The Great Pain Jack

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Contents

Acknowledgments......................................................................vPreface..............................................................................xiChapter 1: A Brief History of Pain...................................................1Chapter 2: Definition and Types of Pain..............................................3Chapter 3: Introduction to a World of Pain...........................................5Chapter 4: Dependence, Addiction, Tolerance, and Pseudoaddiction.....................9Chapter 5: So, You've Got Headache Pain?.............................................20Chapter 6: So You've Got Facial Pain?................................................33Chapter 7: So, You've Got Abdominal Pain?............................................44Chapter 8: So, You've Got Obstetric Pain?............................................54Chapter 9: So, You've Got Pelvic Pain?...............................................60Chapter 10: So, You've Got Neck Pain?................................................71Chapter 11: So, You've Got Back Pain?................................................83Chapter 12: So, You've Got Knee Pain?................................................97Chapter 13: So, You've Got Shoulder Pain?............................................105Chapter 14: So, You've Got Fibromyalgia Pain?........................................116Chapter 15: The Psychology of Pain...................................................128Chapter 16: New Frontiers of Pain Treatment..........................................140

Chapter One

Regardless of race, sex, social status, geographical location, and other factors that divide and separate humanity, pain is something we all experience at one point in time. Thus it is no surprise that since the dawn of time humans have invested so much effort into alleviating and treating pain. Pain is not a unique experience only specific to humans.

In almost all of the animal kingdom, we see pain-generating output as a protective mechanism for survival of the species. For example, if a dog is walking with its owner and accidentally crosses its paw under the foot of the dog owner, the dog will let out a yelp and pull its paw away. This is reflexively accomplished within seconds as a protective mechanism for the animal. The next sequence of events (after the dog realizes it is not mortally wounded) may entail that the dog begins to lick its paw. This action then tells the dog's brain that everything is okay and that the "stomp injury" is merely a flesh wound and not something that needs long-term attention. This extremely adaptive yet simple sequence of events is repeated in the animal kingdom often. The message is that the repair or rejuvenation process is already initiated almost at the time of injury, ultimately to shut down the pain signal. This is one example of how the "great pain jack" occurs in nature.

Unsurprisingly the history of pain management goes back to ancient times. A lot of the early pain relief methods involved religious rites, including prayer and exorcism. Egyptians, for instance, thought of manifestations of pain in a person as possession by spirits.

In China a large contribution to medicine was made by Huang Ti, in 2600 BC, who explored the use of acupuncture in pain treatment. The use of opiates such as opium, for example, due to their anesthetic properties, goes back to ancient times as well, with uses documented in the Trojan Wars in 1220 BC.

Hippocrates, a Greek after whom the Hippocratic Oath is named, focused not on the disease but on the patient—a focus that is prevalent in modern chronic pain treatment. All medical students take the Hippocratic Oath and commit to doing "no harm," though in many chronic pain treatments the opposite can seem to be the case from the patient's point of view.

During the Middle Ages, many of the texts documenting advances in pain management made by the Greeks and Romans were buried and/or destroyed in Europe. However, medical studies flourished in the Middle East, where some of these texts were preserved. During the Renaissance, many of these texts resurfaced in Europe.

Opium was a popular prescription form of pain relief until it was diluted into laudanum, a painkiller used until well into the nineteenth century. Also, during the eighteenth and nineteenth centuries, major leaps were made in reducing pain during limb surgery, resulting in the use of cocaine as an anesthetic. In 1817 pharmacist F. W. A. Serturner made a significant contribution to pain management by creating morphine.

Ether was introduced as an anesthetic in surgery, and by the end of the nineteenth century it was replaced by chloroform. Karl Koller, an Austrian ophthalmologist, explored the numbing effects of cocaine, which led him to discover local anesthesia; that is, instead of the patient going under completely, only the region in need of treatment could be numbed. Koller's contribution to pain treatment was revolutionary and paved the way for the emergence of nerve-block techniques and other modern pain treatment methods.

The twentieth century is marked by many significant medical discoveries and inventions with the sole goal of preserving life and easing pain. Sir Alexander Fleming's discovery of penicillin in 1928, John Hopps's invention of the pacemaker in 1950, Willem J. Kolff's invention of the artificial heart, and the invention of HIV protease inhibitors in the late 1980s and early 1990s, as well as recent advances in genetic engineering and stem cell research, are all milestones in pain management.

Despite all these advances, millions of people all over the world experience acute and chronic pain every year. Their lives often take the form of a struggle from one day to the next, with no hope of relief in sight. Modern medicine has solutions for many of them, but these solutions are useless without a proper diagnosis. The case studies and analyses in this book stress the importance of accurate diagnoses in successful pain-management treatment. If the correct diagnosis and proper treatment is not initiated, "the great pain jack" may be initiated.

Chapter Two

Let us begin with a definition of pain. The IASP (International Society for the Study of Pain) defines pain as: "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

The note at the end of the definition goes on to say that pain "is always subjective." Pain can also exist in the absence of tissue damage, where it takes a psychological form. This book will focus almost entirely on physical pain, though I do use the expertise of a psychologist specializing in "psychological aspects of pain" as part of my treatment team. The mind can often be stronger than the body, and research is bringing new insights into the role of mind over matter.

Physical pain, especially when severe, will often have a serious psychological component and certainly serious mental health issues, not the least of which is dependence, which can arise from untreated and chronic physical pain. For instance, surgery for a defect causing abdominal tissues to descend into the groin area, known as...