Category: pain

Pain Breakthrough

The problem disks!
The problem disks!

Let me tell you a little bit about my last 3 years…

It all started January 2011 when I tripped on the steep stairs of my Dad’s rental property putting away Christmas ornaments.  Because I was holding the ornaments I couldn’t catch myself and slammed head-first into the wall at the bottom of the stairs.  It knocked the wind out of me and I couldn’t move.

It was terrifying because nobody knew I was down there and I didn’t good reception down in the basement (don’t get good reception in Suncrest period).  When I did get through nobody was answering their phones.  I finally got a text out to an interested tenant who was coming to look at the house.  I told him ‘please come help me’.  Thankfully he did and we were able to reach my Uncle Jon and go to the emergency room.

https://smilingldsgirl.com/2011/01/08/the-big-fall/

Dr #1

They took an xray at the time but it wasn’t a very accurate one.  I was in so much pain I couldn’t lift my hands above my head without literally screaming.  They said it was just muscle pain and I should push it as much as possible for it to recover.  They claimed the last thing I wanted to do was rest, so I worked hard and yet the pain persisted.

Dr #2

My body got more achy as the days persisted and so I went to my regular care doctor.  He was at least honest with me and said he had ‘no idea’ what was wrong.  I felt achy in my ribcage, lower back, and my exercise recovery was terrible.  I would spend hours in bed sometimes after a simple workout.

Dr #3 (and 4)

I was assured by so many people that it was just muscle aches that I wondered if it was some kind of flare up with my PCOS.  I had been seeing an endocrinologist in Salt Lake but I wasn’t very happy with him.  He treated me like a drama queen and didn’t answer my questions.  Based on one blood sugar reading after I’d had candy he said I was diabetic, freaked me out (I cried) and then retracted it the next time saying it was just so he could prescribe me the right medicine (which I hated see Victoza is Evil) I still can’t believe he would make up a diagnosis just to give me some prescription.

Then I found a new endocrinologist that I loved.  He would talk to you for literally an hour.  Unfortunately he shut down his practice because of Obamacare (his letter said it not me).  Sigh…

Dr #5

Because I was feeling pain in my ribcage I along with my back I wanted to make sure it wasn’t something serious like cancer.  I decided to try an internal med doctor and she was pretty good.  We did do an MRI and that’s where we figured out about my ‘healed fracture’ to my thoracic spine. I thought this might have been the trigger for the chronic pain (usually is a trigger for it).  Then we tried some thyroid meds and they seemed to help a lot.

It was actually a nurse practitioner at this doctor’s office that I loved.  She had fibromyalgia herself and so she understood chronic pain.  Was very sympathetic and thorough (we tested for everything).  I also refused to take pain meds because I didn’t want to get hooked on anything.

Well, just as we were making headway they fired the nurse practitioner and the doctor tried to prescribe a weight loss drug and didn’t tell me that it was also used to treat epilepsy and could lead your brain to be foggy and unclear….That was the end of that  doctor for me.  I couldn’t believe she wouldn’t tell me something like that.

I refuse to take medicine that alters my brain.  I respect those who make that choice but it is not for me.

Dr #6-

http://utahchronicpain.com/

In May I saw an ad for a place called Utah Chronic Pain Center.  They said they treated the patient from the inside out and that you got 2 free laser massages to try it out.  I figured why not? I went in a little skeptical but I learned that it was doctor supervised not some hippy mumbo-jumbo.

What impressed me the most was their dual approach. We did all the normal blood work, increased my thyroid meds to a more aggressive approach and started a treatment with laser massage, compression and other techniques.  It was hard but almost immediately I sensed a difference.  I started going 3 times a week, than 2, and now 1 time; however, if I miss that 1 time like I did on my trip to Cali I have serious pain.

