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What Is Intractable Back Pain

Sleep On Your Back In A Reclined Setting

what is intractable pain?

Do you feel most comfortable snoozing in a reclining chair? Although oversleeping a chair may not be the very best option for back pain, this position can be beneficial if you have isthmic spondylolisthesis Take into consideration purchasing a flexible bed so you can sleep this way with the most effective placement and also support.

Hormone And Neurotransmitter Replacement

This emerging aspect of IP treatment is promising. Testosterone deficiency appears very prevalent in males and females, so serum testosterone concentration should be determined. Opioids may cause gonadal suppression, and it is possible that pain, per se, may contribute to hypogonadism.5 The authors routinely determine serum pregnenolone concentration, since it is the precursor of all sex and glucocortioids, as well as being a neurotransmitter. If it is low, pregnenolone supplements are administered. Gamma-Aminobutyric Acid is a major neuroinhibitor in spinal cord and peripheral nerves. IP may deplete these neurotransmitters, so daily supplements are a safe, inexpensive adjunct that many patients anecdotally believe assist overall pain control. Research shows that IP over-stimulates the hypothalamus-pituitary-adrenal axis, which initially causes over-secretion of pituitary and adrenal hormones, but uncontrolled, chronic IP may also cause suppression of cortisol and other adrenal hormones which may require replacement for pain control, health maintenance, and proper immune function.6

Who Is The Ip Patient

The authors define IP as pain that is excruciating, constant, incurable, and of such severity that it dominates virtually every conscious moment, produces mental and physical debilitation and may produce a desire to commit suicide for the sole purpose of stopping the pain. In the authors clinical experience, bonafide IP patients suffer profusely and are fundamentally bed- or house-bound in the absence of intense medical management.3 Table 1 presents some common characteristics of the IP patient.

A variety of traumatic and medical conditions may be the underlying cause of IP . Note that over half of them involve spine degeneration.

Common Characteristics of the IP Patient

  • Pain is constant and excruciating
  • Pain reduces sleep and food intake
  • Bed-, chair-, or house-bound in the absence of opioid treatment
  • Depression, attention deficit, confusion, and suicide tendencies
  • Underlying cause is incurable, non-removable, and fails to respond to customary pain therapies
  • Elevated blood pressure and pulse rate
  • Serum adrenal hormone and immune abnormalities

Underlying Causes of Intractable Pain in 100 Consecutive Patients

Admitted to Treatment
Total 100%

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Structural And Functional Mri Studies

The structural MRI could provide anatomical information of the brain with high spatial resolution, and the functional MRI is used to determine the location of the activate brain regions during cognitive tasks . Both techniques are helpful to provide information about brain organization and offer potential new criteria for assessing the neurological status and neurosurgical risk thus they are widely employed to characterize structural or functional brain alterations among CBP patients under clinical settings . Since these neuroimaging techniques have distinct advantages, we reviewed studies that explore the cortical abnormalities in CBP patients using structural MRI, resting state fMRI, and task fMRI, respectively.

Manage The Stress In Your Life

The Difference Between Intractable and Chronic Pain ...

Pain triggers the release of stress hormones that make muscles tighten up. Muscle tension reduces blood flow to tissues, bringing them less oxygen and fewer nutrients. When this happens, you feel pain, explains Dr. Welches.

You cant avoid stress, but you can learn to manage it. Cognitive behavioral therapy and meditation are excellent tools, he says. Skilled therapists can change the way you perceive stress. Meditation can reduce anxiety, provide a calm sense of focus and reduce pain.

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What Is The Prognosis For People With Chronic Pain

Chronic pain usually doesnt go away, but you can manage it with a combination of strategies that work for you. Current chronic pain treatments can reduce a persons pain score by about 30%.

Researchers continue to study pain disorders. Advances in neuroscience and a better understanding of the human body should lead to more effective treatments.

If you have chronic pain and depression and/or anxiety, its important to seek treatment for your mental health. Untreated depression and anxiety can make your pain worse and further lower your quality of life.

