Understanding Chronic Pain

Identifiers and Risk Factors

[From Chapter 3 of Understanding Chronic Pain]

A curious attribute of patients with chronic pain is their tendency to develop different expressions of their illness. They often suffer multiple painful diseases simultaneously. For example, the concurrence of the irritable bowel syndrome, fibromyalgia, and tension headache in a single patient is not uncommon at all! There is an enormous overlap among the different syndromes of pain. Rather few of them are clear-cut, distinct entities. They often coexist with one another, and they often evolve one into another.

A woman with a ruptured lumbar disc comes to surgery but fails to recover. Her low back pain continues. With time, she begins to experience pain in her mid-back and shoulders. No cause can be found. She is accorded the diagnosis of fibromyalgia. Further along, she begins to suffer chronic pain in the neck and head. She is then accorded the diagnosis of tension headache. This type of scenario plays out again and again. It is the destiny of many patients to suffer not just one, but multiple painful diseases. The reader with chronic pain will, I am sure, attest to the validity of this statement. What does it all mean? Does it represent just a run of bad luck in the unprivileged few, or does it occur by some biologic design?

We are not going to understand the nature of chronic pain by dissecting and analyzing its component parts. The study of painful disorders such as headache and fibromyalgia, the delineation of their clinical boundaries and the features that make them distinct illnesses, is certainly a worthy endeavor, but it is not the object of this book. The most remarkable feature of these and other painful diseases is not how different they are from each other, but rather how much alike they really are. There is a master template, a biologic design, which dictates their several behaviors. Therefore, we will abandon the notion that patients with chronic pain suffer several different diseases and say simply that a singular characteristic of chronic pain is its capacity to spread beyond the site of its origin. This is not nearly as fanciful as it might seem at first pass.

The pain of acute cardiac injury, a heart attack, is often felt in the arm or in the jaw. That of pancreas inflammation may be felt in the back and that of gallbladder disease in the shoulder. All of these represent, of course, the referral of pain. It should take no leap of imagination to accept that chronic pain may also be referred. It moves and spreads, almost invariably, to other body parts and in a very unique manner.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:07 AM

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What is Chronic Pain? Mind-Soul Disease