Sunday, September 30, 2012

Got back pain? It could be your genes - Telegraph

 They play a "key role" in lumbar disc degeneration (LDD), for a long time suspected of being the number one cause of chronic lower back pain, according to specialists.

Over the years these discs, which cushion the vertebrae, can end up getting squashed and bulging out. Bony growths can also emerge from the spinal column itself. Both are thought to trigger back pain.

Scientists have now found that serious lumbar disc degeneration is inherited in 65 to 80 per cent of cases.

Dr Frances Williams, from the Department of Twin Research and Genetic Epidemiology at King's College London, said: "The impact of hereditary factors on LDD is remarkably high. In the 70s and 80s the Scandinavians spent millions looking for all the occupations which caused back pain, but they couldn't find them."

Studies of identical twins who went into different professions - such as truck driving and being a PE teacher - showed both ended up with similarly bad lumbar disk degeneration in later life.

Dr Williams has been heading a team, funded by the Wellcome Trust and Arthritis Research UK, that has found a new gene implicated in back degeneration called PARK2.

They discovered it by looking for signs of LDD in back scans of 4,600 people, and then sifting their entire genomes for clues.

Dr Williams said that, although it was early days, this approach could one day lead to new treatments.

However, the relationship between physical degeneration and long term (chronic) back pain is complicated.

Dr Williams said: "Everybody gets LDD at some point, it's like going grey. But not everybody gets back pain."

Those with more serious physical degeneration are more likely to get chronic back pain, but plenty of those whose LDD looks bad feel fine, and vice-versa.

Dr Adam Al-Kashi, head of research at the charity Backcare, said that was because chronic pain was not simply the result of physical damage.

Psychology was also important, he said, and people who had a positive outlook were less likely to suffer.

"We are discovering that pain is an abhorrent response of the central nervous system, which is controlled by the mind," he said.

While most people and doctors still assumed that chronic pain was permanent - and the best one could do was manage it - recent work suggested otherwise.

"We are finding we can reprogramme the software - the brain - to overcome chronic pain," he said.

He also argued that studies which attempted to reduce illnesses to genetics wrongly made people feel helpless.

"They think, 'What can I do?' " he said.

Dr Williams said genetic studies did not claim to reveal the whole picture, and said people should still take care of their general health to minimise the chance of back pain, in particular avoiding smoking and piling on the pounds.

She added: "Sitting up straight and exercising won't change the way your discs change, but they might help you develop good muscular strength to keep a pain-free spine and back."

Steve Tolan, a professional adviser at the Chartered Society of Physiotherapy, said: "We have little control over the genes we are born with, but we can manage how we support our backs in other ways, such as exercise.

"This can prevent an existing condition from getting worse or delay the onset of a hereditary one. The majority of people should be using exercise and a healthy lifestyle to protect their backs against future injury.

"To use an analogy, it doesn't matter what type of car you have, you still need to keep the engine maintained."

Wednesday, September 26, 2012

Unexplained pain in woman’s mouth caused her to lose weight, disrupt her life - The Washington Post

The 80th birthday party for Josephine van Es marked two milestones, only one of which was apparent at the time.

Held in November 2004 at her daughter's house in Rehoboth Beach, Del., the event was a celebration of her longevity, good health and loving family. It also marked one of the last times van Es can remember feeling well and not beset by the pain that developed soon afterward and has left the inside of her mouth feeling perpetually scalded and with a constant metallic taste.

"It's awful," said van Es, 87, who says the burning is worse than the taste, which she likens to "sucking on a penny."

Her daughter Karen van Es says that her mother's problem has taken a toll on both their lives. For nearly eight years, she has taken time from her job at a Northern Virginia veterinary clinic to ferry her mother, who lives independently in a condominium in Lewes, Del., to doctors in Delaware, Philadelphia and Washington.

She also has contacted specialists in Florida and Canada hoping one would propose an effective remedy for an ailment that took more than a year to diagnose and has so far eluded treatment.

"She tells me, 'I just feel rotten all the time,' " said Karen van Es, 63, an only child who speaks to her mother every day and sees her often.

"My mother has lost confidence as a result of this," Karen van Es said, adding that she often feels helpless and frustrated about not being able to do more.

"She's got a strong heart, good blood pressure and she's mentally sharp as a tack. But it's just slowly eating her away."

