The vast majority of the chronically ill suffer from pain and it’s associated anxiety and depression. Pain erodes the ability to accomplish life’s normal every day tasks and reduces the pleasure patients used to find in their activities and relationships. Millions of Americans have to deal daily with the profound problems of chronic pain. Recently, pain management programs have proliferated throughout the country. Some are very good and some remain bound by beliefs in nonproductive stereotypes surrounding addiction and "drugs" in general. Patients don’t have to consult pain specialists but their own physicians are often unable and/or unwilling to serve as pain managers.

It is important to deal professionally with chronic pain. Over time patients may become increasingly depressed and agitated. Inter-personal relationships falter, tempers flare, sleep becomes difficult or impossible. Suicidal thoughts can easily find a home in the ruins left from pain's despair and anguish.

Chronic pain cuts across the various medical diagnoses. It can occur from diabetic neuropathy, MS, or "phantom limb" (neuropathic pain) or from spinal problems, arthritis, organ disease, or cancer (nociceptive pain). Pain can be constant or intermittent. If neuropathic it is usually "bright" and burning while nociceptive is usually a grinding ache. These different types of pain use different nerve pathways and are processed differently by the brain. Sometimes patients have both types of pain or are unable to really define the nature of their discomfort. One of the great dilemmas in chronic pain is that sufferers often don’t know just when the pain will begin and once it’s started they don’t know when it might remit. This not knowing can cause extreme anxiety.

Every individual experiences pain differently for a variety of reasons including genetics, associated anxiety, gender, and experience. There is no worse truism than "it is all in your head". Each individual perceives pain uniquely. The pain people experience is all real. The ideas that pain might "simply" be psychosomatic therefore not require treatment is wrong. Pain can be generated by thoughts and feelings. This type of pain is more correctly termed "psychogenic". While originating in the brain, psychogenic pain hurts just as much as if it originated in an organ, muscle, or peripheral nerve.

Chronic pain is often associated with the following disorders, to name a few:

• Arthritis including inflammation
• Spinal or other bone/joint disorders including nerve impingement and degenerative spinal changes and other joint degenerative processes
• Migraine or other chronic headache
• Organ disease including hepatitis, cirrhosis, cancer, pancreatitis, Crohn's disease, irritable bowel syndrome, and renal failure
• Connective tissue disease including lupus and sclerosing disorders
• Diabetes including neuropathic pain and muscle spasm
• Multiple sclerosis including neuropathic pain and muscle spasm
• Other autoimmune diseases such as rheumatoid arthritis
• Chronic pelvic inflammatory disease, PMS, and PMDD
• Carpel tunnel, TMJ, and ulnar neuropathies
• Chronic viral infections including HIV, shingles and herpes simplex
• Pulmonary disorders including fibrosis and COPD

• Table of Contents

• Steps to Help

• Medications - Introduction and Principles

• Medications - Classes and Effects

• Adjunctive Therapy with Medical Cannabis

• Links and References