The Art of Healing

Chronic Pain Series 1-Types of Chronic Pain

February 08, 2021 Charlyce Davis Season 2 Episode 6
The Art of Healing
Chronic Pain Series 1-Types of Chronic Pain
Show Notes Transcript

This episode is the first in my series covering Chronic Pain.  I will review four types of chronic pain, musculoskeletal, neuropathic, immune related pain and generalized pain.   Understanding the types of chronic pain can be a solid first step in alleviating the pain. 

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Speaker 1:

This podcast episode will be discussing medically related issues. I would like to remind you that although I am a practicing physician, this podcast is for educational and informational purposes only. This is not medical, mental, or religious advice. This is not legal or financial advice, and it is your responsibility to pursue medical care. As recommended. Please see my website for further information on this disclaimer. Hello and welcome back to the Art of Healing Podcast. This is Charise. Thank you so much for joining me for today's episode. Um, for the month of February, I am going to be focusing on, uh, chronic pain. I'm gonna cover again, the inflammation on, um, inflammation. We're gonna make a link between inflammation and chronic pain. And then, um, we are gonna also discuss, um, um, the energy body's connection to chronic pain. So I'm planning on covering all of that, uh, for this month. So for today's episode, this is gonna be, um, chronic pain and the use of holistic remedies, Part one, and I wanna spend an episode discussing the types of chronic pain. I think it'll be a good basis to, to discuss everything else as far as addressing chronic pain. I don't know the exact statistics, although I'm quite sure that in my own practice, chronic pain is gonna be among the top three diagnosis of why patients come in to see me. And it's a fairly well known topic that had been, um, discu being discussed pretty often, um, prior to the pandemic of 2020, which of course took center stage in the healthcare world. Chronic pain is one of those topics that, um, although it is, had been discussed more and will come up more, especially because there will be so many individuals dealing with, um, chronic inflammation, um, related to having had the coronavirus infection. Um, it is definitely an underserved, um, still under discussed topic. And, um, the nature of healthcare now is that for the most part, we just don't address this topic effectively. So, as I was deciding on topics and things that I wanted to discuss, this has been very much the top of my mind. Um, up there with insomnia as well as, uh, waking, there are four types of chronic pain that we will discuss. I'm grouping them into four major groups. There are really gonna be a much larger number of diagnosis that can lead to chronic pain. But for the sake of our discussion, the four types of chronic pain that we will discuss is, is I'm, um, classifying them, are musculoskeletal pain, neuropathic pain, immune related pain in generalized pain. So that's gonna be our approach. This is by no means a comprehensive list. Um, I'm mostly speaking to my experience as a practicing physician in what I see the first type musculoskeletal pain, which is gonna be chronic pain, lasting more than three months duration. Um, and this is pain that's gonna be coming from the joints or the lower back chronic pain originating from these sources. And the most common types of chronic pain, pain lasting over three months or over six months that I see in my practice is gonna be pain originating from the lumbar spine in pain, originating from osteoarthritis. Lumbar spinal pain typically is gonna show up a number of ways, and this is gonna be someone who's experienced, um, moderate to severe lower back pain, um, for at least three months or longer. And, um, these individuals suffering from lower back pain may have had imaging diagnostics, um, maybe not. Um, and it could also be that they've had, um, a pain that's been intermittent. It's been gone at times, and then at times it's come back. And the most common diagnosis that I think of, I don't know that it's necessarily just, you know, the numbers are there, but usually what I see that comes from this is gonna be lumbar disc degeneration and spinal stenosis. Both those conditions are degenerative diseases, meaning that, um, they are gonna be damaged to the vertebra or the the bones, um, leading to damage of the connective tissue. Um, the, um, intervertebral disc, um, that can lead to impingement of nerves that would supply sensation down the legs. Uh, sometimes we call that lumbar ridiculopathy, um, or, uh, sometimes some people think of it as, as sciatica is one example, not, not quite, doesn't quite line up because of the locations. But basically this is gonna be lower back pain from something degeneration, which relates to time, weight, gravity force, chronic inflammation that leads to pain in the lower back, which, um, I believe for most years is gonna be the most common cause of chronic pain. The reason that, uh, patients would be seeking remedies for pain relief, um, seeking, um, interventions, procedures, and even surgeries to relieve this pain. And for many years it had been chronic low back pain that had led to the use of opioids, which is a difficult topic, um, because, uh, a lot of times if we don't look for some way to relieve this lower back pain, um, dependence on opioids occurs. So, um, this kind of lumbar pain, um, probably