Medication, behavior therapy can help pain
Published: Monday, November 14, 2011 at 5:30 a.m.
Last Modified: Wednesday, August 15, 2012 at 11:10 a.m.
Patients with chronic pain such as fibromyalgia (FMS), chronic myofascial pain, chronic arthritis and peripheral neuropathy suffer with pain along with insomnia, depression and fatigue.
Patients with chronic pain can experience an exaggerated response to painful stimulus (hyperalgesia), prolonged length of response after brief stimulus (persistent and widespread pain) and pain after the simple act of touching or rubbing due to a reduction of pain threshold (allodynia).
FMS, one of the central hypersensitivity syndromes, occurs when the central nervous system (brain and spinal cord) becomes hypersensitive to different stimulus. It can lead to many different symptoms such as headache, irritable bowel syndrome and fatigue.
Currently, there is adequate scientific evidence that central hypersensitivity is mainly caused by an imbalance of neurotransmitters such as serotonin, norepinephrine, dopamine or others. Serotonin, norepinephrine and other neurotransmitters are produced and regulated within the brain and spinal cord to keep everyday pain sensation and mood in sync. When levels of serotonin or norepinephrine are decreased and unbalanced, the brain becomes incapable of processing the transmitted pain signals properly. Pain signals can be exaggerated and even disordered. Furthermore, patients may become depressed.
Research has shown that by increasing levels of either serotonin or norepinephrine or both with the use of anti-depressants, pain signals can be decreased. Medications such as Prozac, tricyclic-depressants, or Effexor, Cymbalta and Savella, which are dual-acting anti-depressants that can increase both serotonin and norepinephrine, have proven capable of decreasing pain while treating both depression and chronic pain.
Even though pain signals are processed by the brain, they are heavily influenced by a person's state of mind. Mind and mood are also influenced by neurotransmitters. Feelings of anger or hopelessness, associated with depression and chronic pain, enhance negative thinking, which can intensify pain signals and increase feelings of distress and despair.
Scientists have proved we can train our mind and then change our brains (neurotransmitters). Cognitive-behavior therapy (CBT) focuses on altering distorted belief, attitude and expectation patterns by substituting a new response to pain or suffering. Many studies have also proven that combining CBT with anti-depressants can offer relief to sufferers of chronic pain with or without depression and put them back in control. The key is to realize that some situations cannot be changed but you can change yourself and the way you react to them.
Dr. Yong H. Tsai is board-certified in rheumatology, allergy and clinical immunology and has been practicing in this area since 1993. Send questions to Dr. Tsai in care of email@example.com. You also can check his website: arthritis-allergy.net.
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