Management Of Baseline And Breakthrough Pain

Baseline pain is the constant, ever-present pain that is consciously perceived be the IP patient. A long-acting opioid is used to suppress baseline pain.4 The following medications are available for this task: methadone, sustained-release morphine and oxycodone preparations, and transdermal fentanyl . Long-acting opioid therapy is initiated at a low dose and titrated upward to achieve maximal pain suppression without sedation, bradycardia, and hypertension.

Opioid Therapy of IP

  • Hydromorphone suppository

Table 3.

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Chronic Back Pain Treatment Options Whats Best For You

Home / News / Chronic Back Pain Treatment Options Whats Best For You?

If you are struggling with back pain in Central Pennsylvania, youre part of a vast group. Around 80 percent of adults, at some point in their lives, experience back pain. Its one of the most common contributors to missed work days and job-related disability, according to the National Institute of Neurological Disorders and Stroke . The Orthopedic Institute of Pennsylvania provides chronic pain treatment options at our eight locations, including conservative methods and surgical procedures if needed.

Try Acupuncture For Relief

INTRACTABLE/CHRONIC PAIN: what you don’t see

Acupuncture can help you resume the activity that back pain has limited. Used for thousands of years in China for everything from pain relief to stroke rehabilitation, acupuncture is now used in the United States and other Western counties for a variety of chronic pain.

The outpatient procedure is suitable for most people. Tell your acupuncturist if you are on blood thinners, or have a spinal cord stimulator or pacemaker, says Dr. Welches. The acupuncturist will adjust your treatment plan.

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How Intractable Pain Is Diagnosed

If you experience chronic pain and traditional pain-relief treatments arent effective, you should seek out a doctors evaluation. Its important to describe your symptoms accurately and with detail.

Diagnosing the cause of your intractable pain can be challenging. If you experience daily, chronic headaches, for example, you may be experiencing migraine or tension-type headaches. The symptoms of migraine-induced intractable pain, however, are like those of other types of headaches. This makes diagnosis difficult and treatment similarly problematic. You may end up being treated improperly for a condition that appears to be the cause of your pain.

Usually, intractable pain is formally diagnosed when, over the course of time, a variety of treatments fail to ease your pain. For example, after failing different non-injectable measures, you get a corticosteroid injection and it doesnt ease your pain. Or your pain doesnt ease even after taking several different types of medications, such as:

  • nonsteroidal anti-inflammatory drugs
  • mild opioids
  • anti-seizure medications

If these or other treatments, such as surgery, exercise, and physical therapy, dont work, your doctor may officially diagnose you with intractable pain.

What Is Chronic Pain

Chronic pain is pain that lasts for over three months. The pain can be there all the time, or it may come and go. It can happen anywhere in your body.

Chronic pain can interfere with your daily activities, such as working, having a social life and taking care of yourself or others. It can lead to depression, anxiety and trouble sleeping, which can make your pain worse. This response creates a cycle thats difficult to break.

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About Chronic Back Pain

Most lower back pain is short-term or acute, lasting for several days to several weeks. But, it often resolves on its own with no residual function loss. Most acute back pain is mechanical, which means theres a disturbance in how the backs components muscle, spine, nerves and intervertebral discs fit together and move.

Chronic back pain, on the other hand, persists for over 12 weeks even if doctors treat an underlying cause or injury. Around 20 percent of individuals with lower back pain end up developing chronic low back pain with symptoms that persist for at least one year.

If youve been suffering from chronic back pain, its important you visit us at the OIP to receive a diagnosis for your condition and start treatment to experience pain relief.

Chronic Pain Continues After Tissue Heals

Intractable Pain

The term chronic pain is generally used to describe pain that lasts more than three to six months, or beyond the point of tissue healing. This type of pain might also be termed chronic benign pain or chronic non-cancer pain, depending upon the situation. . For the purposes of this discussion, the term chronic pain will be used.

Chronic pain is usually less directly related to identifiable tissue damage and structural problems. Chronic back pain without a clearly determined cause, failed back surgery syndrome , and fibromyalgia are all examples of chronic pain. Chronic pain is much less well understood than acute pain.