In fact, I was having so much pain after Cali that Dr. Luddington suggested I get some x-rays just to rule certain things out like scoliosis. I went to the US MRI and the xrays only cost me $65 (I don’t have pre-existing condition coverage from my job with Poler until November).  Isn’t that a good deal?  We did 4 x-rays and they put it on a cd-rom for me to take to the dr.

back2

Today I went for a treatment with Dr. Luddington and looked at the x-rays.  The treatment went way better than last week (amazing what a difference it makes if I miss one).  After examining the x-rays he showed me how the disk in the lower back did not have the fullness of the other disks and that they were ‘degenerative’ meaning basically they had been flattened by an extreme event- like falling down a flight of stairs.  This had led to the chronic pain.

The good news is the doctor is confident if I keep with the treatment, keep swimming and stretch like I should than it will continue to grow and heal.

But just think what this means for a second- we now know for sure that I fractured a bone in my upper back and hurt a disk in my lower back and yet I kept on training?  How crazy is that?  Who says this girl can’t handle some serious stuff…

So now I’m armed with knowledge and a doctor that will treat me as long as I need (you pay up front for treatment until you are pain free!). I also have the comfort of hearing a doctor finally say

“So all that time you weren’t making it up.  You were really in pain”.

I really was.  I knew it.  I was just waiting to find someone who believed me.

Oh and I also had surgery on my eyes twice during this time.  Mama Mia!

Have any of you experienced this type of injury or related chronic pain?  What has helped you?  I’d love to hear your stories.

And to all you doctors maybe you should treat people like they are real human beings and believe them when they say they are hurting.  They aren’t drama queens and they don’t need you making up diagnosis, prescribing them weight loss drugs, telling her she needs gastric bypass and treating her like a child.  This is not an assembly line no matter how many patients you see a day.  This is 3 years of my life.  3 years!

Have any of you experienced this type of doctor drama?

 

Disneyland Day 3

Some things you might not know about me from reading only this blog- I have hard time being happy (even in the happiest place on earth) when I am A. Tired, B. Sore, or C. Hungry.  I realize this may seem very ‘first world’ of me but there you go.  We are all weak in our own way.

Well, today started out pretty good. I was feeling strong after my relaxed day yesterday and ended up spending the morning alone at California Adventure.  I like spending time by myself.  I like that nobody can hear me groan and I can go at my own pace, eat what I want, do what I want.  I suppose this is slightly unhealthy of me but again that’s the way it is with me!

Meeting the big man himself.
Meeting the big man himself.
At Muppets 3D.  Don't I look Judge Dredd?
At Muppets 3D. Don’t I look Judge Dredd?

So everything was going well and then after a few hours my feet were beginning to hurt and I headed over to Disneyland to meet up with my sister and Mom.  I waited for the omnibus which was taking forever.  Then I decided to take the train and as I was traveling realized I didn’t have my cell phone.  I had to wait until the train stopped, walk back to the omnibus area and it wasn’t there.  (It was also close to 100 degrees plus humidity!).  I went to lost and found and spent time filling out a report with a rather unhelpful lady (and very hard to understand).

I also didn’t know my sisters cell phone number or I would have called her to meet up.  My Mom didn’t have her phone.  Anyway, I had no idea what to do. Then we called my Dad ( I realized I only have 4 phone numbers memorized.  Not good!).  He was able to reach Madi’s phone and she actually had my phone!  I guess someone had found it and called the last number which was her.  Thanks kind stranger.

Anyway, I was pretty stressed out and then when I went to get back into the park I couldn’t find my ticket.  Despite taking a photo of me and stamping my hand they still require a ticket. Sorry Disney but that is dumb!  The whole situation made me cry.

tears
So that’s what I look like when I cry friends

A lot of this has to do with my frustrations over my pain and my unmet expectations of training and working hard on my physical fitness.  I was hoping to have more energy and fun this trip.  It was very disappointing.

So that was the drama for the day (worthy of a Disney movie right?).  Don’t worry though. It got better quick.

A smile back on my face
A smile back on my face

I’ve learned from this trip something about myself.  I like vacations where I can sleep, reconnect with myself and soak in sun (and swim as much as possible).  My Mom referred to Disneyland as a ‘walking vacation’.  Here’s what I now know:  I don’t like walking vacations.  I like sleeping vacations.

My style of vacation
My style of vacation

Good thing to learn about myself right?