Sounds like reflux

In January 2005, when Josephine van Es — the name is pronounced "van-ess" — mentioned the metallic taste and burning sensation to her internist, "he looked at me like I had three heads," she recalled.

Because the problem seemed to start with a burning in the back of her throat, the doctor suspected gastroesophageal reflux disease (GERD), and referred her to a gastroenterologist. He concurred and prescribed medicine.

But the anti-reflux drug did nothing to ease the pain or diminish the metallic taste, which were sometimes accompanied by severe nausea. An endoscopy performed by the gastroenterologist a few months later ruled out GERD.

Perhaps, Karen van Es thought, the problem wasn't medical but dental. In addition to the burning and bad taste, Josephine van Es noticed that her mouth seemed unusually dry. After a thorough dental exam found nothing, her dentist suggested she use a rinse to alleviate dry mouth and sip water frequently. Neither helped.

"To put it bluntly, it's a b----," she said, adding that she grew increasingly desperate about her situation. She had survived cancer — her thyroid was removed when she was in her 30s — and had lost most of her sense of smell after a severe case of flu about 40 years ago. But nothing had prepared her for this.

In 2006, an ear, nose and throat specialist noted that except for a slightly swollen tongue, he couldn't find anything wrong. He recommended further testing for Sjogren's syndrome, an immune-system disorder that causes dry mouth, as well as for Lyme disease and rheumatoid arthritis, which can accompany Sjogren's. Tests for all were negative.

Because van Es had lost more than 20 pounds, her internist ordered abdominal and pelvic CT scans to check for a tumor, as well as an MRI scan of her brain. All were clear. The MRI found only "relatively subtle evidence" of sinus disease "of doubtful significance," according to the radiologist's report.

Van Es was determined to keep looking for something that might help her mother. "I was taking time off and driving her to different doctors in Delaware, Philadelphia, D.C. — anyone we thought might help," she recalled.

It was clear that Josephine van Es had become depressed, although doctors did not consider her mental state to be the underlying cause of her problem. Various doctors prescribed antidepressants, but most of the drugs just made her groggy or loopy and did nothing to alleviate the scalded feeling or metallic taste.

"My mother had been a social butterfly" her daughter recalled, but she began withdrawing, avoiding social situations with her friends, especially those that revolved, as many do, around food.

Diagnosis of exclusion

By January 2008, mother and daughter were in Philadelphia, seeing a dental specialist at the University of Pennsylvania. After reviewing the stack of lab tests and scans, the specialist concluded that Josephine van Es's symptoms were consistent with a poorly understood condition called glossodynia, or burning mouth syndrome, which most often affects post-menopausal women.

The cause of the syndrome, which can appear suddenly, is unknown, according to the National Institute of Dental Care and Research.

Linda Bartoshuk, a taste researcher at the University of Florida and an expert on the syndrome, said that it is a diagnosis of exclusion: Other conditions that can cause similar symptoms, such as Sjogren's and Type 2 diabetes, must be ruled out first.

Most scientists believe that the problem may stem from damage to the nerves that control taste. The ability to taste diminishes after menopause, when it becomes more difficult to distinguish substances that are bitter.

Luckily, burning mouth is "quite rare," said Bartoshuk, who has evaluated more than 75 people with the problem, which affects "supertasters" — those born with a heightened sense of taste because they have more tastebuds than most people.

One treatment that has proved successful is a very low dose of clonazepam, an anti-anxiety medicine that diminishes nerve fiber activity.

A small study in 1998 by Toronto dentist Miriam Grushka and others found the drug worked for 70 percent of patients; earlier this year, another small but more rigorous study confirmed its effectiveness. For others, paradoxically, diluted capsaicin, the ingredient responsible for heat in hot chili peppers, can desensitize a pain signal chemical in nerve cells. Other patients find relief by chewing sugarless gum, sucking on ice chips and avoiding highly spiced or acidic foods.

Although chewing sugarless gum has made Josephine van Es 's mouth less dry, nothing else has helped.

Her daughter contacted both Bartoshuk and Grushka but found that her mother had already tried the treatments they recommended, including clonazepam and capsaicin.

"Unfortunately we don't know what to do" for patients if clonazepam doesn't work, Bartoshuk said. "We desperately need more research on this."

