Click on the icon below to read about the differences between acute pain and chronic pain. Again, you will need Adobe Reader to view the document. If you do not have Adobe Reader on your computer your can download it for free at www.adobe.com/products/acrobat/readstep2.html.

Please click on the icon below to view a diagram showing how pain has affected the lives of people with chronic pain that we have worked with.

More and more research looks at why a person can have so much pain
wen their doctors can’t find any specific visible problems with their body.

Some of the research that has been especially valuable in helping us
understand chronic pain has suggested that pain is controlled in our
bodies by a series of mechanisms that act like gates. One theory that
has come from this research is called the Gate Control Theory.

Here are a few  things that we know from the Gate Control Theory

• From many years, pain was thought to be felt in the body simply
through the sending of pain messages along unchanging nerve
pathways to the brain. Like a telephone system with a central
exchange in the brain

• However, although this idea made some sense, when we look at
how pain is experienced in reality, it is not explained very well by
this simplified explanation

• One theory that seems to account for a lot of what we see happening in people with chronic pain is the Gate Control Theory of Pain

In its simplest form, the Gate Control Theory of Pain is as follows:

• Nerves from all parts of the body run to the spinal cord which is the first main meeting point for the nervous system. Nerve impulses are carried from the injured body part or disease to the brain through the spinal cord

• Some of the cells in the spinal cord act like gates

• The spinal cord is thought to have a series of gates into which incoming pain messages pass from all over the body

The kind of messages that come out from the gates to reach the brain depends on a number of other factors:

• If the gates are more open, lots of pain messages pass through to the brain and the person experiences high levels of pain

• If the gates are more closed, fewer messages can get through and the person experiences less pain

The gates can be open or shut by different amounts, allowing various amounts of pain to be experienced. These gates can also make the pain message stronger and increase the signal of pain

 

 

There are many interesting examples of how changes in the spine and brain lead to change in a person’s pain experience:

• Phantom pain: Some people continue to feel pain in their arm or leg even after that arm or leg has been amputated. This is
called phantom limb pain and happens because of changes in the spinal cord and brain

• Some people like soldiers wounded in a battle or athletes injured in a big game, may not even notice the pain from their injury
until much later

The nervous system is divided in two:

1. The Central Nervous System (CNS)

This is the largest part of the
nervous system. It includes

• The brain

• The spinal cord

There are three primary analgesic classes used in Multidisciplinary Pain Centre:

Opioids

A family of drugs that reduce pain by working on special pain receptors in the central nervous system. Codeine, Morphine, Methadone, Fentanyl, and Oxycodone are all examples of opioid drugs

Non-opioids

These types of drugs work more directly on the injured body part. They work as an anti-inflammatory and also decreases pain. Examples of non-opioid drugs are Acetaminophen (Tylenol), NSAIDs (Aspirin, Naproxen, Ibuprofen) and COXIBs (Celebrex)

Adjuvants

These are drugs that weren’t designed for pain relief, but that improve pain as a side effect. Examples of adjuvants are antidepressants (Elavil, Zoloft), muscle relaxants (Robaxin, Norflex), anticonvulsants (Gabapentin), and anti-anxiety drugs (Diazepam, Xanax)

C

C

C

Many medications are prescribed to chronic pain patients as part of their treatment. Some people hesitate to take pain medication because they fear addiction. It is important to clarify what addition is and what it isn’t.

Read the definitions for Physical Tolerance, Physical Dependence, and Addiction on the next page. It is important to be able to tell the difference between each of these

Physical Tolerance

When your body has adapted to a drug and it doesn’t seem to work as well over time. This doesn’t mean your body is addicted; it only means your body has built up a tolerance to a certain dose of medication. A common result is that a person’s dose of medication needs to increase to have the same effect

Physical Dependence

When your body feels like it doesn’t work properly without a drug. When you stop taking the drug you have withdrawal symptoms and you feel sick without it. This usually goes away after a few days and it does not mean that you are addicted to the medicine

Addiction

A constant use of habit-forming substance where the user knows it is harmful but still uses it

Unless you have a substance abuse problem to begin with, you are very unlikely to
become addicted from taking prescribed pain medications

The 3 C’s of Addiction

Loss of Control

Compulsive use

Consequences (use despite harm)

These are the 3 common signs that a person has an addiction problem. You could be addicted if you:

• Use a drug despite the consequence

• Show no control over how much medication you can use

• Use as much medication as you can as often as you can

If you feel like this has happened to you, please talk to someone who can get you some help. You can find some helpful phone numbers by clicking on the red phone icon in the lower left hand corner of the website.