So, I don’t want you all to think I didn’t have a good time or am ungrateful because that’s not true.  I did have fun.  I am grateful, especially for my Dad, everyone at Poler and my roommate for making this all happen.  Thank you so much!

Now tomorrow I’m going to the beach.  HURRAY!!!!  I can’t wait.

So you’ve got to keep learning and growing.  Hope you are all doing well.

 

 

 

 

Rest Day at Disney

So I’m here in Anaheim for my first vacation in 3 years.  Yesterday I had a fun day at Disneyland but was pretty exhausted and my feet hurt very badly.  My back had also been seizing up on me.  Normally in my training I can take a day off to recover after a day on.  Walking all day is one of the hardest things for me.  I would much rather swim a 5k than stand and walk for hours.  Strange I know but its true.

I woke up this morning and knew I was in trouble.  I was in a lot of pain and didn’t want to move out of my bed.  Even my new shoes weren’t helping much.  I honestly thought about getting a scooter but that felt so embarrassing.   Plus, I’d worked so hard and was frustrated that nothing seemed to be showing from it.  I had gotten the whole inspiration to get in shape from going to Disneyland in 2010 and having so much feet pain. I thought that if I got in shape I would be able to do better but it didn’t work out that way.

I guess I just have bad feet and walking all day isn’t my thing.  I’ll swim all day instead!

Anyway, I was at the park until about 2 pm and went to the hotel and honestly felt really discouraged.  I was in pain and discouraged about it.  I felt like a failure and a little judged, not by family but by the nameless masses at Disneyland (I realize that is ridiculous but sometimes we are ridiculous!)

After a little cry I went for a swim with my Mom and that made me feel much better spiritually and physically.  Then I said to myself ‘I wish I could have a massage right now, especially on my feet.  Then I said ‘maybe I can?’  I did a quick google and found a service that did door-to-door massages and the price was reasonable.  I made the appointment and they came at 5:15.  It was an hour long and the best massage I’ve ever had.  It was deep and strong but so great.  I felt near-comatose after, so relaxed.

Me in relaxed state!
Me in relaxed state!

Then I ordered thai food and relaxed the rest of the day.  I feel like I’ll be ready to go for tomorrow.  Wahoo! I realized something about myself.  If I’m going to have fun on vacation I need to plan a day on full of busyness, a day off relaxing, repeat.  I think that will be true no matter what shape I’m in.  When you have chronic pain that’s the way life is.

So I may have wasted a day at Disney but I don’t see it that way.  I learned something about myself and had the day I wanted to have.   Its my vacation and I have to take responsibility for having a good time.  That’s the way it is! Live and learn.

 

 

 

Disneyland Day 1

So we had a successful day in Disneyland.  I was amazed at how much we go through in 1 day.  I honestly did almost every ride I wanted aside from the one’s that were closed (thunder mountain railroad and haunted mansion are closed 😦 ).  Its hard for me to stand and walk for hours.  I was hoping as I got in better shape that would improve but it really hasn’t.  In fact, if anything its gotten worse as my pain sensitivity and fibro has increased.

Tomorrow I plan on taking things more slowly with breaks.  I also bought shoes today that should help.  I just wish my feet and back weren’t so sensitive.  It would make things like this a lot more fun.

It was also super hot today.  99 degrees with high humidity.  Made the whole day challenging for me; nevertheless, it is the happiest place on earth and my first vacation in 3 years.  Still had a great time and am very blessed.   The prices also seemed more reasonable than I remembered them. I don’t know if that is because everything else has gotten more expensive or prices at Disney have gone down. Either way it wasn’t too bad.

Here are some photos of the trip so far.