For the past few years, Josephine van Es has been seeing a psychiatrist, who has helped her devise a routine to manage eating, an activity she dreads.

"I sit in the front of the TV and just poke it in," said van Es, who has lost about 30 pounds in the past eight years. Her diet is unvarying: Breakfast is thin oatmeal and fruit ("I call it gruel"), lunch is yogurt and Ensure, and dinner is broccoli florets and a small chicken breast submerged in applesauce. She also eats ice cream twice a day and has found that drinking is less painful than eating.

"If she was lactose-intolerant, she'd be in trouble," Karen van Es said, referring to an inability to digest dairy products.

Meanwhile, mother and daughter are trying to manage as best they can. Karen van Es is on the lookout for anything that might help her mother. "We've done everything imaginable," she said.

Josephine van Es says she is most grateful for her daughter's unwavering devotion. "I could never have anyone better than Karen," she said. "I pray every day and plead with God to take this away. Nothing's happened yet."

Poor Pain Control for Cancer Patients -

Recounting her father's struggle with cancer was difficult for the young woman, even several years after his death. He'd endured first surgery and then chemotherapy and radiation, she told me, and the cancer had gone into remission. He was thrilled, but the aggressive treatment left him with chronic, debilitating pain. Once active, he struggled to get around in his own home.
"It wasn't the cancer that got him," the daughter said. "It was the pain."
Her father had turned to all of his doctors, with little relief. His surgeon had looked at his operative wounds, pronounced them well healed, then stated that they were in no way responsible for his disability. Both his cancer doctor and his radiation doctor congratulated him on being in remission but then declined to prescribe pain medications since they were no longer treating him and couldn't provide ongoing follow-up and dosing guidance. His primary care doctor listened intently to his descriptions of his limitations, but then prescribed only small amounts of pain meds that offered fleeting relief at best.
"I'll never forget what my father had to go through," she said, weeping. "I wouldn't wish this on anyone."
I wish I could have reassured her that her father's case was unusual. Sadly, according to a new study in The Journal of Clinical Oncology, a significant percentage of cancer patients continue to suffer from pain as her father did.
Researchers who surveyed more than 3,000 cancer patients found that nearly two-thirds said they were in pain or receiving pain medications. Roughly a third felt they needed more painkillers to fully treat their symptoms.
A month after the patients saw their oncologists, the researchers again asked the patients about their pain. Instead of showing improvement, the percentage of patients who continued to be in pain remained unchanged.
Their pain, in other words, had not been treated.
The findings are a sobering echo of research from nearly two decades ago that revealed that more than 40 percent of cancer patients did not receive adequate treatment for their pain. While patients were reluctant to ask for relief or to take prescribed pain medications, the researchers found that physicians were just as unwilling to prescribe the needed medications. Nearly a third of cancer specialists waited until the patient was only months away from death before offering maximum pain control.
These results were eye-opening for the oncology community and helped fuel a firestorm of initiatives in the late 1990s and early 2000s aimed at improving how doctors address pain in general. State medical boards began to mandate that all doctors take pain management courses before renewing their licenses to practice. In a move presaging today's checklists, pain was declared a patient's "fifth vital sign," a body function to be assessed after temperature, heart rate, respiration rate and blood pressure. And hospital systems, regulatory agencies and entire medical specialty organizations, confident that better education and more explicit efforts were all that was needed, heralded the various proposals as the new norm.
Unfortunately, that new norm turned out to be not so different from the old.
"It was a 'Groundhog Day' moment, certainly not a feel-good one," said Dr. Michael J. Fisch, lead author of the recent study and professor and chairman of the department of general oncology at the University of Texas M.D. Anderson Cancer Center. While there had been a slight improvement in the number of patients whose pain was controlled, nearly a third of patients were still inadequately treated.
Some of the disappointing results may have been owed to physician and patient fears of narcotic addiction or concerns over side effects. But the main reason, Dr. Fisch and his colleagues believe, is that early initiatives simply underestimated the complexity of good pain management.
To optimize pain treatment, physicians need to carefully navigate the exam-room interaction, ask open-ended questions and empathize with patients who, in some of the most challenging cases, come from backgrounds very different from their own and describe pain and its effects on their lives in unique ways. A patient from China, for example, might describe her leg as feeling "sour" rather than painful. A man from a community that values stoicism might mention that he is now confined to his bedroom but not volunteer a description of sharp, 8-out-of-10 knifelike pain that he now suffers from intermittently.
Not surprisingly, minority patients in the study tended to have more difficulty getting adequate pain control.
Cancer patients who were living with the disease were also less likely to have their pain adequately controlled, compared with others. The current reimbursement insurance system offers little incentive to any single provider to take on responsibility for all of their complex needs. Oncologists may no longer be interested in seeing or caring for them because they have finished their cancer treatment and are doing relatively "well." Primary care providers may not be comfortable taking on the intricate follow-up schedules required to detect recurrent cancer.
And many doctors may simply hesitate to take on the heavy responsibility of monitoring a patient's ongoing narcotic use, the complicated challenge of figuring out whether the dosage is sufficient while worrying about the potentially lethal complications of prescribing too much, or creating an opportunity for abuse.
"A doctor can't help but wonder, 'Am I going to be the one responsible for refilling these prescriptions until the end of this patient's life?'" Dr. Fisch said.
While this study offers important follow-up data to work conducted two decades earlier, it also represents a growing interest among researchers in the symptoms of cancer, particularly for the growing number of people who are living longer than patients from even a decade ago. Thanks to advances in cancer treatment, more than half of all cancer patients now live five years or more past their initial cancer diagnosis. "We need to be better prepared for this best-case scenario," Dr. Fisch said, because it's one that can include not only more years of life but also persistent fatigue, arthritis, hot flashes, depression, sleep problems and chronic pain.
In the case of chronic pain, one thing is clear: Adding assessments to a checklist of vital signs and mandating more physician education aren't enough.
"Pain is all about the doctor-patient relationship and taking the whole person into account," Dr. Fisch said. "Those things are not quick fixes."

