The mystery of chronic pain

Posts Tagged ‘neuropathic pain’

The mystery of chronic pain

Posted on: May 19th, 2016 by Isobel Addison No Comments

The mystery of chronic pain

Why do some people develop chronic pain following an injury while others do not?

The question has remained a mystery to both doctors and scientists.

Chronic pain affects millions of people.  People who suffer from severe, chronic pain know only too well how it can utterly disrupt and damage day-to-day life. Pain can make it a challenge to get through each day let alone to enjoy even the simplest daily activities.

Chronic pain has historically been misunderstood. The medical profession used to believe that pain could only be a manifestation of an underlying injury or disease. As such, doctors focused on treating the underlying cause of the pain, with the belief that once the injury or disease was cured the chronic pain would then disappear.

If no underlying cause could be found for the pain, then the patient was often told that, “the pain must be in your head”. Unfortunately, some doctors still practice in this manner, having no appreciation for the unique difficulties experienced by sufferers of chronic pain.

A new study led by researchers at the Rehabilitation Institute of Chicago (RIC) and Northwestern University Feinberg School of Medicine has revealed that the risk of a patient developing  chronic pain is determined by the brains anatomical properties, and not the initial injury.

“While simple, the logic of addressing problems at the site of an injury to remove pain has resulted in only limited success,” said senior study author Marwan Baliki, PhD, research scientist at RIC and an assistant professor of physical medicine and rehabilitation at Feinberg. “The central processes of chronic pain have largely been ignored, so our research team set out to better understand the brain’s role.”

The researchers found that patients who developed chronic pain had a smaller hippocampus and amygdala compared with those who recovered. The hippocampus is the primary brain region involved in memory formation and retention, while the amygdala is involved in the processing of emotions and fear. In addition to changes in size, these regions also showed differences in connections to the rest of the brain, particularly to the frontal cortex, an area involved in judgment.

The study’s results challenge long-standing views of the science of pain, establishing that the gross anatomical properties of the brain determine the most risk for developing chronic pain.

The results pave the way for the development of a different approach for the prevention and treatment of chronic pain.

The full study, “Corticolimbic anatomical characteristics predetermine risk for chronic pain,” will be published in the June edition of Brain. In addition to Apkarian, Baliki and Vachon-Presseau, study authors include Pascal Tétreault, Bogdan Petre, Lejian Huang, Sara E. Berger, Souraya Torbey, Alexis T. Baria, Ali R.Mansour, Javeria A. Hashmi, James W. Griffith, Erika Comasco, and Thomas J. Schnitzer.


Axium™ Neurostimulator

Posted on: April 12th, 2016 by Isobel Addison No Comments

St. Jude Medical Axium™ Neurostimulator Stimulator launched

On 11th April 2016 St. Jude Medical, Inc., a global medical device company, announced the U.S. launch and first post-approval implants of the St. Jude Medical Axium™ Neurostimulator System.

The treatment for patients with chronic pain involves dorsal root ganglion (DRG) stimulation. it is hoped that the treatment will help patients who have not been receptive to traditional spinal cord stimulation (SCS).

The first commercial implants of the St. Jude Medical Axium™ Neurostimulator System device have taken place at the Centre for Pain Relief in Charleston, and at the Sutter Santa Rosa Surgery and Endoscopy Centre in Santa Rosa, California.


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(Photo: Business Wire)

Half of the states in the USA will treat patients using the  DRG implants in the coming weeks.

St. Jude Medical has partnered with 59 implanting chronic pain specialist centres across the country. They hope to conduct more than 100 procedures in the first month.

They aim to train more than 300 physicians to effectively deliver DRG therapy to patients over the next year.

The treatment is designed for patients in immediate need of targeted stimulation to alleviate chronic pain resulting from moderate to severe chronic intractable pain of the lower limbs in adult patients with Complex Regional Pain Syndrome (CRPS) types I and II.

Stimulation of the DRG, a spinal structure densely populated with sensory nerves that transmit information to the brain via the spinal cord, allows physicians to treat the specific areas of the body where pain occurs. This new approach is designed exclusively to treat moderate to severe chronic intractable pain of the lower limbs in adult patients with CRPS.

