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Just My Thoughts, Medical Testing, Medicines

Chronic vs Intractable Pain

I would like to cover the word “pain”.  It has four letters and is rather a small word for what it covers.  I have written about the different levels of pain, but here I want to talk about two very different labels given pain.  We have “chronic pain” and we have “intractable pain”.  [A fun post to visit is:  Digesting Pain Reactions]

If we draw a line with the words that label pain, then we might start with short term at the beginning of our line.  But even before that, we should see a word that might mean “just seconds of pain”.  We can call this a “boo-boo”.  Example: when we step on a stone and then the next step our foot feels fine.  Next, we might have a dull pain for  a few minutes or an hour or so.  That dull pain can get stronger before it goes away.  But go away it does, even without OTC meds.  Then as we continue making marks on the drawn line, we have pain that we know we are going to need help kicking it to the sidewalk.  Or we might have pulled a muscle or knocked something out of joint.  We will need pain meds for a longer amount of time.  These ‘pains’ become part of what is called “acute”.  As we travel down the line of pains, we come to what is called Chronic”. 

Medical world tags Chronic as: pain that is moderate to mild and intermittent.  Then in the next sentence they go a little further to consider it to be persistent.    Chronic pain might be recurring and can be tolerated without pain meds, but can be helped with prescribed meds.  They give a time frame to this label.  They say it can last 3 months.  They also say that chronic pain [CP] can cause a person to have problems functioning normally.  That is, it can have a disturbing effect on sleep, appetite, fatigue, mood, and mobility.  You can check this article out :  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869/

So, now back to our drawn line of  “Pain”.  Does our line just end there?  Well, it used to and still does for most doctors.  Even I, myself, generically used that term when writing my posts.  It is a general term that everyone is familiar with.  It was after I was reading a research paper that I came across another term.  Intractable Pain!

I was not for certain that the term, Intractable Pain”, was what I was living with,  so I started looking into it.  What did I find?  I was one of the patients that should have been labeled with such.  Why?  Well into the definition we go!

Let us look at one word:  “intractable”.  Check out the dictionary.  [ https://www.merriam-webster.com/dictionary/intractable ]  The site’s definition is:

  • not easily governed, managed, or directed, i.e. intractable problems
  • not easily manipulated or shaped, i.e. intractable metal
  • not easily relieved or cured, i.e. intractable pain

Just a few years ago, the part about “pain” would not have been found.  My handy 1940’s dictionary only had a single word, unmanageable”. 

Yep, that single word definitely hits the nail on the head.  But we can look up on our internet for what is being said today about this label of pain.  We read that it is removed from “acute”, and even removes itself from “chronic”.  Our local news channel did a post on the new MM laws that have included now PTSD and Intractable Pain [IP] as reasons to get your medical marijuana permission.  In their internet report they define “intractable pain” as:pain that has a cause that cannot be removed and for which, according to generally accepted medical practice, the full range of pain management has been used for at least six months without adequate results or with intolerable side effects.”¹ There we have it, a state government says it is so.  There are similar articles in several states that give this type of pain an identity

Just think, our society now has to finds words to give a person validation of their pain. 

Other points that I found that separates intractable from chronic are many.  One such is time”.  There is no time limit for IP but for chronic it is limited to 12 weeks but extending to 6 months.  Here I was going around telling people my pain was chronic.  No, I passed the 12 weeks about 5 years ago.   But let us delve deeper in to the time issue.  For chronic they say the pain is intermittent in those 12 weeks.  Sorry, once my pain kicked in it has never been “intermittent”.  It is there daily, even in my sleep.  Even if I am having fun. 

Then let us see what they say about causes”.  Acute pain is caused by an injuryChronic pain is when the acute pain hangs around longer than the healing of the injury.  Then when the acute turns to chronic it stops sending those signals of physiological nociception.  That means, warning us that we might be getting our body too close to something that can harm it.  So, now what causes it to be ‘intractable?  To me, this means that the pain is constant.  In, so much so, that you do not pay much attention to what might cause you to harm your body; by simply making adjustments for the pain that you are constantly dealing with.  For a lot of us with Tarlov Cysts, we have adopted the Cleopatra pose on our couches.  That messes with the spinal alignment and causes hip issues.  Then with these cysts they cause neuropathy and paresthesia in our legs, thus we are adjusting our gait to deal with the constant discomfort.  Of course, adjusting the gait can cause further damage to the sciatic nerve.  So with these two examples it is not until we have damaged our body further, with the adjustments, do we realize what we have done.  Our adjustments, in a healthy person, would have been rejected by the body sending out acute pain signals to stop us.  Our body no longer sends these signals out.  It has too much to deal with to bother with warning us we are getting into further trouble.

Take my example of my falling on stairs.  I don’t realize I am in trouble until I am going down.  My body is not sending the correct signals to my legs and my body is ignoring it or it has lost the ability to pre-conceive my danger.

What else differentiates it?  Well, let us take the way they want to hold off on calling it “intractable”.  They use treatments”.  You have to have tried all the known medicines, ie, n-saids, opioids, muscle relaxants, anti-seizure medications; then progress to physical therapy, electronic devises and psychological evaluations.  Even questionable surgery.  In other words, you have to try different brands of the same medicines, and medicines that are used off label.  You have to agree to try to do physical activities that could cause further damage to you body.  I read one report that said the doctor should not use the term intractable unless he has records of each and every treatment he has tried.  Including [don’t be shocked] emergency room visits because a treatment failed or harmed the patient. 

The next thing I noticed was that it can be labeled IP if what is causing the pain can not be removed from the body.  Or if corrective surgery has caused further harm.  So a note here for Tarlov Cyst Disease:  our cysts can not be removed, they can be worked on, but not removed.  So why are we not immediately given the term of IP

IP can affect hormones because it raises levels of inflammation.  Typically CP does not raise inflammation, but it (inflammation) is a symptom of the illness that causes the CP.  And CP does not change hormones in the body.  That might not seem much in difference, but to me it means a lot.  Other changes that IP can cause is high blood pressure, high pulse rates, sexual dysfunction, chronic fatigue and can even cause the pain to extend beyond the region of the thing causing the pain.  The mental side of the fatigue is that it can interfere with thinking skills. 

Well, you have to have tried everything under the sun that is suggested for chronic pain.  Now we can call it Intractable Pain!

Something that stuck with me is from a site that I visit frequently.  It said, The authors define IP as “pain that is excruciating, constant, incurable, and of such severity that it dominates virtually every conscious moment, produces mental and physical debilitation and may produce a desire to commit suicide for the sole purpose of stopping the pain.”   [ https://www.practicalpainmanagement.com/resources/intractable-pain]

Isn’t that the truth?!!

I usually never add links to other sites, but for this post I think it will help.  Several sites I think you might find interesting are:

https://www.painnewsnetwork.org/stories/2018/1/16/the-difference-between-intractable-and-chronic-pain-YJBcS

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071146/

https://www.healthline.com/health/intractable-pain#complications

¹  https://www.11alive.com/article/news/health/what-is-intractable-pain-a-new-condition-in-ga-medical-marijuana-law/85-550072825

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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