Unlike acute pain, such as from a sprained ankle, chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. What causes chronic pain? While we are still working to fully understand this condition, clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid. Endorphins are hormones that reduce the sensation of pain and affect emotions.
“The spinal cord and brain set the volume control on whether people will feel pain and, for people with chronic pain, the volume is turned up too high,” says Daniel Clauw, M.D., a professor of anesthesiology and director of the Chronic Pain and Fatigue Research Center at U-M.
Dr. Clauw talked with mCancer Partner about managing chronic pain; his remarks may also help people whose pain comes from cancer.
mCancer Partner: What causes chronic pain?
Dr. Clauw: There are three different underlying mechanisms for chronic pain:
- Inflammation or damage to peripheral tissues
- Nerve injury
- Brain or spinal cord amplification of pain
There is also a familial or genetic connection to chronic pain. In addition, severe, early life trauma can contribute to chronic pain so that, once the traumatized children become adults, their volume control ‘set points’ for how the brain perceives pain are turned up. And once you have chronic pain, it feeds upon itself in a vicious cycle. It increases your stress level because you can’t do what you want, the stress contributes to more pain and to sleep loss, which causes further pain, etc. So there are consequences to pain that need to be managed, too.
mCancer Partner: How can chronic pain be treated or managed?
Dr. Clauw: Sleep and exercise are the most potent treatments for controlling pain sensitivity – they help to lower the volume control setting on what the brain recognizes as pain. There are also drugs that work on the brain to affect the volume control.
mCancer Partner: Can people learn to manage their own pain?
Dr. Clauw: Yes, through education, exercise, cognitive behavior therapy and other forms of complementary medicine. I give a free, two-hour lecture and workshop each month on managing the pain caused by fibromyalgia, but the information is applicable to chronic pain caused by other conditions, too. Our research group also has a wonderful patient-focused website chock full of valuable information. Again, although it addresses pain caused by fibromyalgia, anyone with chronic pain can benefit.
mCancer Partner: Does exercise have to be in the part of the body having pain?
Dr. Clauw: No, in fact, just the opposite. Choose an aerobic exercise that uses different parts of the body than what is having pain. Aerobic exercise, which increases your rate of breathing and circulates more oxygen through the blood, release endorphins into the bloodstream. These bind to the same brain receptors that the strongest narcotics bind to. So use the parts of your body that DON’T hurt, and the endorphins will positively affect your brain while not contributing to more pain in the painful place.
mCancer Partner: Does meditation help?
Dr. Clauw: Yes, and that goes for yoga, tai chi and similar meditative exercises, too. Doing them turns down the volume control in your brain’s pain center. Also, believing your pain will get better works, too. Conversely, if people think they WON’T get better, then they won’t.
mCancer Partner: How can a person tell if the pain is acute or chronic?
Dr. Clauw: It’s not necessarily an either/or situation. People who are experiencing a physical, pain-causing condition may ALSO have chronic pain. A good pain expert can help sort things out and make sure that both conditions are being treated appropriately.
mCancer Partner: People may not be aware there are medical experts who specialize in pain management. How can people get access/know about experts like you, with a specialty in pain management?
Dr. Clauw: A lot of primary care doctors are good at management of pain. But beware of the people who bill themselves as ‘pain management specialists’ with minimal training. Their goal may be to make money off continual treatments such as injections, rather than actually managing patients’ pain. There are a couple of good pain clinics in Michigan, including here at U-M, where our doctors generally are not getting paid extra for what they prescribe.
Talk to your doctor about managing pain or call the U-M Cancer AnswerLine at 800-865-1125 to speak with a nurse.