When Your Pain Has No Name

It is a success story that stands in stark relief against the lives of those who are still searching for answers to their agony. Michael Smith, associate professor in psychiatry and behavioral sciences at Johns Hopkins University in Baltimore, says that there are a number of pain conditions for which the origins and exact causes are still unknown.

"We're supposed to be this wonderful medical system that can do anything, that can save lives," Smith says. "But we really don't know enough about pain."

"It is often difficult to come up with a diagnosis for a patient with chronic pain in particular," agrees Dr. Paul Christo, director of the Multidisciplinary Pain Fellowship at the Johns Hopkins School of Medicine. "Sometimes these types of pain do have names, but we still don't understand the exact mechanisms of the pain."

And because chronic pain is often misunderstood, many patients go without the treatment they need. This, in itself is a problem; untreated, chronic pain conditions can actually worsen, recruiting more nerves until the pain spreads throughout the body.

Dr. Doris Cope, director of the Pain Medicine Program at the University of Pittsburgh Medical Center, says that this spread is often ignored -- particularly in the absence of a proper diagnosis.

"Some doctors say, 'Oh, there's nothing wrong with you,'" she says. "Meanwhile there is pain."

Still, patients may find themselves swept into dismissing their conditions as well.

"First of all they begin to doubt it themselves," Cope says. "Secondly, they get the feeling of helplessness and hopelessness. They don't know what's happening."

Worse, for these sufferers chronic pain has not only a physical component but an emotional one as well. As the pain spreads, the same chemical signals involved in depression, anxiety and stress also come into play, commencing a symphony of physical and emotional misery for the chronic pain patient.

"For many people, their pain takes over their entire life. It affects their work life, their family life, their social life," Cope says.

It is a personal tragedy to which Toussaint can attest.

"It destroyed every relationship in my life except for my relationship with my partner, John," she says. "He stood by me, but my entire family left me behind.

"The emotional pain becomes more serious than the physical pain."

Chronic Pain, Depression Closely Linked

Little surprise, then, that chronic pain is regularly tied to depression.

"Imagine that you develop chronic pain and in time you are no longer able to work," Christo says. "That can be very disruptive and lead to a loss of self-esteem and self-worth. At the same time, it can change the nature of your relationship with your family and friends.

"If the patient has lost their sense of self-worth and become depressed, that in turn can lead to social isolation."

Smith agrees. "[Patients] get the feeling that they really can't control the pain; they feel helpless about it... In some cases these patients can go to full-blown clinical depression."

The roots of this depression even appear to transcend emotions alone. On Monday, scientists revealed additional biological clues as to why pain and depression may be so closely linked. A team of researchers led by Irina Strigo of the University of California San Diego compared brain scans of people with depression to those of 15 people who were not depressed while these subjects anticipated or experienced a painful sensation.

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