Fatigue associated with chronic pain

Daytime fatigue1 is commonly reported with chronic pain and can be just as challenging to manage.2 Restorative sleep is undoubtedly important and adhering to the guidelines for sleep restriction and sleep hygiene can improve the quality and often the quantity of sleep. Less well-known are diurnal rhythms, which are independent daytime biological patterns, and how they affect us and how we can affect them. Changing what we do, how and when we do them, can help these invisible hormonal and chemical patterns synchronize and as a result have less fatigue. 

The most vexing of all questions in the debate over long-term opioid management for pain is subtle, difficult to articulate, and rarely considered. It lies at the heart of whether and how we maintain patients with severe pain on long-term opioids or whether we help them learn to self-manage it instead.

This most vexing of questions involves how we understand the nature of pain severity and its relationship to its degree of tolerability in the long-term opioid management patient. For depending on how we understand the intolerability of severe pain, it leads to contradictory treatment considerations among well-meaning, competent patients and providers, and even within the larger society.

Patients and healthcare providers commonly think of pain as a symptom of an underlying injury or illness. Say, for example, you hurt your low back while lifting. Perhaps, you’ve injured a muscle or ligament, or perhaps it’s an injury to the spine, like a disc bulge or herniation. Either way, you now have pain and the pain is the symptom of the injury. The same might be true for any health condition that causes pain, particularly when it first starts.

What is biofeedback?

Biofeedback is a treatment used for a variety of chronic pain and other medical conditions that consists of sensors placed on the patient’s body while physiological data is viewed on a computer screen or other monitor in real time. It is considered a self-regulatory therapy because it is a tool for increasing awareness of and changing individual physiological responses to reduce symptoms or improve performance. The Association for Applied Psychophysiology and Biofeedback (AAPB), the Biofeedback Certification International Alliance (BCIA), and International Society for Neurofeedback and Research (ISNR) provide this standard definition:

 "A community is a group of people banded together by gifts and stories."

Charles Eisenstein

It is embedded in our human history: stories. Even before modern day, numerous cultures have shared history lessons in the form of stories. By sharing wisdom and experiences, stories can build communities. In essence, individuals no longer feel alone; they feel a sense of belonging and connection. Those stories can generate emotion and help people cope with life's complexities.

On initial reaction, it might seem absurd to talk about the benefits of self-managing chronic pain without opioid medications. "What," one might ask, "would you use to reduce pain? You wouldn't want to live the rest of your life in pain, would you?" The topic seems absurd because pain reduction reflexively seems so important. Indeed, pain reduction from the use of opioids seems so important that it trumps everything else, even problems associated with the use of opioids.

What is irritable bowel syndrome?

Irritable Bowel Syndrome (IBS) is a common condition for which patients seek healthcare and the most common reason for a visit to a gastroenterologist. It affects at least 1 in 10 people and is considered the most common of the functional gastrointestinal disorders (FGIDs). The primary symptom is abdominal pain -- usually in the large intestine or stomach -- along with either constipation or diarrhea or both. The pain can be intense and constant, but often it fluctuates. Food moving through the intestines too quickly may result in diarrhea; too slowly, constipation. The gut may thus lose its normal rhythmicity.

The notion of a neuromatrix of the brain is a theoretical model that explains the nature of pain, including chronic pain. Ronald Melzack, PhD, a psychologist, and one of the founding fathers of the field of pain management as we know it today, developed the theory and published it in a series of papers at the end of the last century.1, 2, 3, 4 Melzack had previously revolutionized the field of pain management in an earlier theory that he had developed and published with his physician colleague, Patrick Wall, in what is known as the gate control theory of pain.5 Few theories in modern science have spawned more empirical research than those of the gate control theory of pain and the neuromatrix of pain. Indeed, while technically theories, the field largely considers these models as accurate explanations of the nature of pain, given the great wealth of empirical evidence that now confirms them. So, what is this notion of the neuromatrix of the brain that explains the nature of pain?

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