Wednesday, September 19, 2012

Headaches: diagnosis and management of headaches in young people and adults - National Institute for Health and Clinical Excellence (NICE)

Fast, easy summary view of NICE guidance on 'headaches'

This guideline offers evidence-based advice on the diagnosis and management of tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster headache and medication overuse headache in young people (aged 12 years and older) and adults.

BBC News - Painkillers 'are the cause' of millions of headaches

Up to a million people in the UK have "completely preventable" severe headaches caused by taking too many painkillers, doctors have said.

They said some were trapped in a "vicious cycle" of taking pain relief, which then caused even more headaches.

The warning came as part of the National Institute for Health and Clinical Excellence's (NICE) first guidelines for treating headaches.

It is also recommending acupuncture in some circumstances.

"Medication overuse headaches" feel the same as other common headaches or migraines.

There is no definitive UK data on the incidence of the condition, but studies in other countries suggest 1-2% of people are affected, while the World Health Organization says figures closer to 5% have been reported.

While painkillers would be many people's instant response, they could be making sufferers feel even worse.

Prof Martin Underwood, from Warwick Medical School, who led the NICE panel, said: "This can end up getting into a vicious cycle where your headache gets worse, so you take more painkillers, so your headache gets worse and this just becomes worse and worse and worse.

"It is such an easy thing to prevent."

Exactly how painkillers have this effect on the brain is unknown.

Most of the people affected are thought to have started with either everyday, tension-type headaches or migraines. The headaches then became worse as they treated themselves at home.

Manjit Matharu, a consultant neurologist at the National Hospital for Neurology and Neurosurgery, said there was a tipping point at 10 to 15 days of using pain relief each month when the drugs became the issue.

He said: "This is a huge problem in the population. The figures in terms of the number of people who have medication overuse headache are one in 50, so that is approximately a million people who have headaches on a daily or near daily basis because they're using painkillers."

People with a family history of tension-type headaches or migraine may also be genetically more vulnerable to medication overuse headaches. They could be susceptible when taking pain relief even if it is not for headaches.

The new guidelines for doctors in England and Wales advise telling sufferers to immediately stop taking all pain relief. However, this will lead to about a month of agony as patients contend with regular headaches without pain relief, until symptoms eventually improve.

The panel said other options for controlling any underlying headaches, such as preventative treatments, could be considered.

The guidelines also include a recommendation for acupuncture in patients susceptible to migraine and tension headaches.

"We would expect that to lead to more people getting acupuncture, but given there is good evidence to show this is effective for the prevention of both tension-type and migraine-type headaches then that is a good thing because people are getting access to an effective treatment," Prof Martin Underwood said.

