Mr. Derek Cawley, spinal surgeon and consultant with Irish Doctors for the Environment talks to Claire about 3 types of physical pain and how to build a 360° plan for managing long-lasting pain. Listen back above.
Chronic pain can be hard to treat and is sometimes trivialised, leaving desperate sufferers reaching for solutions that make the problem worse. One such quick-fix remedy is the drug OxyContin, which plays a significant role in the opioid epidemic in the US, as dramatized in the series Dopesick (available to watch on RTÉ Player). Spinal surgeon Derek Cawley talks to Claire Byrne about the mistakes made in the US in the way OxyContin was used for chronic pain. He explains the three types of pain and explains how solutions to chronic pain can be both medical and social.
What does "chronic" pain actually mean? Derek says it's a condition that deserves more attention:
"Typically, chronic pain or what’s now called persistent pain is more than 3 months long. It’s difficult, because it’s trivialised – society doesn’t really want to know about it. It’s the end of every long waiting list."
The source of pain can be broken down into three main types: nociceptive, neurogenic and nociplastic. The first two are well understood, the third one less so, Derek says. Nociceptive pain results from an injury like a broken bone, or where there is arthritis, like in the hips, for example. Derek explains that when a joint is inflamed in the case of arthritis, or swelling develops around a break; a pain message is sent to the brain:
"The body learns through its nerves that there’s a problem there."
The second type of pain is nerve pain or neurogenic pain. It is caused by damage to nerves or pressure on nerves in the case of, say, sciatica. Finally, there is a type of pain that is not easily attributable to a source like joint inflammation or nerve damage, as the surgeon explains:
"The third one is probably the one that we find difficult. It’s called nociplastic pain or central sensitisation; it’s where the pathways, those nerves become a little bit fuzzy, and it transmits a pain that may not necessarily be organic in source. They are often the ones that are likely to become the more chronic ones – they are less well understood, less well diagnosed."
People in pain are looking for solutions, but often there is no quick and easy remedy, Derek says. He brings up the perfect storm that overtook the US, where people in chronic pain were offered a treatment option that wasn’t right for them:
"As was shown in the US, these people are described opiates, which isn’t of particular use to them or benefit to them."
The drug was heavily marketed to patients, who were told that they could not become dependent on it. This was not true, Derek says:
"It was marketed as not addictive, which it is. It has one and a half times the potency of morphine. People were cycled through increasing doses very quickly, because of the increased tolerance that the body develops to a drug."
In promoting OxyContin, there was an attempt to re-frame the narrative around chronic pain in a way that Derek says is misleading:
"There was this concept that was introduced; 'to break through pain’, which is not really a thing. But it was enough for them to be able to market it significantly."
So what are sufferers to do? Derek Cawley offers suggestions for a ‘360° plan’ for chronic pain; taking in medical and social supports and starting with a proper diagnosis:
1. As far as possible, find out from the experts what is the source of your pain; and which one of the three types it falls under - nociceptive, neurogenic or nocioplastic. This will help to find the best treatment pathway for your particular complaint. As Derek says,
"Pain is best managed by an accurate diagnosis."
2. Take some exercise – something that doesn’t hurt, like aqua aerobics, floor exercises or cycle on a stationary bike. This is not a quick fix, but it helps your body help itself, as Derek explains:
"The natural endorphins that are created from exercise are huge – they help. They are the body’s pain killer mechanism."
3. Increase human contact. Talking to people and actually being heard can reduce your anxiety, and lowering anxiety has been proven to reduce pain, Derek says. He likens it to what happens when we comfort children after a fall. When his daughter bumped her head recently, a kiss on the head doesn’t "cure" anything, he says; but it does make her feel better in a real and important way:
"She felt reassured by the fact that I cared about the bump on her head. So feeling supported and listened to and allowing that person to feel their anxiety is being addressed has a massive impact on their pain."
Derek Cawley responds to listeners questions on chronic pain, which you can hear in the full interview by clicking above.
Dopesick is available to watch on RTÉ Player.