the most common and can be excruciating and can definitely lead to, uh, changes in the quality of life, um, can occur pretty commonly. Um, almost any of us can actually have issues in our lower back. If you consider the job of the lumbar spine is actually to be a weight bearing structure as well as a, a cushion against gravity. So it's holding the weight up of your torso, of your abdomen, your chest, your head. Then it is also shock absorbing so that every time one of your feet pants, uh, hits the ground when you're walking, some of that force transmits up to your back and reaches the lumbar spine. So it's no surprise that this would be a common place to have, uh, chronic pain, osteoarthritis, which I classify with the musculoskeletal chronic pain, um, which is also degenerative, meaning a disease process that happens over time. Um, and arthritis is gonna be a combination of mechanical injury, inflammation. Um, the body's attempt to heal the area leading to further inflammation and damage, um, gravity, and depending on location weight, um, common places for arthritis, osteoarthritis that would lead to chronic pain would be the knees and the hips. Um, and then another place that we can see chronic osteoarthritis that isn't always so much. It, it really isn't way bearing. It's more inflammatories, osteoarthritis of the hands. Knee osteoarthritis and hip osteoarthritis, um, can occur for a number of reasons, old injuries, old trauma. But keep in mind that degenerative nature, meaning that time, mechanical stress in combination with the body's immune system activating to attempt a healing process, leads to, um, destruction of the ligaments and cushions. For example, within the knee, there's, uh, structures that serve cushions that become prone to damage. Um, this can allow areas that should not rub against each other to start to rub. So people have heard of the term like bone on bone osteoarthritis, and then the, uh, oval fluids role in trying to heal this, where the oval fluid will become more inflammatory and an attempt to contain this damage. And all of that can lead to, to pain. And a similar process happens as well in the hip. Osteoarthritis of the hands, um, is interesting and at least as far as I know in my practice, um, it seems like it occurs more in women. And what we see is that same thing that degenerative nature. So it occurs over time, along with use. Um, and we see that the joints of the hands become tender and become, they change, it become a little bit larger over the years. And, um, sometimes when we see the arthritis of the hands, we start to wonder about another condition, rheumatoid arthritis, which we'll discuss. Um, but we may do tests and those may come back. Negative osteoarthritis of the hands, although I do think of it as musculoskeletal, um, because these joints are small. Um, and at least right now what we know, we don't have any specific tests that tells us that this osteoarthritis of the hands is a distinct condition from, uh, rheumatoid arthritis or the osteoarthritis of the knee. Um, I often will educate my patients on anti-inflammatory measures in their lifestyle to help with the arthritis in the hands, including limiting the intake of sugar, um, consuming good fats, um, exercise, actually exercise in the whole body so that the immune system can be optimized to heal the damage's happening in the hands. Um, osteoarthritis in some of the smaller joints happens, but not quite as often. Um, it's really gonna be the hands that tends to be what I see the most in my practice. So, um, with those conditions, the musculoskeletal issues for, uh, chronic pain, um, the back, knees, hips, and then hands are kind of what we see the most. Next, uh, source of chronic pain being neuropathic pain, meaning this is pain that originates from nerve damage. Neuropathic pain I break down is I'm assessing patients. Is, is this pain originating from the central nervous system or the peripheral nervous system? So if it's from the peripheral nervous system, meaning the nerves, um, it's likely gonna be called a neuropathy. Neuropathy meaning, um, nerve pathology. And so as far as neuropathies, um, fairly common, unfortunately, um, probably becoming more common is gonna be nerve damage related to diabetes. So, uh, related to, um, metabolic dysregulation, which we call diabetic neuropathy. Diabetic neuropathy typically involves the feet and the legs. Although it can involve the hands, it can be incredibly painful, and it is caused by, um, elevated levels of glucose causing damage to the nerves that supply the motor and sensory reflection to the legs and feet. What often tell my patients is that, um, many parts of our body we're lucky, regenerate very easily, and our body's healing process, um, the way our body heals ourselves is miraculous. As long as we don't get in the way of it, our human bodies can recover from a lot. Our nerve tissue is a little bit different. The nature of nerves, the, um, nerves in your brain is well, as the nerves in your legs and feet are that, um, they don't really regenerate or it takes a very long time for them to recover. So they really require a lot of protection from damage from the body, from the system, the nerves and the legs and the feet, um, are especially prone to damage from high sugars and basically sugars, uh, glucose can be corrosive, is a good way to think of it. So too much exposure to that corrosive material damages those nerves leading to painful sensations that can be described a number of