Doctors have also been asked not to refer patients for brain scans "solely for reassurance" that they do not have a brain tumour. The NICE panel said a tumour would come with other symptoms such as a change in behaviour or epilepsy.

The chief executive of the Migraine Trust, Wendy Thomas, said: "The guideline will assist with accurate diagnosis, appropriate referral and evidence-based information for those with troublesome and disabling headaches.

"It will also raise awareness of medication overuse, which can be an issue for those with severe headaches.

"People with disabling migraine will experience improved quality of life as a result of this guideline."

Dr Fayyaz Ahmed, the chair of British Association for the Study of Headache, welcomed the guidelines.

He said: "Headache is the most prevalent condition and one in seven of the UK population has migraine.

"The condition puts an enormous burden on the healthcare resources and the economy in general."

Monday, September 17, 2012

September is 'Pain Awareness Month' - The Hill's Congress Blog

For most Americans, a sudden feeling of pain indicates that something could be wrong. If it persists, we typically visit a doctor or nurse for a diagnosis and treatment. But what if the pain never goes away? And what do you do if your medical professional can't diagnose the cause, or even worse, what if there is no simple solution to make it go away? This is not a nightmare, but a reality that too many Americans – including me – face as they are forced to suffer and cope with chronic pain.

An estimated 100 million Americans suffer from chronic pain, but few realize its true impact and many doubt its legitimacy as a medical condition. Unfortunately, I do not have the luxury of ignorance. In 2003, while lifting a box at my catering company, I severed the sciatic nerve in my back. What followed was two years of major surgeries that thankfully have enabled me to continue to walk, but forced me to endure every waking hour in constant pain. Some days the pain comes in the form of lightning bolts coursing through my neck, back and leg while other days the softest touch can feel like my bones are being crushed. My life as an energetic chef and business owner changed in an instant.
Though personally tragic, my story is not a new one and certainly not the worst case. During my darkest days after my injury, I sought out others who could understand what I was going through and was shocked to learn how many Americans are impacted by pain. I also quickly learned that pain does not discriminate – people of all ages, genders, ethnicities and financial walks of life are impacted, each suffering from a unique set of symptoms.
I call my fellow sufferers "Pain Warriors." They are those who fight for the public to better understand how chronic pain impacts our society. They fight for more investment into the research of the root causes of pain and for safer, more effective treatment options. And above all, they ask their neighbors, family and friends to listen to their concerns and frustrations and join them in the fight to eliminate chronic pain. 
As September marks "Pain Awareness Month," I am offered the opportunity to remind my fellow Americans that there are those living among you who understand your suffering. It is also a time to recognize the great progress that is being made in treating pain. In labs across America, researchers are working behind the scenes to pinpoint the specific genetic and neurological sources of pain so they can develop more personalized treatments to better prevent, manage and ultimately eliminate pain. From rehabilitative and physical therapy, to behavioral interventions and medications, physicians and nurses have a vast set of tools at their disposal to treat pain.
But more must be done. Given the number of Americans who are impacted by chronic pain, this is clearly a public health problem that requires a much broader conversation among physicians, insurers, policymakers and the patients themselves. Only through a coordinated effort can we ensure patients receive an accurate diagnosis and physicians are educated on the proper use of each treatment method available. Just as critical, we must empower patients to take control of their own health needs.
Lastly, we must turn the tide of public opinion and eliminate the bias against those patients who legitimately need and depend upon prescription pain medications to alleviate their suffering. There is no question prescription drug abuse is a serious problem in this country and we must remain committed to finding a solution. But we must not cause unnecessary burden on pain sufferers in the process. Chronic pain sufferers already face many hurdles just living their lives. The last thing an ill person needs is to jump through hoops with their insurance company, their pharmacist or with their physician to access the treatment they so desperately need. Only through a balanced approach can we ensure the appropriate treatments reach the patients who desperately need them while restricting access to those who do not.
In life, we cannot avoid temporary pain now and then, but chronic pain should not be inescapable. In honor of "Pain Awareness Month," I implore each and every one of us to consider how chronic pain impacts those we love and support efforts to make their world better. Let's join together as warriors against pain and fight to ensure every American has the chance to feel better.
Gileno is president and founder of the U.S. Pain Foundation. He has been a chronic pain sufferer since 2003.