Madi, Sam, Rachel
Madi, Sam, Rachel
Sam was a sweetie and carried our stuff in his backpack.
Sam was a sweetie and carried our stuff in his backpack.
My BYU shirt actually got a lot of questions and comments.  Go Mormons!
My BYU shirt actually got a lot of questions and comments. Go Mormons!
It was so hot had to get ice cream
It was so hot had to get ice cream
dole whip. Only other place you can get them is the Dole Plantation in my beloved Haleiwa. Been dreaming about them.
dole whip. Only other place you can get them is the Dole Plantation in my beloved Haleiwa. Been dreaming about them.
Entrance to park
Entrance to park
3 Wagner girls
3 Wagner girls
Mickey Mouse!
Mickey Mouse!
Minnie
Minnie
Brother and sister
Brother and sister
Hurray comfortable shoes!
Hurray comfortable shoes!
Madi and I.  Her feet weren't as big a problem and she could have gone 24 hours at the park. Sigh...
Madi and I. Her feet weren’t as big a problem and she could have gone 24 hours at the park. Sigh…
the girls at the castle
the girls at the castle
Yeah, space mountain kind of whooped me.  I'm not as young as I once was
Yeah, space mountain kind of whooped me. I’m not as young as I once was

 

April Randomness

Here’s one of my random posts!

FOODSAVER

My new freezer is awesome but I also tried out my foodsaver for the first time this morning.  I got a great deal and am excited to add it to my garage of culinary gizmos.  There’s just something about seeing vacuum packed food that makes you feel like you’re in the future!

My first saved food!

I’m hopeful that the eggs will stay yellow with the air being sucked out.  I’ve had bad luck with freezing eggs.  They get kind of gray and gross.  It makes cooking breakfast in advance hard and I hate cooking breakfast.

The limes and peppers are leftover from my last bountiful basket.  I hope to use them for salsa and hopefully there will be tomatoes in the next basket, which I am getting on Saturday!  My friends Erin and Kate are splitting 2 baskets with me. Oh la la!  It is really exciting to wonder what you are going to get and everything has been so delicious the anticipation is palatable!

(Using the foodsaver and freezer supposedly food can last for 2 years! This should save me a lot of money throwing away uneaten food).

DOTERRA

I have mentioned it a few times but in recent years I have become a fan of essential oils, particularly from Doterra because their oils are not merely aromatic.  They help me with my pain, ward off illness and even boost my mood. I used to have a roommate who was super into essential oils and it drove me crazy so I will spare you a spiel.  I just wanted to share a new idea my friend Jill told me about.

With a low thyroid I get dehydrated more quickly so I have to focus on drinking lots of water.  My new trick is to put Doterra lemon/lime oil in my water and it is sooooo good!  Its so much better than a wedge of lemon or lime.  Its sweeter and less bitter than you’d expect.  Its really delicious.

BADGER RUB

On a related note I have found a rub for muscle relief I love.  Its called Badger Sore Muscle Rub.   It’s one of the only muscle rubs I’ve tried without menthol which provides mostly placebo relief.  Essential oils are great but sometimes too strong for use in public.  Badger rub provides relief but it smells nice and lemony, not overpowering.  The little container goes a long way and at $10 its a great price!

I could easily wear this to work or around town and nobody would notice anything offensive.  Its a wonder product!

Back in the Pool

Today I am tired and sore but glad to be so.  As I was working on my diagnosis I didn’t want to muddle my chronic pain symptoms with exercise related pain so I held off of any hard training.  This means its been a few weeks since I did a serious swim- really since the QUAC swim.  QUAC was awesome but it was very tough to recover from.   I think because I was going through other stress and the gnawing pain in my ribcage (which in itself is a stressor) it made the recovery more difficult.

Anyway, I wanted to be able to tell my doctor for sure that the pain I was feeling was the chronic pain, not something from exercise.  Also with labs and doctors visits I had to be careful to get my work hours in and that left less time for exercising; however, after a promising week of results with  my thyroid medicine I felt like I was ready to get back to training. As much as I moan and groan about workouts I really do miss them when I can’t do them anymore.  Especially swimming.

Today I met with my swim coach for the first time in over a month (crazy how fast the time goes!).  He gave me a good workout- 1500 meters with intervals (250m fast, 250m slow, 200m fast, 200m slow…all the way down to 50m).  It was intense and my arms felt heavy but it was awesome!