ways from just numbness to tingling, to stabbing, to burning, um, or, um, even like a sensation of can't rest the legs, number of ways that diabetic neuropathy can present. But a very important topic as far as understanding origins of, of chronic pain. Um, it is possible to have neuropathy without diabetes, which sometimes will call idiopathic neuropathy, meaning that we may not understand the, um, inciting cause of it, or sometimes we might, so we might know that there was an anoxic exposure or a viral exposure. It does get into, you know, a much deeper area and definitely more of a neurologist area. Um, but it's important to highlight that it is possible to have neuropathy without necessarily having the diagnosis of diabetes. Um, there is, um, a fairly rare condition that, um, i, I try to keep at the top of my head when I'm working with patients that, um, involves both the nerves as well as the blood flow to a region called regional pain syndrome, which is basically a result of trauma 10 area leading to arteries and nerves. Having a dysregulated, um, dysfunctional relationship that can cause a severe, chronic painful condition in one limb can be very difficult to diagnose and very difficult to treat. Um, but it's nice to have an awareness of this, especially if I'm working with a new patient that has pain that's not very well diagnosed, central nervous, chronic pain, um, and probably you'll be able to, um, to infer that this is gonna be migraine, um, tension headache, any sort of reoccurring headache, um, would fall in this category. And of course, um, migraines a can be episodic many times when they're first diagnosed. They are episodic, they're not occurring, um, very often, maybe every few months or once a month, but migraines can evolve into a frequently occurring event. And then even a chronic event, um, migraines are caused by an issue in the covering of the brain that causes some of the blood vessels to act up. That leads to pain. The pain's not actually from the brain itself, it's from the covering of the brain. Um, but migraines, um, as well as, um, uh, classified tension headaches, uh, which could be most skeletal, but those are basically gonna be from muscle tension in the neck leading to, um, a pain from the head, um, are important to realize that they can be classified as chronic pain. Um, and particularly if something like a migraine has evolved into a daily event, um, this, it can be hard to actually piece out the diagnosis exactly what is this because of the way it's presenting. But in my world, when I'm working with patients, I do put this in the classification of chronic pain, someone that's having a daily headache, immune related chronic pain. Um, and, um, and I actually forgot one, I guess I'll mention it here. It's gonna be generalized pain as a broad topic, but immune related pain, um, I will think of in my head in this way because now we're getting into chronic pain issues that are from a diagnosis that are gonna be non localized. So these conditions can cause pain and symptoms in multiple parts of the body, and likely they do. So one, one of those diagnosis, um, that often will mimic another. Um, so a type of chronic pain that's really gonna be the immune system, but it seems like it's, you know, just from one region is gonna be rheumatoid arthritis. Um, rheumatoid arthritis is gonna be activation of the immune system, one component of the immune system to start attacking, uh, a particular structure in the joints, which will cause pain and swelling and stiffness. And over time, actual destruction of the joint where the joint becomes, um, hard to use. Rheumatoid arthritis can often be confused for osteoarthritis, particularly if it's presenting with initially just one joint that's involved. Um, but I like to point out it's non localized. So because the core problem's gonna be the immune system being overactive, um, and then a number of inflammatory markers being high and activating the immune system in a number of ways that rheumatoid arthritis, um, can cause pain in really any joint and can also cause pain in non joints, muscle pain and, and headache. The difference with these inflammatory or immune related chronic pains is that, um, these are the ones that we tend to try to diagnose as rapidly as possible because of the nature of the disease. They may not be limited to just joint and, um, muscle pain. We could be having, uh, immune related damage to the heart, the lungs, and other structures. So rheumatoid arthritis will often present with stiffness in the morning, um, joint pain and swelling in the morning. It's kind of the classic, but it's definitely not limited to that. It could be pain in the hands, the feet, ankles, knees, um, again, non localized. So it could be pain anywhere as a diagnosis. Um, it can usually be confirmed with lab work, but that's not always necessary or mandatory. And, um, often time we may wanna get imaging to see if any joint damage is happening that's visible. And with these sort of immune related non localized chronic pain, um, we typically are gonna need the help of specialists that, um, treat these kind of, um, diseases because we may need to use injectable medications, uh, or other type of medications to calm down the immune system. The next that I'm mentioning, although, um, you know, really it's, as far as the numbers of it is not very common, it's going to be lupus. Um, often many of my patients are concerned that they may have lupus. Um, and again, it's gonna be a source