For more information on the differences between addiction, physical tolerance, and physical dependence, please click here.

There are many common thoughts about chronic pain and it is not easy to know which ones are true and which ones are false. You may have heard certain things about chronic pain or maybe you are experiencing your own difficulties. Relying on false information can be serious and may lead to dangerous situations.

Please click on the icon to see a list of common thoughts on chronic pain and see whether that statement is true or false. You might be surprised about certain answers; it helps to read the explanation to see why that common thought turned out to be either true or false

Did you know?

For some interesting statistics on chronic pain, please look at the following findings gathered by Statistics Canada. You might be surprised!

In terms of health care dollars, chronic pain ranks higher than the cost of cancer and heart disease combined

Back problems and arthritis or rheumatism are the leading conditions associated with chronic pain

Chronic pain is the most frequent cause of suffering and disability that seriously impairs quality of life

Almost 3.9 million (17%) of Canadians over 15 years old experienced some chronic pain or discomfort in their lifetime

Click on the video to hear more

Kelly picks a problem to work on...

When I am in pain I can’t help but feel tense and when I feel tense, my pain
gets much worse. I don’t know how to stop this cycle!

Now that you have read the Picking a Problem section, start thinking of ways that you may be able to solve the problem you picked in this section.

Click on the icon below to access the worksheet for this section. Note: All the worksheets, checklists, diaries, and pain scales inserted in the chapters are for your use only. If you would like to advise or want to show these to a health professional, please feel free to bring a copy to your next appointment at the Pain Clinic.

 

Picking a Problem - Worksheet

Now that you have picked a problem to work on, it’s time to decide what to do. Ready... set... action! In this section, the second section of PACE, we will look at things you can do in your everyday life to help improve your quality of life.

Remember earlier in this chapter, there was  a section that talked about Pain Gates and Gate Control Theory of Pain? Now it’s time to apply your knowledge. Click on the icon below for a list of different factors that can open and close the pain gates.

Here are some techniques that may help you close the pain gates. Try some of them and see if they reduce the pain that you feel:

Massage

Gentle massage or stroking can be very calming and soothing when you are in pain. There are many specific methods of massage, but it is best to do what you find most effective.

Heat and Cold

Both heat (like a hot water bottle, or heating pad) and cold (like an ice pack) may relieve pain. As with all suggestions, be sure to ask your nurse or doctor first whether you can use this method to help relieve the pain.

Prescription Medications

Always remember to take pain medications as prescribed by your doctor. Pain medication is most helpful when it’s taken regularly. If you are not getting good pain relief from medications, it is important to discuss this with your doctor. It can sometimes be hard to measure what good pain relief is, so you may want to use the number scale found at the end of the chapter.

We identify 11 essential steps to help you find control in your life
and not let pain take over. All of these steps are covered
throughout the Pain 101 program.

Kelly takes action

I asked my doctor why I am still experiencing pain when my accident
happened so long ago. He briefly explained that I am experiencing chronic
pain and gave me some pamphlets and a list of book references I could read
to better understand my condition. My doctor has also referred me to a pain
centre where health professionals give me advice on pain management and
inform me about different pain treatment options.

Now that you have read the Acting upon your problem section, start thinking of ways that you may be able to solve the problem you picked in the last section.

Click on the icon below to access the worksheet for this section. Note: All the worksheets, checklists, diaries, and pain scales inserted in the chapters are for your use only. If you would like advice or want to show these to a health professional, please feel free to bring a copy of your next appointment at the Pain Clinic.

 

Acting Upon the Problem - Worksheet