If your leg is in a cast or your arm in a sling, total strangers offer sympathy and assistance. But chronic pain usually is an invisible disorder. In most cases, no one can tell that you're any different from anyone else.

That makes it difficult for even your family and friends to understand what you're going through, or what they can do to help. You may feel isolated and alone.

Many people feel better when they can talk with others who are experiencing similar challenges. If you don't have a friend who can adequately relate to your situation, you can connect online through message boards. A support group can provide help, advice, belonging and understanding that you might not find anywhere else. I have been runing a group like that since 2001. Visit the online support group Friends International to see whether the group can be of help for you!

The information given on this website is not a substitute for medical advice. Always consult a qualified medical professional.

My chronic pain experience

I have lived with chronic pain for more than 25 years. My pain problems didn't start with pregnancies, but got worse after pregnancies. After my first pregnancy I got a sacroiliac joint dysfunction and I developed a sitting disability. I worked while lying down for many years after that. I could walk and run cross-country skiing, I could just not sit for more than a short time. I had chronic pain without any known reason for many years. I didn't hear about sacroiliac joint dysfunction until long after second pregnancy.

After second pregnancy I developed disabling upper back pain, while still suffering from my sacroiliac joint problem. Some years later my back pain was so bad I couldn't walk more than a few minutes at a time. I had to give up my work as a lawyer.

When my home was connected to the Internet, I created Friends International support group for people living with chronic pain. The group has become an activ Cyber community for people around the world. The board is a joint effort of volunteers that provides support and continual updated information about chronic pain, including Fibromyalgia and backpain.

Sacroiliac joint dysfunction (SPD)

The sacroiliac joint, due to its anatomic aspect, is a very particular joint. The following information is taken from an excellent article by dr.Sady Ribeiro and his colleges dr. Andre Prato Schmidt and dr. Peter van der Wurff.

Sacroiliac Dysfunction seems to be a biomechanical dysfunction of this joint and could be a cause of chronic back pain. History and physical exam, due to poor specificity, might not be enough to make this diagnosis. Imaging studies are not very helpful either Anesthetics block, guided by fluoroscopy, CT, or MRI is considered the "gold standard" test, which proves that pain originates from the joint.

When conservative treatment fails, invasive therapeutic modalities can be used, but their efficacy has not yet been proven. Arthrodesis should be reserved for the very disabling cases that did not respond to the less aggressive approaches. Opioids may be the last hope for some patients.

Disorders of the sacroiliac joint sometimes can be a challenge regarding diagnosis and treatment. Since the joint is deeply located, proper assessment is difficult. Its anatomy is complex and unique with a syndesmotic superior compartment and synovial inferior one. The iliac bone presents a thin fibrocartilagionous cartilage and the sacral bone is covered by a thicker hyaline cartilage, which makes the iliac side more vulnerable to any pathology that might affect the joint.

Chronic pain - a disease?

Research shows that chronic pain can be a disease. Unlike ordinary or acute pain, which is a function of a healthy nervous system, chronic pain resembles a disease, a pathology of the nervous system that produces abnormal changes in the brain and spinal cord. New technology, like functional imaging, which is generating the first portraits of brains in action, is revealing the nature of pain's pathology.

Far from being simply an unpleasant experience that people should endure with a stiff upper lip, pain turns out to be harmful to the body. Pain unleashes a cascade of negative hormones like cortisol that adversely affect the immune system and kidney function. Patients treated with morphine heal more quickly after surgery. A recent study suggests that adequate cancer-pain treatment may influence the prospects for survival: rats with tumors given morphine actually live longer than those that do not receive it.

The general lack of understanding of how persistent pain becomes magnified and ingrained prevents many patients from receiving the level of care that they need to regain control of their lives and resume normal activities.

Our genes may affect pain

People who say they are less sensitive to pain than others could be right. Researchers have found a gene that appears to affect how people feel discomfort.

Tests in rats showed that blocking increased activity of the gene after nerve injury or inflammation could prevent the development of chronic pain, a finding that points to possible ways to develop new pain drugs.

And studies in volunteers showed that about a quarter of them had the genetic variant that protects them from pain somewhat, and 3 percent carried two mutated copies that make them exceptionally insensitive to pain, the researchers reported in the journal Nature Medicine.

"This is a completely new pathway that contributes to the development of pain," said Dr. Clifford Woolf of Massachusetts General Hospital and Harvard Medical School in Boston, who led the research.

A new definition of chronic pain

In the last decade or so, psychologists and other pain researchers are coming around to a new definition of just what is pain. Gone is the old telegraph model that served medical science for thousands of years: You put your hand in a hot fire you felt the pain of the burn until the tissue eventually healed.

In its place, some scientists are putting forward the notion that pain ricochets through the body more like the way the internet works: The initial experience sets off a complex chain of reactions involving one's general health, genetic makeup, brain chemistry and perhaps even how one has come to think about pain in the first place.

The chronic pain that doctors seem to be seeing much more of, where even the slightest touch can send some patients into fits of agony, appears to be a function of the brain being unable to turn off its own alarm circuit. The pain signal just seems to go around and around in a high intensity loop and neither narcotics nor anti-depressive drugs appear able to shut it off.

Chronic pain - without any known reason

Chronic pain may develop for no apparent reason. Despite repeated examinations and tests, your doctor may not be able to link it to an identifiable physical cause or condition. This doesn't mean that the pain doesn't exist. Pain is, by its very nature, subjective. It is not tangible. X-rays and lab tests can't "see" pain.

Your pain may be associated with factors that are difficult to diagnose. It's also possible that the normal method of pain processing has been disturbed in your brain or spinal cord. For example, your pain could be similar to the phantom pain some amputees feel in their amputated limbs. Even subtle damage to nerves can cause severe pain.

Often, the cause of chronic pain isn't well understood. Years of research have failed to uncover the precise physical causes of many painful ailments.

Heightened sensitivity to pain may be a factor. People with chronic pain often have lower than normal levels of painkilling endorphins. In other cases, pain signals from injured or diseased tissue amplify or distort pain messages by activating pain circuits in the peripheral nervous system, spinal cord and brain.

If you have any questions or need support, join us at the message board in the forum called Coping with chronic pain.

CRPS - reflex sympathetic dystrophy

The complex regional pain syndromes (CRPS I and CRPS II), also known as reflex sympathetic dystrophy and causalgia, have been recognized for the past 2,500 years and believed in for the past 150, but they have yet to be understood. These syndromes can be characterized by discrete sensory, motor, and autonomic findings, but many patients with CRPS continue to suffer for years without a diagnosis, jf. Pub.Med. 1: Pain Med. 2006 May-Jun;7 Suppl 1:S64-96.

The role of the sympathetic nervous system in maintaining these syndromes and its appropriateness as a target for treatment continue to be subjects of enduring controversy. As might be expected in a group of disorders that we still have trouble naming, much less diagnosing, it has been very difficult to reach a consensus on how to treat people afflicted with the CRPS. Recent insights into how the nervous system responds to injury are beginning to explain some of the "impossible" neurological findings that are characteristic of CRPS. These research findings may soon be translated into specific therapies targeted at the processes of neural inflammation that appear to play an important role in these syndromes.

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