Thursday, September 06, 2012

Webicina.Com • PeRSSonalized Headache

Current information about headache from:

Medical Journals

Medical Blogs

Medical News

Web 2.0 Tools (Twitter, YouTube)

Saturday, September 01, 2012

Canadian Pain Fact Sheet - Canadian Pain Society and the Canadian Pain Coalition

Pain in Canada Fact Sheet

Presented by the Canadian Pain Society (CPS) and the Canadian Pain Coaltion (CPC)

Pain is poorly managed in Canada

  • Although we have the knowledge and technology, Canadians are left in pain after surgery, even in our top hospitals.
  • Only 30% of ordered medication is given, 50% of patients are left in moderate to severe pain after surgery and the situation is not improving (Watt‐Watson, Stevens et al. 2004; Watt‐Watson, Choiniere et al. 2010).
  • Growing evidence has identified that many common surgical procedures cause persistent post‐operative pain that becomes chronic (Kehlet, Jensen et al. 2006).
  • Pain is the most common reason for seeking health care and as a presenting complaint accounts for up to 78% of visits to the emergency department, recent research continues to document high pain intensity and suboptimal pain management in a large multicenter emergency department network in Canada and the United States (Todd, Ducharme et al. 2007).
  • Uncontrolled pain compromises immune function, promotes tumor growth and compromises healing with increased morbidity and mortality following surgery (Liebeskind 1991).
  • One in five Canadian adults suffer from chronic pain (Moulin, Clark et al. 2002; Schopflocher, Jovey et al. 2011) children are not spared with 15‐30% of children experiencing recurring or chronic pain (Stanford, Chambers et al. 2008) and the prevalence increases with age (Hadjistavropoulos, Gibson et al. 2010).
  • Many cancer and HIV survivors have greater quantity of life but unfortunately a poor quality of life due to chronic pain conditions caused by the disease or the treatments that cause irreversible damage to nerves (Levy, Chwistek et al. 2008; Phillips, Cherry et al. 2010).
  • Chronic pain is associated with the worst quality of life as compared with other chronic diseases such as chronic lung or heart disease (Choiniere, Dion et al. 2010).
  • Based on US figures documenting that the cost of chronic pain in adults including health care expenses and lost productivity is $560‐$630 Billion annually it is estimated that the annual cost of chronic pain in Canada is at least $56‐60 Billion dollars (Relieving Pain in America - 2011).
  • People living with pain have double the risk of suicide as compared with people without chronic pain (Tang and Crane 2006).
  • A recent review of opioid (narcotic) related deaths in Ontario, identified the tragic fact that pain medication related deaths in Ontario are increasing and that most of the people who died had been seen by a physician within 9‐11 days prior to death (emergency room visits and office visits respectively) and the final encounter with the physician involved a mental health or pain related diagnosis. In almost a quarter of the cases the coroner had determined that the manner of death was suicide (Dhalla, Mamdani et al. 2009).
  • Veterinarian students receive three times more pain education than human health professionals and five times more hours than medical students (Watt-Watson, McGillion et al. 2009).
  • Pain research is grossly under‐funded in Canada (Lynch, Schopflocher et al. 2009).

“Psychology Works” Facts Sheet: Chronic Pain - Canadian Psychological Association

What is chronic pain?

Chronic pain is pain that does not go away. When pain lasts longer than 3 or 6 months, or beyond the usual time for recovery, it is said to be chronic. There are different types of chronic pain, many of which are not clearly understood. Chronic pain may be associated with an illness or disability, such as cancer, arthritis, or a phantom limb. Some types of pain start after an injury or accident and become chronic over time.

Others may begin gradually, as is sometimes the case with low back pain. In some types of chronic pain, like migraine headaches, the pain is recurrent, rather than constant. There are many other kinds of chronic pain, such as postsurgical pain, fibromyalgia, temporomandibular disorders, and neuropathic pain. In some cases, the cause of chronic pain is known, whereas in many other cases it is not.

It is estimated that between 10% and 30% of Canadians experience chronic pain. The direct and indirect costs associated with chronic pain are staggering and they are estimated to be in the billions of dollars annually. Chronic pain affects both sexes, however, the rates are slightly higher in women. Although chronic pain can occur at any age, it is most common in middle age (for additional information about pain in the elderly see the CPA Chronic Pain among Seniors fact sheet).

