Poppy's Chronic Pain Forum Archives
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Poppy's Chronic Pain Forum Archives
Page Eight



This is a place for articles that may require reading more than once.

  • Chronic Pain - continued from Archive : Page Seven
  • Cry If You Want To
  • Let Me Cry

Chronic Pain

--National Institute of Neurological Disorders--

Continued from: "Chronic Pain" - Archives : Page Seven

The Major Pains:

* Neurogenic pain:

The most difficult pains to treat are those that result from damage to the peripheral nerves or to the central nervous system itself. Mentioned earlier in this brochure as examples of extraordinarily searing pain were trigeminal neuralgia and shingles, along with several drugs that can help in these conditions. In addition, trigeminal neuralgia sufferers can benefit from surgery to destroy the nerve cells that supply pain-sensation fibers to the face. An advantage to using a treatment called "thermocoagulation" -- which uses heat supplied by an electrical current to destroy nerve cells -- is that pain fibers are more sensitive to the treatment resulting in less destruction of other sensations (such as touch and temperature).

Sometimes specialists treating trigeminal neuralgia find that certain blood vessels in the brain lie near the group of nerve cells supplying sensory fibers to the face, exerting pressure that causes pain. The surgical insertion of a small sponge between the blood vessels and the nerve cells can relieve the pressure and eliminate pain.

Among other notoriously painful neurogenic disorders is pain from an amputated or paralyzed limb -- so called "phantom" pain -- that affects a significant number of amputees and paraplegia patients. Various combinations of antidepressants and weak narcotics like propoxyphene are sometimes effective. Surgery, too, is occasionally successful. Many experts now think that the electrical stimulating techniques hold the greatest promise for relieving these pains.

* Psychogenic pain: Some cases of pain are not due to past disease or injury, nor is there any detectable sign of damage inside or outside the nervous system. Such pain may benefit from any of the psychological pain therapies listed earlier. It is also possible that some new methods used to diagnose pain may be useful. One method gaining in popularity is thermography, which measures the temperature of surface tissue as a reflection of blood flow. A colour-coded "thermogram" of a person with a headache or other painful condition often shows an altered blood supply to the painful area, appearing as a darker or lighter shade than the surrounding areas or the corresponding part on the other side of the body. Thus an abnormal thermogram in a patient who complains of pain in the absence of any other evidence may provide a valuable clue that can lead to a diagnosis and treatment.

Where to Go for Help:

People with chronic pain have usually seen a family doctor and several other specialists as well. Eventually they are referred to neurologists, orthopedists, or neurosurgeons. The patient/doctor relationship is extremely important in dealing with chronic pain. Both patients and family members should seek out knowledgeable specialists who neither dismiss nor indulge the patient, physicians who understand full well how pain has come to dominate the patient's life and the lives of everyone else in the family.Contrary to what many people think, pain patients are not malingerers or hypochondriacs. They are men and women of all ages, education, and social background, suffering a wide variety of painful conditions.

People with pain problems may feel isolated, helpless, or hopeless. But many of those who suffer with a pain problem can be helped if they -- and their families -- understand all the causes of pain, and the many and varied steps that can now be taken to undo what chronic pain has done. As a result of the strides neuroscience has made in tracking down pain in the brain -- and in the mind -- we can expect more and better treatments in the years to come. The days when patients were told "I'm sorry, but you'll have to learn to live with the pain" will be gone forever.

The following organizations are directly concerned with pain problems. They are excellent sources of additional information, research updates, and specific help and referrals:

American Chronic Pain Association, Inc. P.O. Box 850 Rocklin, CA 95677 916-632-0922

American Council for Headache Education (ACHE) 875 Kings Highway, Suite 200 Woodbury, NJ 08096 609-384-8760 800-255-2243

National Chronic Pain Outreach Association, Inc. P.O. Box 274 Millboro, VA 24460 540-997-5004

National Headache Foundation 428 W. St. James Place Chicago, IL. 60614 773-388-6399 800-843-2256

The "Chronic Pain Letter" is a newsletter that offers information for both professionals and patients. For subscription information, write:

Robert J. Fabian Memorial Foundation Chronic Pain Letter P.O. Box 1303 Old Chelsea Station New York, NY 10011

In addition, many organizations concerned with specific diseases, such as arthritis or heart disease, provide information and advice about attendant pain problems.

Other NINDS publications on conditions causing pain include:

Headache: Hope Through Research

Shingles: Hope Through Research

Fact Sheet: Reflex Sympathetic Dystrophy Syndrome

One-page information sheets on:

Central Pain Syndrome, Back Pain, and Trigeminal Neuralgia (tic douloureux)

For a free single copy of any of these publications, or for information on pain research supported by the Institute, write to:

Office of Communications and Public Liaison National Institute of Neurological Disorders and Stroke National Institutes of Health Building 31, Room 8A06 Bethesda, MD 20892 301-496-5751

Additional information on pain research supported by the NIH may be obtained from:

Public Information and Reports Branch
National Institute of Dental and Craniofacial Research National Institutes of Health Building 31, Room 5B49 Bethesda, MD 20892

The National Institute of Neurological Disorders and Stroke of The National Institutes of Health. NIH Publication No. 98-2406. Chronic Pain: Hope Through Research. November 1989. Last revised, August 31, 1999. (Online) National Institute of Health - Chronic Pain: Hope Through Research



Cry If You Want To

Written by Scott-- Copyright Signal Songs

 Recorded by Holly Cole Trio

 Cry if you want to
I won't tell you not to
I won't try to cheer you up
I'll just be here if you want me.
It's no use in keeping a stiff upper lip
You can weep, you can sleep,
you can loosen your grip
You can frown,
you can drown and go down with your ship
You can cry if you want to.
Don't ever apologize venting your pain
It's something to me you don't need to explain
I don't need to know why; I don't think it's insane
You can cry if you want to.
The windows are closed, the neighbours aren't home
If it's better with me than to do it alone,
I'll draw all the curtains and unplug the phone
You can cry if you want to.
You can stare at the ceiling and tear at your hair,
Swallow your feelings and stagger and swear,
You can show things and throw things, and I wouldn't care.
You can cry if you want to.
I won't make fun of you,
I won't tell anyone
I won't analyze what you do or you should have done,
I won't advise you to go and have fun
You can cry if you want to.
Well, it's empty and ugly and terribly sad,
I can't feel what you feel,I know that it's real and it makes you so mad
You can cry.
Cry if you want to
I won't tell you not to
I won't try to cheer you up
I'll just be here if you want me to be near you.



Let Me Cry

By Methos

Let me climb into your lap,
and feel your warmth.
Here amidst your arms I can stare at fear,
from a safe place. If I shut my eyes
and press my ear against your chest,
your heart beat reminds me of home.
I can breathe.
I can sleep.
No words to say,
none can express it.
Two strangers in brief expression,
like silhouettes etched on emotion's wall.
I can't explain,
there is no why.
Just cradle me,
and let me cry.




What is Headache?

--From About.com--

This article describes the major types of headaches: tension, migraine, cluster, and those caused by other medical problems.


Headache pain occurs in the tissues covering the brain, the attaching structures at the base of the brain, and the muscles and blood vessels around the scalp, face, and neck. The brain itself is insensitive to pain. Headache is defined as primary or secondary. Headache is considered primary when a disease or other medical condition does not cause it. The three most common primary headaches are tension or muscle contraction, migraine, and cluster. It is not uncommon for someone to experience a combination of these headaches. In fact, some experts believe that all headaches are derived from the same mechanisms that cause migraine, and they are simply variations on a single biologic theme. Secondary headaches are caused by other medical conditions, such as sinusitis infection, neck injuries or abnormalities, and stroke.

Tension Headache

Tension headache is often experienced in the forehead, in the back of the head and neck, or in both regions; it is described as a tight feeling, as if the head were in a vise. Soreness in the shoulders or neck is common. These headaches can last minutes to days and may occur daily in some sufferers. Tension headaches do not cause nausea or limit activities as migraine headaches do, although depression, anxiety, and sleeping problems may accompany persistent headaches. They sometimes evolve in people who initially experience migraines, and, in such cases, can become chronic and difficult to treat.

Migraine Headache

The word migraine is derived from the Greek word hemikrania, meaning "half of the head". In general, there are four phases to a migraine.

Vague premonitory symptoms (called the prodrome phase) may precede a migraine attack by several hours, or even a day or two. Such prodrome symptoms can include sensitivity to light or sound, changes in appetite, fatigue, malaise, and mood changes.

About 20% of migraine sufferers have preheadache sensory disturbances called auras. Migraine headaches with auras are termed classic migraines; migraines without auras are called common migraines. A person may experience one or the other at different times. Typical auras include visual disturbances such as the appearance of zigzag lines, stars or shimmering areas, blind spots, and tunnel vision (inability to see to the side). Speech disturbances, tingling or numbness, weakness in an arm or leg, perceptual disturbances such as space or size distortions, and confusion may also occur, though these symptoms are less common. Migraine auras last between 15 and 45 minutes. A type of migraine known as ocular migraine is painless and produces only auras or other visual symptoms.

A typical migraine attack produces throbbing pain on one side of the head, often accompanied by nausea, sometimes with vomiting; visual symptoms are common, and facial tingling or numbness may occur. If untreated, attacks usually last from 4 to 72 hours. Pain sometimes spreads to affect the entire head and is worsened by physical activity. Extreme sensitivity to light and noise are common, and patients may feel cold and look pale.

After a migraine attack, there is usually a postdrome phase, in which patients may feel exhausted and mentally foggy for a while.

Although half of women with migraines report they are related to menstruation, experts believe that true menstrual migraines are less common than thought. Such migraines are without auras and defined as those that regularly occur during the first three days of menstruation, but not during ovulation or right before a period. The study found no association between menstruation and migraines with auras.

Children may have a form of migraine known as a migraine equivalent or abdominal migraine, which does not cause a headache at all. Instead children experience periodic bouts of nausea and vomiting (called cyclic vomiting syndrome) or other secondary symptoms found in adult migraine, such as a reaction against light or sound.

Cluster Headache

Cluster headaches cause very severe, stabbing pain centered in one eye. People often awaken with them a few hours after they go to bed. Associated symptoms include excessive tearing, a drooping eyelid, and one stuffy or runny nostril, all on the same side as the pain. Feelings of intense restlessness are common, unlike migraine attacks, during which the tendency is to sleep. People in the throes of a cluster headache may pace the floor or may even bang their heads against the wall in an attempt to cope with the pain. Attacks are usually brief, lasting between 30 and 90 minutes, although they can persist for up to 3 hours. During an active period, sufferers can experience one or more bouts a day, or as few as one every other day. Patients typically experience recurrent cluster attacks over 4 to 12 weeks, with headache-free periods lasting several months or even years. In a rare form of cluster headache, known as chronic paroxysmal hemicrania, as many as six attacks per day can occur.

Headaches Secondary to Other Medical Disorders

About 90% of the people seeking help for headaches have one of the primary headache disorders discussed above. In secondary headaches, there is an underlying disorder that produces the headache as a symptom. Many conditions produce headache; some of the most common are listed below.

Headache Due to Neck Problem

Some headaches may be caused by abnormalities of the neck muscles resulting from prolonged bad posture (such as sitting in front of a computer keyboard or daily driving for long periods), arthritis, injuries of the upper spine, or abnormalities in the cervical spine (the spinal bones in the neck). Nerves in the neck converge in the trigeminal nerve in the face and can generate pain signals that the brain may interpret as headache. Pain is usually on one side; even if it effects both sides of the head it is usually more severe on one side. The quality of the headache may be similar to an aching tension headache or a mild migraine without auras.


Sinus Headache

Fever, runny nose, congestion, and general debilitation accompany headaches produced by sinus infection. Sinus headaches are usually around the eyes, across the cheeks, or over the forehead. They are usually mild in the morning and increase during the day. Many primary headaches are misdiagnosed as sinus headache when, in fact, there is no infection; a true sinus headache lasts until the infection is treated.

Temporomandibular Joint Dysfunction (TMJ)

TMJ is caused by clenching the jaws or grinding the teeth (usually during sleep), or by abnormalities in the jaw joints themselves. The diagnosis is easy if chewing produces pain or if jaw motion is restricted or noisy. TMJ pain can occur in the ear, the cheek, temples, or neck and shoulders.

Glaucoma

Acute glaucoma is caused by increased pressure in the eye and requires immediate medical attention. Throbbing pain may be felt around or behind the eyes or in the forehead. Patients have redness in the eye and may see halos or rings around lights. Pain may be referred to other areas.

Brain Tumor

Fear of brain tumor is common among people with headaches, but headache is almost never the first or only sign of a tumor. Changes in personality and mental functioning, vomiting, seizures, and other symptoms are more likely to appear first. When the headache does develop, it is often worse early in the morning or may awaken sufferers during the night.

Hypertension

Although many people attribute headaches to high blood pressure, the two are rarely associated. An exception is malignant hypertension, an uncommon medical emergency, in which the blood pressure abruptly rises to extreme levels, causing damage to blood vessels in the brain, heart, and kidneys.

Strokes Caused by Blood Clots or Hemorrhages

A blood clot or hemorrhage in the brain leading to a stroke can cause a severe headache, sometimes referred to as a thunderclap headache when it is very sudden and severe. The onset of such a headache, particularly if it is associated with confusion, stupor, or other neurologic symptoms, mandates prompt medical attention. It is important to determine if a clot or bleeding is causing the stroke, since treatments are very different.

Head Injuries

It is obvious that a significant blow to the head will cause pain. Post-injury headaches, however, can reflect serious damage, ranging from skull fractures to internal bleeding.

Disorders of the Meninges

The meninges are the membranes covering the brain and the spinal cord. In very rare instances, ordinary physical strain may injure or weaken the meninges, causing a leakage of cerebrovascular fluid. This can cause severe headache and nausea, which are relieved by lying flat. The condition is very treatable. Meningitis, which is an infection or irritation of these membranes, is an uncommon but potentially serious cause of severe headache. Other symptoms include nausea and stiffness or pain in the neck.

Gynecologic Problems

Many clinicians have anecdotally linked gynecologic problems, such as ovarian cysts and menstrual disorders, to chronic headaches, and new data are emerging to support this association.

Temporal (Giant Cell) Arteritis

Certain causes of headaches are unique to the elderly, such as temporal arteritis, also called giant cell arteritis. Inflammation in arteries that carry blood to the head, neck, and sometimes the upper part of the body can cause very severe headaches. In addition to being over 70, the risk for this headache is highest among women, people of European heritage, and patients with polymyalgia rheumatica.

Miscellaneous Causes of Benign Headaches Rapid consumption of ice cream or other very cold foods or beverages is the most common trigger of sudden headache pain, which may be prevented by warming the food or drink for a few seconds in the front of the mouth before swallowing. Other common benign causes of headache include eyestrain, dental problems, allergies, systemic infections, and caffeine withdrawal. Headaches may be induced by sexual activity or intense physical exertion.


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