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.
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.
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?
Stigma is a significant and persistent problem for those with chronic pain. Stigma occurs when someone is judged for having a condition that they didn't choose to have, like chronic pain. In other words, stigma is the criticism of being bad in some way for simply having a condition that you didn't choose to have. It can also occur in relationship to how a patient with chronic pain is coping. Stigma thus arises when moral judgments occur not for wrong behavior, which might rightly get criticized, but for simply being who you are, for simply having the health condition that you have, or for how you are dealing with it.
What is insomnia?
Insomnia is a sleep problem that is marked by having difficulty falling asleep at the beginning of the night or returning to sleep upon awakening in the middle of the night.
Insomnia is common in persons with chronic pain. Upwards of half of all people with chronic low back pain, for instance, report insomnia.1, 2
The meaning of "chronic" and why the healthcare system refuses to accept the chronicity of chronic pain
We live in an age of chronic illness. Conditions like heart disease, diabetes, asthma and chronic pain are common. All these health conditions are chronic. The term chronic means that a condition has no cure and so will last indefinitely.
It’s common to complain about healthcare and our healthcare system. We complain about our health insurance and we also complain about reforms to the health insurance industry. We complain about the long wait times to see a provider. We also complain about the short amount of time that we actually get once we see a provider. We complain about how much money we pay for healthcare. We also complain about how much money certain providers and insurance executives get paid. With our healthcare system so large and complex, most anyone can find something to complain about.
Opioid, or narcotic, pain medications are beneficial in a number of ways. Terminal cancer patients, for instance, benefit from their use. The short-term use of opioid pain medications is beneficial, especially while recovering from an acute injury or a surgery. However, the long-term use of opioid medications for chronic, noncancer, pain remains controversial. While a number of issues contribute to this controversy, the main reason for the controversy is addiction. Opioid pain medications are addictive.
This controversy makes opioid pain medications a highly sensitive issue for patients who take them.