Q & A
Q & A
If you have any questions you would like to have answered, please don't hesitate to contact us and we will do our best.
These questions have been answered by Dr John Quintner, Rheumatologist and member of the Chronic Pain Switzerland National Advisory Panel
Q: If the scans (MRI and CT) are not showing any problems, why do I still have pain?
A: Because x-rays and other imaging techniques do not show pain. They show changes in spinal structure that may or may not have anything to do with your pain.
Q: Why is my pain worse when I am feeling stressed out?
A: It takes a lot of mental effort to manage pain at the best of times. When you are "stressed out" there is less of it in reserve.
Q: Is BED REST useful when I first hurt my back?
A: No evidence that rest helps after the first day or so.
Q: I have heard people talk about the BIOPSYCHOSOCIAL MODEL- what is it?
A: It is simply a framework that helps you and your advisors to look broadly at issues in your life that may need attention so that you can better understand and manage your pain.
Q: I live with chronic pain. Should I consider reducing my CAFFEINE intake?
A: Well worth a try in individual cases. Caffeine can interfere with your sleep pattern and lead to worsening of your pain.
Q: I am not thinking or remembering as well as I did before I had pain. What is going on?
A: see above
Q: What is COMPLEX REGIONAL PAIN SYNDROME (CRPS)?
A: A set of nasty features that can follow injury to a limb. These include widespread pain, swelling, temperature disturbance, redness of the skin, and abnormal sweating. It was formerly known as Reflex Sympathetic Dystrophy Syndrome.
Q: Is there a CULTURAL INFLUENCE on the way pain is experienced?
A: Different cultures have different ways of expressing painful experiences.
Q: Is there a way to diagnose the disc as a source of my pain?
A: Yes. Injecting dye into a disc can show if it normal or abnormal. However, in order to be sure that it is a painful disc, local anaesthetic needs to also be injected. If the pain is relieved, then the disc may be the source of pain. Because this test can give a false positive result, it is necessary to also test the discs above and below the suspected painful disc. Infection of the disc is a rare complication of discography.
Q: Why does DISTRESS seem to make me worse?
A: see above.
Q: Does EDUCATION about the physiology of pain help?
A: Yes, there is evidence to support this form of education in the management of low back pain.
Q: What is EXPOSURE training?
A: Repeatedly exposing oneself to the threatening stimulus and trying to learn a different (less distressing) response.
Q: What is HYPERALGESIA?
A: Literally, an increase in response to a painful stimulus.
Q: Since I have been living with pain I am using more NICOTINE- is that an issue?
A: Yes, it can be. Clinical studies have shown that smokers take much more analgesics than do non-smokers and have a higher probability of developing opioid dependence.
Q: I have weekly physiotherapy where my therapist rubs me and puts machines on me. Why does it give me PAIN RELIEF?
A: This benefit is explainable through gate control theory, whereby activation of large diameter nerve fibres by rubbing switches off spinal transmission cells in the spinal cord. There is also a placebo effect if the therapist is a person to whom you positively relate.
Q: Does PRIOR PAIN EXPERIENCE have an effect on my present pain?
A: When we are no are longer experiencing pain, we tend to forget what it was like. However, the nervous system does seem to retain pain memories. In other words, it never forgets.
Q: My SLEEP patterns have changed. Is this because of pain?
A: Pain can be a likely cause of disturbed sleep patterns. We also know that there are other potentially important causes of sleep disturbance - intake of caffeine and other stimulants (nicotine), alcohol, lack of exercise, older age, medications, other medical conditions. Lack of sleep can also impact upon pain by lowering pain threshold and tolerance.
Q: When should I have SPINAL SURGERY to relieve my pain?
A: When all else has failed and you have obtained at least two independent opinions. Should these opinions differ, you must seek a third one and be prepared to follow the advice that you receive.
Q: I use a TENS machine. Should I be careful?
A: Yes. It should not be worn if you have a cardiac pacemaker.
Q: My pain onset was associated with trauma - could this be having an effect on my pain?
A: Persistent pain and disability following trauma is a huge issue. A traumatic event causing tissue damage can set off a chain reaction, rather like the "big bang" theory of the formation of the universe. We suspect that this reaction includes changes in nerve transmitters, etc.
Q: I have tingling and burning in my feet. What should I do about it?
The small nerves that supply sensation to the skin of your feet are very excitable. They can fire off spontaneously or following minor stimuli such as touch, pressure, and exposure to modest cold or heat. There are many causes of this "nerve damage" situation, including diabetes, certain drugs, long-continued alcohol intake & vitamin deficiencies (such as Vitamin B12). You need to talk to your GP, who may perform some blood tests after examining you. You may be referred for a consultation with a nerve specialist = a neurologist.
Q: what is NEUROPATHIC pain?
This is pain thought due to disturbance(s) within your nervous system. Again, there are many possible causes of such pain. It is thought to involve entirely different mechanisms than those responsible for the pain of damaged or diseased tissues. This pain is referred to as NOCICEPTIVE PAIN.