of chronic pain similar to rheumatoid arthritis where the immune system's been activated and the body is generating, um, weapons against its own tissue. Um, the suspicion for lupus and many patients is gonna be high because of a number of symptoms they may be presenting with, including fatigue and joint pain, skin changes and rashes. Um, but actual confirmation of the diagnosis really not very common. But I thought it's worth mentioning because when I working with patients, they often mention to me, Could this be lupus? Um, lupus is different from some of the other autoimmune diseases in that this sheer number of bodily areas that are involved or very high. Um, and oftentimes we don't just see damage to just the joints. Uh, we can see organ issues and even issues in the brain and digestive system. Um, and then under immune related disorders, actually gonna be a number of disorders of really long list that, um, I don't even know all the diagnosis, but we'll sometimes call those mixed, mixed tissue connective disease. Um, and basically, you know, non localized immune system's been activated in causing pain in multiple areas of body, including the joints, the connective tissue of the joints, or in other places. Um, so the key with the immune related chronic pain issues is that although we still need to address the chronic pain, we probably are gonna need a step as far as helping the immune system calm down with medication as well as with lifestyle. Finally, there is a, um, a class of diagnosis, or I think of them this way, just generalized pain that, um, although we may call it just this one thing, I think at some point as science develops, this technology develops, we'll have a much better way to describe these, and that would be fibromyalgia or chronic fatigue syndrome. And, uh, these are gonna be non localized pain syndromes, particularly fibromyalgia, where we could now have pain of not just the joints, but also the muscles, the skin, um, along with other generalized symptoms of fatigue and poor cognition or brain fog along with mood symptoms like depression and anxiety. So I do think where we stand right now, we probably have an umbrella of, of issues that fall in the category of fibromyalgia. I think we just don't diagnose, well, we don't have the technology, we don't have the research to diagnose those well, but, um, with fibromyalgia, it's the one condition that, well, you know, probably listeners may be more expert than me on this because, um, so many individuals are personally affected or they're families are affected by fibromyalgia, but it's a one chronic pain syndrome that can cross all of them that can mimic muscular skeletal or mimic neuropathic or mimic an immune related, um, and can be very frustrating because of the nature of the symptoms and, and pain with fibromyalgia, there's often a number of procedures and diagnostics that happen and, and they're not coming back with any one diagnosis. This is, yes, it's this, yes, it's at. So when I meet patients that have fibromyalgia or I potentially am the first one to diagnose them with fibromyalgia, I try to be very careful because I don't want them to think that it's all in your head. Um, no, I, I actually do believe they're having pain from something. I think that science has not caught up to what's happening in their bodies. Fibromyalgia is definitely a dense separate topic, but I did wanna mention it here as a source of chronic pain. And then finally, chronic fatigue syndrome, which, um, I think is gonna, it falls probably gonna be an umbrella diagnosis, but at least currently we consider it as a widespread non localized syndrome where there's pain and fatigue throughout the body and can often mimic other syndromes. Um, so, um, that is sort of the, the brief discussion on chronic pain. And I'm touching on the topics that I see the most. And keep in mind, I'm internal medicine, so if I practice a different specialty, my list might look very different. Like if I was an orthopedic surgeon, my list might look different or, um, even if I were like a, um, gastroenterologist, I may have a different, um, list of, you know, these are the conditions I feel I see the most as far as chronic pain. But in my practice, which is, you know, primary care, internal medicine, these are the things I anticipate seeing throughout my day and the things that I try to keep in mind that, um, we wanna be having a good plan for. Cuz they won't have an immediate fix, more than likely. So thank you so much for joining me for today's topic. Um, for the second of this series, um, it is gonna be, um, approaching chronic pain part two, but I'm gonna start discussing, um, some of the treatment options that come up in chronic pain. And again, because I do feel that this topic is, um, underserved, under discussed and potentially can, can happen to any of us, any of us can suffer a chronic pain that I think it's worth touching bases on and reviewing. So next in this series I'll be discussing, um, treatment options and approach to some of the holistic remedies. Again, thank you so much for joining me. Um, I am a physician full time and I'm a beginning podcaster. Um, if you are enjoying my podcast, I would really appreciate if you could leave a review if you're listening on Google podcast or if you're listening on Stitcher, I would so appreciate that. Um, and also, um, feel free to leave me some feedback. I'll make sure to leave some of my contact info along with my website in the podcast description. So, and time.