Image by Gerd Altmann from Pixabay
Pain is an intense emotional and sensory condition. Most of the time pain is useful — it makes us aware of injury and protects us during recovery. But pain may not be protective and may not be associated with injury.
The Global Burden of Disease Study in 2013 reported that ‘chronic low back pain was the leading cause of years lived with disability.’ This study also ʻshowed that the associated problem of opioid use disorders accounted for
5.8 million additional years lived with disability’.
In response to this growing epidemic of opioid use with its associated death and disability, the New England Journal of Medicine published a review by Nanna B. Finnerup, M.D. titled Nonnarcotic Methods of Pain Management.
This is a thorough review of the causes that underlie the many types of chronic pain as well as the many treatments available. It emphasizes the fact that long term opioid treatment has ‘minimal effects on chronic pain and can cause tolerance, drowsiness, and dependence, as well as impaired memory, concentration, and judgment.’
There is a section on pain in the chapter on Perception in my book How the Brain Thinks.
One of the main issues in chronic pain in particular is to get a patient in obvious distress to think outside the usual injury-damage-body paradigm and to think of their pain as a perceptive problem caused by long term changes in brain function.
As a General Practitioner who deals with patients in pain a lot, it was really nice to see a thoughtful, intelligent, well written article by Hannah Millington in the Guardian recently.
One of the main issues in chronic pain in particular is to get a patient in obvious distress to think outside the usual injury-damage-body paradigm and to think of their pain as a perceptive problem caused by long term changes in brain function. These changes happen over a long period of time and are the result of a mishmash of previous and current experience often resulting in major disability.
Hannah’s article is a great example of how story can connect with us to inform us, to teach us, and to provide examples that are relevant and transportable that we can use in our everyday life. Hannah’s story fulfills all of these and more. I have already begun to use her example in my daily practice.
I have written about the effect of story in the chapter on Emotion in my current book How the Brain Thinks.
Dr Graham Desborough is a general practitioner, writer, mountaineer and photographer. If you like this post, you can join his mailing list at drgrahamdesborough.com or check out his book How the Brain Thinks.
