Is it possible to develop chronic pain without having had acute pain?
Just spontaneous, ongoing, slowly developing chronic pain?
The answer is yes.
Actually, many people with chronic pain do not remember a specific date that their pain
started.
They can’t relate their chronic pain to an injury, an accident, or a disease.
It just started like that, gradually, insidiously, slowly.
So, why does this happen?
Can this type of pain be diagnosed sooner than later?
Can this be prevented?
Is the treatment better if it starts early?
So, let’s talk about chronic pain with a gradual beginning
Let me start by saying that pain is a very complex phenomenon.
The scientific community is still discovering mechanisms that trigger pain sensations.
When someone says “I am in pain”, what is exactly the meaning of that?
We all have experienced pain in our lives, except for some humans who were born with
a genetic disorder that they are incapable of feeling pain, and they don’t live long
lives because of that.
Chronic pain means that the person has constant, ongoing, persistent daily pain for 3 months
or more.
In the medical community, when we see a patient with pain, acute pain, chronic pain, any pain,
we want to find an injury, a disease, or a lesion, because that is the easiest thing
for us.
We remove the cause of the pain and the patient feels better, is happy, and leaves.
Next patient, please!
But pain is not that easy.
First, even when we identify the cause of the pain, the treatment that we propose may
cause more damage and more pain.
An example is surgery.
If someone has an acute pain, let’s say inguinal hernia, a disc herniation, or a broken
bone.
The surgeon will try to fix the cause of the pain, but in turn, the patient may develop
persistent post-surgical pain.
This is not so rare.
Every year, thousands of people develop chronic pain after surgery.
I have another video about that.
Can we identify a cause for the chronic pain in every single patient that comes to our
office?
The answer is no.
There are some people that have no idea how their pain started.
It just started.
In the medical community, we are puzzled too.
We wonder if we are missing a cause, an obscure diagnosis, something super rare, and we certainly
do not want to miss a condition like cancer, infection, nerve damage, fracture or inflammation.
So, fortunately, these serious conditions commonly have other symptoms, other features,
other signs, and we can detect them by talking to the patient and asking some questions,
examining the patient, and ordering some tests.
But, when we can’t find a cause we wonder what else could it be?
Then, we look at features of nociplastic pain.
If the pain is caused by a malfunction of the pain system, then we know that we need
to retrain the pain system.
I have another video that I explain the 3 types of pain: nociceptive, neuropathic and
nociplastic.
Basically, nociceptive pain is when pain is a normal response to an insult to the body,
something that is perceived as dangerous, like a burn or appendicitis.
Neuropathic pain is pain from an injury or disease to the peripheral or central nervous
system.
And nociplastic pain is when the pain is not nociceptive, it is not neuropathic, and it
is a malfunction of the pain system, it is an altered state of nociception.
In the analogy of the alarm system that I like to explain, nociceptive pain is equivalent
to a house fire, you call the firetruck.
Neuropathic pain is equivalent to a short-circuit of the alarm wires, there is a false alarm
because you opened the kitchen cupboard.
You need to fix the wires.
And Nociplastic pain is when there is no fire, the wires are all good, but the alarm system
is malfunctioning, the volume of the siren is too loud, or the alarm is going off all
the time for no reason.
What you do?
You call the alarm company and they come to fix the alarm system.
In this case, you don’t call the firetruck, and you don’t replace all wires and sensors.
You just need to regulate the alarm system.
So, in many cases of chronic pain, the pain can be nociceptive, neuropathic, nociplastic,
or mixed.
Before I continue, please remember that this video is for educational purposes only and
is not intended to replace medical advice, and if you have pain, please talk to your
doctor.
If there is an emergency please go to the nearest emergency department or call an ambulance.
So how do you know if a person has nociplastic pain or not?
There are questions we ask and suggest nociplastic pain.
There are specific clues in the physical examination that will show the person has nociplastic
pain.
There are patterns that we recognize, and these patterns point to similarities in symptoms
and signs.
The classical example is fibromyalgia.
More than half of patients with fibromyalgia cannot identify a cause for their pain.
It is impossible for them to know the exact day that their pain started.
If you are a healthcare professional and you want to learn more about how to diagnose nociplastic
pain, I have a free gift for you.
Check the link in the description of the video below, and download the Handout “How to
take a pain history of your patients”.
I use this form in my own practice and it helps me to identify patterns of pain.
Once I have these patterns in my memory, I can use them to correctly diagnose patients
with nociplastic pain.
You don’t need to guess anymore.
You are not going to tell your patient “I don’t know what you have, so you must have
nociplastic pain”.
No, that is not the right diagnosis.
The correct diagnosis of nociplastic pain is by, first, excluding any nociceptive or
neuropathic pain, and second, looking for clues in the history and physical examination
that will show you patterns of conditions that are nociplastic.
For people with nociplastic pain, they need to understand that for us, physicians, it
is not easy too, and that these concepts are currently not taught in most medical schools,
nursing schools, pharmacy, physiotherapy, psychology, etc.
So, we need to work together to bring neuroscience education to healthcare professionals all
over the world.
It is really important that people with chronic pain, especially nociplastic pain, are correctly
diagnosed and as soon as possible.
It is possible to retrain the brain even after 30, 40 or 50 years of chronic pain.
I have seen that.
But it takes more effort, it takes longer and what is sad is that the person could have
lived a better quality of life for so many years.
I have other videos that I talk about pain retraining, but basically, they involve movement
for the body and mind exercises.
At the present we don’t have good medications to eliminate nociplastic pain.
Antidepressant and anticonvulsant medications help with the other symptoms that the person
may have: sleep problems, anxiety, and depression.
Sometimes we need to combine medications to treat an ongoing nociceptive pain, like an
inflammatory arthritis, or a neuropathic pain, like a post-herpetic neuralgia.
But to retrain the pain system, to revert nociplastic pain, the best treatments that
we currently have are exercises for the body and for the mind.
If you liked this video, don’t forget to give your thumbs up here and subscribe to
this channel.
Good bye