Back in the pool! My face was so red after the workout. Something about these post-workout photos I love

There is something about diving into the water that I find so therapeutic.  There is a peace in the white noise of water that I love.  You can scream under water and nobody knows. I find the minute I dive in my mind becomes clear and the repetition of the strokes allows me to mull over the problems in my life.   Most importantly my body floats away, the pain with it.  I don’t feel like a heavy girl in the water.  I feel like I am flying!

It was great to get back in the water!  Tomorrow I meet with my trainer, thursday swim with my friends and Saturday I am taking boxing lessons!  I’m so excited about that!  Yes, I’ve always wanted to take boxing lessons!  There is a gym in Salt Lake that teaches boxing classes just for women.   http://www.boxingisforgirls.com. I think it will be awesome.  I took self defense at BYU and loved it. So, take notice and don’t tick me off in the future.  I will be trained! 🙂

I got my first bountiful basket this Saturday!  It was delicious! I’ve been enjoying the oranges this week and all the yummy vegetables.  I made corned beef and cabbage on Sunday and that was yummy (my fridge is now stuffed with crockpot meals I’ve made the last few weeks!).   Today I had a steak.  My mother can not make steak.  Cooks it to death.  Once I learned how to make it right I love it! Its expensive and high in calories but for an occasional indulgence Ok. Especially after my intense swim.  Don’t get too worried because with all my delicious veggies I made a massive salad to go with the steak!

There is something better about carefully selected produce.  You don’t really realize it until you try the good stuff and there is such a difference.  Yesterday I had dinner at Anna’s and she made ginger ice cream.  With the fresh grapefruit and orange sections the citrus and ginger combined well, creating a delicious dessert.

My friend Kate and I decided we will do the baskets every other week.  For $20 how can you go wrong?  (We split the box equaling $21.50 per person). This week they had special pineapples to order.  Hope they will have something like that next week.  Yum!

Interesting Results and Hope

So this blog has road the ride of my crazy health the last year and a half.  In addition to the struggles of getting in shape and losing weight, I’ve faced borderline diabetes, PCOS, a fall down a stairs, unexplained ribcage pain for over a year, possible fibromyalgia and more.  I’ve had a hard time finding a doctor I can trust.  Because I was having so much ribcage pain I decided to go to an internal medicine doctor in August.  Dr.  Ling in American Fork.  Between her and her nurse practitioner Sarah Smith we have made headway.

Yet, still the pain persisted.  Finally Sarah ordered 14 tests last week and xrays. She said ‘we are going to test everything!’.  I really appreciate her investigative spirit.  I find this is the rarest but greatest trait in a medical professional.  I was going to meet with her next Monday but the anxiety (and pain) was making me crazy and I couldn’t take it another week.  So, I called and met with Dr.  Ling today.  I went in anticipating a ‘all your tests were normal’ response but after talking to the doctor she revealed some interesting results:

Low Thyroid level

Low vitamin B12

Low vitamin D.

(By the way this doctor’s office gives you a print out of notes from your visit. How great is that!)

I had been taking a B12 vitamin but evidently you need to have a sublingual pill for true absorption.  This is kind of like a melt-away.  You put it under your tongue and wait 30 seconds to swallow and it absorbs the vitamins into your blood stream faster.

I also got a thyroid med and a prescription vitamin D.  I had no idea before today that these deficiencies could cause pain. She said the pain meds don’t work very well because its not a muscle strain in the traditional sense.  It has more to do with the nerves and endocrine system.

I had also been tested for thyroid problems many times but evidently those ‘normal’ results needed to be dug into more completely. I’ve also learned there are 3 tests not just one TSH/T4/T3. Perhaps that test was done before.  Who knows.  All that matters is we had results now and we’re trying something out. That feels exciting! (I really feel like I should get an honorary medical degree after this year!).

Even if this isn’t the full answer I just feel excited to have a doctor who is asking questions and helping me figure things out.  I will meet with her again in 6 weeks, repeat the tests and see how things are going.  As I was leaving she said ‘I hope you feel better’.  I said ‘That’d be great but I really just want to know what it is I’m fighting against’.

We will see but I have hope and feel more encouragement than I have in over a year.  Still have the pain but at least some of the anxiety about the pain has lessened for the moment.

Will be sure to keep you posted! Anyone who has experience with any of these 3 deficiencies I would love to hear them.  Thanks in advance and thanks to everyone for all your support during this insane year and a half.

Please continue to keep me in your thoughts and prayers. What a journey! I feel exhausted just thinking about it.

Chronic Pain

Ribcage pain! The bane of my existence. The great mystery

“[Pain] removes the veil; it plants the flag of truth within the fortress of a rebel soul.” CS Lewis

So we are still diagnosing my pain and I haven’t given up on finding a solution.  However, I have been living with this rib cage pain for over a year and learned a few things along the way. Here are a few:

1. Nobody truly understands your pain but there are a lot of people who try.  That is the blessing. I used to get so frustrated trying to explain how I felt.  It isn’t really possible.  I’ve learned to be grateful for those who try.

2. Sometimes the pain can lead to anxiety, panic attacks and frustration.  Nothing wrong with that. Just part of the condition like a cough is part of a cold (plus, a side effect of some meds so check).  Be patient with your brain and body.

3. Try your best to keep pushing ahead. The days where I went out despite the pain usually ended up being great.

4.  Thank goodness for swimming. No pain when I swim and its what I love.  What a blessing from my Heavenly Father.

5. Find something productive you can do during healing time.  I have my blog and fortunately my job can usually be done when I’m in pain.

6.  Be patient with yourself and just do the best you can!

7.  Find a doctor you trust who takes your condition seriously.  It took me a year to find a doctor with an investigative spirit.  Someone who asked questions and didn’t dismiss me.

8. Treatments are a personal decision.  I chose to not take most pain meds and am very cautious with meds in general.  I use lots of essential oils and heat/cold therapy and over-the-counter pain meds when necessary.  Either way, its your choice but be informed and understand risks. Take friends suggestions for pain relief with a grain of salt.  They are trying to be helpful.  Usually if you just say ‘thank you’ and then do what you want it is forgotten.  On the other hand, be open minded to trying  new things out.

Its amazing that with all we know about the human body we still don’t know some basic things about pain and pain management.

9.  Stay informed but also know that in the end God makes decisions on pain, and He has his reasons why certain trials are necessary. I like what CS Lewis said:

“God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is His megaphone to rouse a deaf world.”

10.  Communicating with other chronic pain sufferers (much more than me) has helped give me perspective and hope.

I’d love to hear what you have all learned from similar experiences.

I don’t normally post articles but I really liked this one from the New York Times.

Living With Pain That Just Won’t Go Away

By JANE E. BRODY

Pain, especially pain that doesn’t quit, changes a person. And rarely for the better. The initial reaction to serious pain is usually fear (what is wrong with me, and is it curable?), but pain that fails to respond to treatment leads to anxiety, depression, anger and irritability.

At age 29, Walter, a computer programmer in Silicon Valley, developed a repetitive stress injury that caused severe pain in his hands when he touched the keyboard. The injury did not respond to rest. The pain became worse, spreading to his shoulders, neck and back.

Unable to work, lift, carry or squeeze anything without enduring days of crippling pain, Walter could no longer drive, open a jar or even sign his name.

”At age 29, I was on Social Security disability, basically confined to home, and my life seemed to be over,” Walter recalls in ”Living With Chronic Pain,” by Dr. Jennifer Schneider. Severely depressed, he wonders whether his life is worth living.

Yet, despite his limited mobility and the pain-induced frown lines in his face, to look at Walter is to see a strapping, healthy young man. It is hard to tell that he, or any other person beset with chronic pain, is suffering as much as he says he is.

Pain is an invisible, subjective symptom. The body of a chronic pain sufferer — someone with fibromyalgia, for example, or back pain — usually appears intact. There are no objective tests to detect pain or measure its intensity. You just have to take a person’s word for it.

Nearly 10 percent of people in the United States suffer from moderate to severe chronic pain, and the prevalence increases with age. Complete relief from chronic pain is rare even with the best treatment, which is itself a rarity. Doctors and patients alike, who misunderstand the effects of narcotics, are too often reluctant to use drugs like opioids, which can relieve acute, as well as chronic, pain and may head off the development of a chronic pain syndrome.