Dr Pope, who has already performed the procedure says that, “Stimulation of the dorsal root ganglion is the first therapy option designed specifically for patients suffering from complex regional pain syndromes. This serious and traditionally challenging to treat chronic pain condition can occur from complications to recovery from surgeries such as knee arthroscopy, foot surgery or hernia surgery. Having a treatment option rooted in clinical evidence fundamentally changes our approach to treating patients.”

The Institute of Medicine reports that chronic pain affects more than 100 million Americans. This is more than heart disease, cancer and diabetes combined. Neuropathic pain represents one of the most prevalent yet under-treated forms of chronic pain in the United States.

Initial results evaluating patients suffering from neuropathic chronic intractable pain associated with CRPS I and II or peripheral causalgia (PC), showed DRG stimulation provided patients with superior pain relief over traditional tonic SCS.

Information for patients to learn more about chronic pain can be found at

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If you are suffering from chronic pain syndrome as a result of an accident or someone else’s negligence call our experts on 01285 654875.


What is Pain?

Posted on: March 3rd, 2016 by Isobel Addison No Comments

Pain; what is it?

Mark Tawn discusses

Serious Injury Expert Mark Tawn


At some time in our lives most of us experience it.

But just what is pain?

My English dictionary provides the definition as:

“Physical hurt or discomfort caused by injury or illness….emotional suffering or mental distress.”

Interestingly, my concise medical dictionary doesn’t include a definition. Perhaps this is because the answer is far from straightforward.

IASP, the International Association for the Study of Pain defines it  as:

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

The notes to this definition continue:

“…Pain is always subjective…It is unquestionably a sensation in a part or parts of the body, but it is always unpleasant and therefore also an emotional experience….Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain.”

In the context of having suffered an accident my clients often report pain to many different people. These may include:

  • Emergency service personnel – paramedics, ambulance crew, police or fire crew
  • Hospital staff – A&E, nurses, orthopaedic, neurology, rheumatology or pain management
  • GPs
  • Family and friends
  • Employers and colleagues
  • DWP/welfare benefits personnel
  • Me!

How is pain described?

I have heard (and read) hundreds of different expressions and words from many different clients to describe their feelings, these include:

Ongoing, constant, periodic, occasional, permanent, regular, worsening, mild, moderate, bad, terrible, awful, agonising, excruciating, burning, gnawing, stabbing, niggling, exhausting, freezing, deep, like toothache, worse than having a baby, the worst agony I’ve ever had.


How does pain affect people?

Because it is subjective it affects different people in different ways.

One client who had to have surgery without any anaesthetic, when asked about his experience brushed it aside saying: “worse things happened during the war.”

Another, who had suffered a low velocity road traffic collision, was in “constant agony” which continued, unabated, for years despite all sorts of treatment: medication and injections, physical therapy and psychological therapy. The same client underwent investigations which included X-rays and MRI scans which revealed no underlying bony injury (e.g. a break or fracture), nor any soft tissue damage that would account for the reported symptoms.

For how long does pain last?

It may be short-lived. This is referred to as acute pain.

Long term pain, which has lasted for three months or more, is widely referred to as chronic pain.

What types are there?

Nociceptive pain occurs when nerves which sense and respond to parts of the body are activated (usually by damage) transmitting signals to the brain. When the damage heals the pain usually ceases.

Neuropathic pain results from injury to or a problem with the nervous system. The injury may not actually include damage to the nerves. The experience of pain continues beyond the apparent healing of damaged tissue. The system itself is (or has become) dysfunctional.

Pain may be experienced owing to a mix of neuropathic and nociceptive factors and can be complicated by psychological and social issues.

Why might other issues affect me?

If one is suffering and it isn’t getting better (or worsening) all sorts of questions can arise: Who will take the kids to school? Might I lose my job? How will I pay the bills? This can cause worry, anxiety, fear, and may lead to depression. This can be a downward spiral:

Pain → worry → more pain → more worry

The degree of discomfort experienced can also be influenced by broader social issues. Absence from work can cause problems with employers, the need to claim benefits, to find help from charities and so on. It can affect relationships: feeling or becoming needy or dependent; partners becoming carers as opposed to lovers and withdrawal or alienation from family and friends.

In a compensation claim if you have long term pain it is vitally important that your solicitor discusses these issues with you and those nearest to you.

If you have a complex claim talk to us: