Pain

Last month was all about chronic pain. Musculo-skeletal (do you know about trigger points? I learn that I have some myself!), fibromyalgia, neuropatic pain and CRPS (complex regional pain syndrome, very interesting!), and a lot of psychiatric pain.  And it was amazingly interesting.

To start with the beginning, pain always comes from the brain. Pain is an interpretation or a translation of a signal, which can -or not - lead to pain. The brain decides if it should be painful (like when you burn yourself with a bath too hot) or if it is insignificant and just delete the signal (the sensation of your clothes on your skin). The brain can also produce some pain without even a significant signal from the system... The brain being this incredible piece of very complex machinery could very easily malfunction.

My attending explains pain to patient with the perfect analogy. Your body is like the alarm system you have at home. You have some nociceptors (pain receptors), which are like the windows and doors detectors. They can be activated if there is a thief  trying to get in, or they can malfunction (false alarm). When the detectors are activated -in nociceptive pain like pain from a broken bone or osteoarthritis- the alarm central (which is your brain) can decide if it is real and send the police (pain) or decide that it is probably a false alrm and dismiss it. The communication lines (the nerves) between your detectors and the central can also be damaged - in neuropathic pain like diabetic neuropathy, or when your nerves are damaged by diabetes. When it is the case, your central does not know if the signal is real or not and might send the police to investigate. Finally, your central can decide that there is a lot of thieves around the neighborhood and will send the police even if there isn't real significant signal - in central sensitization pain. Thieves can be any signal being identified as damaging to the brain, including important emotional events.

Chronic pain is therefore a very diversified practice. I visited two clinics in two different cities and the patients in both clinics were not similar. While in one clinic, we saw more women and psychiatric conditions, in the other clinic, it was more about men with back pain trying to get disability (which the attending was not giving easily. It is well supported in litterature that if the patient stop working, it will be very difficult to get him back to work. So, manage pain with different modalities, but keep them working.)

What I love about chronic pain management is the interdisciplinary approach. During my time there, I has been interacting with a nurse, a physical therapist, a psychologist and a social worker. I really want my future practice to include some interdisciplinary work. I don't know if it is going to be in a chronic pain clinic, but I would be interested in such a position if available at that time... We'll see...

Next month, public health!