Chronic pain can take many forms, but is often placed in one of these two major categories of its own:

  • Pain with an identifiable cause, such as an injury. Certain structural spine conditions, including degenerative disc disease, spinal stenosis, and spondylolisthesis, can cause ongoing pain until they are successfully treated. These conditions are due to a diagnosable anatomical problem. If the pain caused by these types of conditions has not subsided after a few weeks or months of nonsurgical treatments, spine surgery may usually be considered as a treatment option. In reality, this type of chronic pain might be conceptualized as a long term acute pain even though the term chronic pain is used.
  • See Understanding Different Types of Back Pain

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    Dont Plunge Over Your Workdesk

    When sitting in a workplace chair, utilize the same good stance methods you use when standing. Its critical to keep excellent stance as well as sustain your back when taking a seat, particularly if you do it for several hrs daily. Pick a high quality chair that gives firm support for your reduced back, and make sure your knees are a little more than your hips when you rest. Intractable Low Back Pain

    Pathophysiology Of Back Pain Or Backache:

    • Radicular Pain: Chronic pain caused by pinched nerve or irritation of the nerve at nerve root close to spinal cord or at foramina before its exit from the spinal canal.1Radicular pain is associated with tingling, numbness or weakness. Pain, tingling and numbness are symptoms of sensory nerve injury called as radiculopathy. Sensory symptoms are associated with weakness if motor nerve is irritated or squeezed.
    • Muscular Pain: Backache is also secondary to muscle spasm, muscle strains and tear in the back muscles. Backache is often observed in fibromyalgia and myofascial pain syndrome.2
    • Facet Joint Pain: Facet joint pain is seen in older patients suffering with degenerative disk disease and in individuals following surgery or motor vehicle accident.
    • Ligamentum Flavum Hypertrophy: This is observed after trauma, whiplash injury and surgery.
    • Posterior Ramus Syndrome : Also recognized as Maigne syndrome or thoracolumbar junction syndrome. Cause of unexplained activation of the posterior ramus of thoracolumbar nerves is unknown.
    • Referred Pain Visceral pain from stomach, pancreas and kidney disease is often referred to lower back and mid back3:

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    Examples Of Intractable In A Sentence

    DiscoverTimeNew York TimesintractableintractableintractableCNNintractable Wiredintractable National Reviewintractable Los Angeles TimesintractableWashington Postintractable STATintractableRolling StoneintractableWired

    These example sentences are selected automatically from various online news sources to reflect current usage of the word ‘intractable.’ Views expressed in the examples do not represent the opinion of Merriam-Webster or its editors. Send us feedback.

    Will I Need Any Tests

    Intractable pain

    If it’s a short-lived mild pain with an obvious explanation , your doctor will probably suggest some treatment before arranging tests.

    However, because back pain is more likely to be serious if it occurs in the thoracic area rather than in your neck or lower back, your doctor is likely to suggest tests if the pain persists, is severe, or is accompanied by any of the ‘red flag’ features mentioned in the section on Symptoms.

    The tests will depend on the conditions that the doctor wants to rule out. They are likely to include blood tests such as a full blood count and inflammatory markers, and maybe a magnetic resonance imaging scan. An ordinary ‘plain’ X-ray doesn’t give much information unless you have an unusual appearance of the spine or a fracture is suspected.

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    Can Therapy Help With Chronic Pain

    Certain therapies may help you manage chronic pain, including:

    • Cognitive-behavioral therapy : This counseling method helps you think differently about pain and teaches you ways to cope.
    • Counseling: Talk therapy can help you manage chronic pain, especially psychogenic pain.
    • Occupational therapy: Occupational therapy teaches you how to do everyday tasks differently to lessen pain or avoid injury.
    • Physical therapy: Physical therapy involves exercises that stretch and strengthen your body, which can help reduce your pain.

    Back Pain Affects Adults Of All Ages And Incomes

    In general, the characteristics of adults with back pain and the total adult population are not very different. Some differences between the two populations exist with respect to age and income, however. Some 41 percent of adults with back pain are 18 to 44 years old, compared to 54 percent of all adults. Slightly over one-quarter 26 percent of adults with back pain have an annual income of less than $20,000, compared to one-fifth of all adults.

