialist in an interdisciplinary setting.
THE CHRONIC PAIN PATIENT
Being a sensation of discomfort, distress or even agony, pain can exert definite physical and mental effects. The lives of chronic pain sufferers change in too many ways for them to cope and deal with pain. Personality and attitude change many times, leaving behind a feeling of hopelessness and despair. Depression, irritability, loss of sleep, isolation and lack of activity makes life an endless misery. As a result, trying to deal with pain becomes the center of the patient's life. The patient gets into the habits of doctor shopping, drug dependence, multiple invasive and non-invasive procedures, until at last the patient finds himself running from place to place on a never ending merry-go-round.
TYPES OF PAIN
Our facility treats the following common pain disorders:
- Lower Back Pain Phantom Pain
- Pelvic Pain
- Myofascial Pain
- Reflex Sympathetic Dystrophy
- Cancer Pain
- Abdominal Pain
- Head and Neck Pain
- Extremity Pain
- TMJ Pain
- Thoracic Pain
- Pain Due To Injury
- Carpel Tunnel Syndrome
- And Others.........
What Is Myofascial Pain?
Muscles make up the bulk of the human body and are instrumental in mobilizing, balancing and coordinating our motions, both voluntary and involuntary. Myofascial pain is pain produced by stress or damage to muscle and fascia. Myofascial pain is often overlooked, yet it is the major cause of pain and dysfunction in the body.
The muscles and fascia suffer the most wear and tear; however, health care professionals tend to focus on bones, discs or nerves. This bias must be changed. I am a pain specialist, and considering the prevalence of myofascial pain, its devastating effects on pain sufferers, and its toll on the economy, I consider it urgent to educate not only physicians and pain patients but the public as well.
Myofascial pain is a relatively new term which describes pain of muscular and fascial origin. A myofascial trigger point is a center of pain within the muscle, a taut band of the muscle or fascia. The most common symptoms of myofascial pain are referred pain. This referred pain is usually dull and aching, often deep, with intensity varying from mere discomfort to pain so severe that the patient cannot work or even rest.
Pain can be localized to one part of the body or it can be generalized. About two-thirds of patients state that they "hurt all over." Myofascial pain is also described as radiating, burning, shooting, pressing or nagging pain.
The majority of patients evaluated in pain management programs have myofascial pain. Yet most physicians have received little or no training in this area, and hardly recognize it. This is unfortunate because in most cases the cause of the pain can be eliminated and the body can be restored to full function. The most significant finding in myofascial pain is the presence of multiple trigger points.
What Is a Trigger Point?
A Myofascial Trigger Point (MTP.) is a focus of hyper-irritability in a muscle or its fascia that causes pain. A myofascial trigger point can be active or latent. An active trigger point produces pain even at rest, and then again with any movement of the muscle that stretches it. An active trigger point is always tender; it is present in a palpable band of muscle fibers. It usually weakens the muscle, and produces a "twitch response" when palpated directly
A latent trigger point does not cause pain during normal daily activities but causes pain only when palpated. In addition it can limit the range of motion such as difficulty in bending. Patients who come to Pain Centers often ask, "I have been suffering from this pain for years now! Why wasn't I diagnosed with myofascial pain before? "
The answer to this question is that the job requires experts. Myofascial pain is best diagnosed by physicians who are well-versed in myofascial pain. A detailed history and thorough physical examination, especially of the muscles, for myofascial trigger points is essential.
Some Facts about Myofascial Pain
Routine x-rays, EMG or MRI Scan studies do not provide specific clues to myofascial pain. Pain caused by myofascial trigger points is aggravated by dry, cold or humid weather, overuse or over activity, stress, anxiety or depression.
Poor sleep is also common with myofascial pain. In response to the question "Do you sleep well?", 66% of patients describe their sleep to be poor. However, 80% of patients complain of "morning fatigue". Poor sleep may be indicated by difficulty falling asleep, waking up frequently, light sleep, increased dreams and morning fatigue.
Approximately 85% of patients with myofascial pain complain of "generalized tiredness". Some patients describe this as exhaustion, tiredness, generalized weakness. This fatigue is aggravated by physical activity and can cause significant dysfunction in daily activity.
Pain caused by myofascial TPs can reveal itself to the physician in various ways. The most common symptoms relate to the neck, shoulders, upper extremity, fascial area, low back and lower extremity.
In one study of 164 patients done by Fricton, et al, the pain was variously described as pressure (48%), dull (27%), throbbing (26%), sharp (18%), burning (26%), and heavy (14%).
Myofascial pain can also manifest itself as ear pain, tinnitus, nausea, dizziness, tingling sensation, or headaches.
Some patients with trigger points in the fascial muscles suffer the following symptoms. They are unable to chew, or to open the mouth wide, and their teeth are sensitive to temperature. They may have been diagnosed as TMJ, whereas the pain might be coming from trigger points in the fascial and neck muscles.
The neck muscles are a frequent and vastly overlooked cause of headaches. Patients are diagnosed with "migraine headaches" and treated unsuccessfully with a long list of pain medication or migraine medications. Frequently, careful examination reveals that the patient's pain originates from trigger points in the neck muscles.
The most important part of the treatment is to make the patient understand that the pain he is suffering is not from a pinched nerve or arthritic joint. It is not coming from inflamed tendons or bursae, but is arising from his muscles. More important is to re-assure patients that trigger point pain can be relieved by specific treatments.
The treatment involves multi-modality treatments. These treatments may begin by identifying the factors which perpetuate and complement the pain. Then the pain physician may continue with trigger point injections, nerve blocks, and non-narcotic pain medication. Of course, since the problem involves every aspect of the patient's life, the pain physician will treat the patients' entire body by treating sleep disturbance, and then by assisting in neuromuscular conditioning and physical rehabilitation to increase strength, flexibility of muscles, and endurance. Finally, the psychic parts of the problem may be addressed; secondary depression is alleviated and cognition is improved by meditation, while stress and anxiety are treated with supportive psychotherapy.