Why Pain Persists

The problems with chronic pain are that it never really ends and does not always respond to treatment. If the pain initially was caused by an injury or illness, it can persist long after the injury has healed or the illness defeated because permanent changes have occurred in the body.

Mark Grant, a psychologist in Australia who specializes in managing chronic pain, says the notion that ”physical injury equals pain” is overly simplistic. ”We now know that pain is caused and maintained by a combination of physical, psychological and neurological factors,” Mr. Grant writes on his Web site, http://www.overcomingpain.com. With chronic pain, a persistent physical cause often cannot be determined.

”Chronic pain can be caused by muscle tension, changes in circulation, postural imbalances, psychological distress and neurological changes,” Mr. Grant says on his site. ”It is also known that unrelieved pain is associated with increased metabolic rate, spontaneous excitation of the central nervous system, changes in blood circulation to the brain and changes in the limbic-hypothalamic system,” the region of the brain that regulates emotions.

Dr. Schneider, the author of ”Living With Chronic Pain” (Healthy Living Books, Hatherleigh Press, 2004), is a specialist in pain management in Tucson, Ariz. In her book, she points out that the nervous system is responsible for the two major types of chronic pain.

One, called nociceptive pain, ”arises from injury to muscles, tendons and ligaments or in the internal organs,” she writes. Undamaged nerve cells responding to an injury outside themselves transmit pain signals to the spinal cord and then to the brain. The resulting pain is usually described as deep and throbbing. Examples include chronic low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia, headaches, interstitial cystitis and chronic pelvic pain.

The second type, neuropathic pain, ”results from abnormal nerve function or direct damage to a nerve.” Among the causes are shingles, diabetic neuropathy, reflex sympathetic dystrophy, phantom limb pain, radiculopathy, spinal stenosis, multiple sclerosis, Parkinson’s disease, stroke and spinal cord injury.

The damaged nerve fibers ”can fire spontaneously, both at the site of the injury and at other places along the nerve pathway” and ”can continue indefinitely even after the source of the injury has stopped sending pain messages,” Dr. Schneider writes.

”Neuropathic pain can be constant or intermittent, burning, aching, shooting or stabbing, and it sometimes radiates down the arms or legs,” she adds. This kind of pain tends ”to involve exaggerated responses to painful stimuli, spread of pain to areas that were not initially painful, and sensations of pain in response to normally nonpainful stimuli such as light touch.” It is often worse at night and may involve abnormal sensations like tingling, pins and needles, and intense itching.

Some chronic pain syndromes involve both nociceptive and neuropathic pain. A common example is sciatica; a pinched nerve causes back pain that radiates down the leg. In some cases, the pain of sciatica is not felt in the back but only in the leg, making the cause difficult to diagnose without an M.R.I.

Beyond Physical Problems

The consequences of chronic pain typically extend well beyond the discomfort from the sensation of pain itself. Dr. Schneider lists these potential physical effects: poor wound healing, weakness and muscle breakdown, decreased movement that can lead to blood clots, shallow breathing and suppressed coughing that raise the risk of pneumonia, sodium and water retention in the kidneys, raised heart rate and blood pressure, weakened immune system, a slowing of gastrointestinal motility, difficulty sleeping, loss of appetite and weight, and fatigue.

But that is hardly the end of it. The psychological and social consequences of chronic pain can be enormous. Unremitting pain can rob a person of the ability to enjoy life, maintain important relationships, fulfill spousal and parental responsibilities, perform well at a job or work at all.

The economic burdens can be severe, especially when the patient is the primary breadwinner or holds a job that provides the family’s health insurance. Only about half of patients with chronic pain ”who undergo comprehensive multidisciplinary pain rehabilitation are able to return to work,” Dr. Schneider reports.

As for the notion that chronic pain patients are often malingering — seeking attention and escape from responsibilities — pain specialists say that is nonsense. No one in his right mind — and most patients were in their right minds before the pain began — would trade a fulfilling life for the misery of chronic pain.