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    Family And Community Support

    Patients may enter IP treatment after they have been medically and socially isolated for many months or years. The authors require a family member or caretaker to accompany the patient until the patient can mentally and physically function well enough to comply with the treatment program. Community resources should be greatly utilized. These may include psychological therapy, religious participation, vocational rehabilitation, and transportation. Local mental health resources can be invaluable. A pharmacist who is familiar with IP is essential to supply medications for lifetime management.

    What Alternative Treatments Are Available For Chronic Pain

    Intractable Pain

    Alternative treatments that have been shown to relieve chronic pain over time include:

    • Acupuncture, which uses small needs placed in the body.
    • Aromatherapy, which uses aromatic plants and essential oils.
    • Biofeedback, which teaches you how to tweak the way your body works, influencing such things as heart rate, breathing and muscle tension.
    • Relaxation techniques, such as massage, meditation and guided imagery.

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    Whats The Difference Between Chronic Pain And Other Pain

    Chronic pain differs from another type of pain called acute pain. Acute pain happens when you get hurt, such as experiencing a simple cut to your skin or a broken bone. It doesnt last long, and it goes away after your body heals from whatever caused the pain. In contrast, chronic pain continues long after you recover from an injury or illness. Sometimes it even happens for no obvious reason.

    Medicine From The Shop Intractable Low Back Pain

    There are two kinds of over the counter pain relievers that often help with back pain: nonsteroidal anti-inflammatory medications as well as acetaminophen. Both have some side effects, and also some people may not have the ability to take them. Talk to your physician prior to taking pain relievers As well as dont anticipate medicine alone to address your pain trouble. Researches show youll probably require greater than one sort of treatment.

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    Diagnosis Of Intractable Pain

    Diagnosis of intractable pain in a patient is made when the patient fails to respond to the traditional treatment methods for acute and chronic pain, which include medications such as anti-inflammatories, non-opioid analgesics, mild opioids, muscle relaxants, antidepressants and anti-seizure medications. Patients with Intractable Pain also do not respond to corticosteroid injections in and around the peripheral nerves or spinal column. Exercise, physical therapy and psychological interventions also prove to be of little benefit, as the patient is not able to participate in all this because of the excruciating nature of the pain. The only treatment till now which has shown to relatively control and manage intractable pain is lifetime therapy of potent opioids. This line of treatment should be done as a last resort or end-stage because of its expense and complications.

    Physical Therapy And Exercise

    Intractable abdominal pain

    Once opioids control IP, the patient can begin measures to strengthen his/her musculo-skeletal system and hopefully reduce pain on a permanent basis. Stretching exercises involving the afflicted anatomical structures that produce IP are essential. Patients should be taught stretching and strengthening exercises that they can practically accomplish each day for their lifetime. Weak or degenerative anatomic structures may benefit from a prosthesis, specially-fitted shoes, or walking stabilization with a cane or walker.

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    Downhearted Feelings Are Common Among Adults With Back Pain

    Substantially larger proportions of adults with back pain, compared to those without back pain, report feeling sad, worthless, or hopeless . Almost three-quarters 72 percent of those with back pain report that such feelings have interfered with their life, compared to 61 percent of those without back pain. People with chronic back pain report significant levels of psychological distress, including feelings of anger and depression, while people who have suffered an acute episode of back pain are less likely to report these feelings.

    A Few Words About Age Fitness Body Weight

    You cant stop aging or its effects, but you probably have some control over your fitness level and body weight. While you cant stop the clock on the cellular changes that are known to accompany agingsuch as loss of muscle mass and/or bone densityyou can take small steps today to build a stronger you tomorrow.

    Its understood that patients with chronic back or neck pain may not feel like being active, going to the gym or even following a home exercise program. However, being active can help chronic pain because during exercise your body releases endorphinsyour bodys natural painkiller.

    Furthermore, by teaming up with your doctor and/or physical therapist you can start to build strong abdominal musclesessential to your bodys core strength that helps support your spine. Several studies demonstrate that low-impact aerobic exercise is effective in maintaining the structural integrity of the intervertebral discs in the lower spine, which can lessen chronic back pain.

    Did you know that by losing even 5 to 10 pounds you can reduce back pain? Its true. Carrying around extra weight translates to added stress to the lower back that can exacerbate pain.

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