Chronic pain can make simple movements hurt, disrupt sleep, and reduce energy. It can impair work, social, recreational, and household activities. People who have been injured in accidents may develop anxiety symptoms in addition to pain. Chronic pain can have a negative impact on financial security and in some cases it can contribute to alcohol or drug abuse. It can also disrupt marital and family relationships.

Medications are one of the most common ways to treat pain. Indeed, medications can be helpful in managing chronic pain, however, the suitability of long-term medication use needs to be carefully considered.

Pain is invisible. This can lead people who experience chronic pain to feel misunderstood or alone in their suffering. Some people find that the legitimacy of their pain is questioned. Other people believe that pain is "all in the head". Pain is indeed all in the head because the brain is very actively involved in this experience. Also, what happens in one's mind is inherently tied to what happens in one's body. Given the impact pain can have on quality of life and other life domains, it is not surprising that more than a quarter of people who experience chronic pain also experience significant depression or anxiety.

How can a psychologist help a person with chronic pain?

Psychologist are involved in many aspects of chronic pain, including treatment/clinical work, research, and teaching. In terms of treatment, psychologists use several different techniques to help people with chronic pain improve their quality of life, regain their sense of purpose, and recover their strength.

They also focus on important themes such as acceptance. Specific techniques to help people with chronic pain include support, education, and skill building in areas such as relaxation, biofeedback, stress management, problem solving, goal setting, sleep hygiene, and assertiveness.

Cognitive behavioural therapy (CBT) is an approach that focuses on thoughts, feelings, and actions. It aims to help people think and behave in more adaptive ways. Acceptance and commitment therapy (ACT) is another psychological approach that focuses on acceptance, choice, and taking action. It aims to help people live in ways that are consistent with their values. The basic goal of both approaches is to help people better manage chronic pain and live meaningfully, as opposed to eliminating pain symptoms.

Vocational assessment examines a person's interests, aptitudes, and abilities. It is useful for individuals who may need to change the way in which they work, or the kind of work they do, because of pain.

Psychotherapy for anxiety and/or depression can be very helpful for individuals experiencing chronic pain. When indicated, treatment for drug or alcohol abuse helps people deal with addiction. For people who find that chronic pain has affected their personal relationships, couple/marital or family therapy is often recommended.

Are psychological approaches effective?

Psychological approaches have been shown, in numerous studies, to help people with chronic pain improve the quality of their lives. In particular, they are known to increase functioning in many life domains, such as activities of daily living, emotional health, and interpersonal relationships, and result in decreased pain symptoms. Following psychological treatment, people report that they are more active, less depressed, less anxious, and more in control. Even though people continue to experience chronic pain, it is more manageable.

Although individual therapy may be offered, people experiencing chronic pain are often treated in groups where they are able to share their experiences with others who live with pain.

Because chronic pain is complex, psychologists often work in interdisciplinary or multidisciplinary teams with other health care professionals, such as physiotherapists, occupational therapists, physicians, nurses, social workers, and pharmacists to help people with chronic pain develop satisfying and healthy lifestyles.

Interdisciplinary chronic pain rehabilitation programs are as effective in reducing pain intensity as medications and medical interventions, however, they are more effective in decreasing medication use, reducing health care utilization, improving functional activities, improving mood, and promoting return to work.

If they can put a man on the moon and replace a heart, why can't they get rid of my pain?

In addition to working directly with people who have chronic pain, psychologists have contributed significantly to our understanding of chronic pain through many kinds of research. Clinical research is often conducted by psychologists in collaboration with organizations and workers in an attempt to reduce the incidence of some types of chronic pain, either through injury prevention or early intervention programs. Clinical research conducted with people experiencing chronic pain has helped develop effective management approaches.

Where do I go for more information?

For information about chronic pain you can contact the North American Chronic Pain Association of Canada at 1-800-616-PAIN (7246) or visit their web site at You can also contact the Canadian Pain Society at 905-404-9545 or visit their web site at

Information about pain in children is available at the web site entitled "Pediatric Pain - Science Helping Children" at Dalhousie University at 

This fact sheet has been prepared for the Canadian Psychological Association by Dr. John Kowal of the Ottawa Hospital Rehabilitation Centre.