Living in the age of chronic pain

Insomnia, forgetfulness, increased irritability, depression.

No, I am not describing a typical day around my house.

These are the "Big Four" of chronic pain, according to psychologist and pain specialist, Dr. Michael Errico.

Chronic pain affects more than 86 million Americans. And by far the majority of them are middle-aged or above.

Why does chronic pain somehow automatically show up as our constant companion right alongside that offer of AARP membership?

The reasons are two fold, according to Errico.

There is the "wear and tear" factor. More of us are staying physically active into our 40s, 50s and beyond. This translates to putting more stress on an older system. With this older system, there is just more opportunity for trauma. Nevertheless, says Errico, a well thought out exercise program -- in moderation -- is one of the best things we can do to keep pain at bay.

And the second, even more intriguing reason for an increase in chronic pain as we age, is the decrease in efficiency in our hormonal and neurotransmitter systems. We all know about the wonderful natural high we get from our brain's own production of endorphins; the "runner's high," for example. Endorphins are our bodies' natural pain killers.

According to Dr. Errico, "These systems become less efficient, inhibiting pain as we get older. We are therefore more likely to experience things as painful than we would have in our 20s."

It seems that another critical neurotransmitter -- serotonin -- also naturally decreases as we get older. "That is why we tend to see depression alongside chronic pain," says Errico.

I mentioned to Dr. Errico my theory of an "Age-related Pain Syndrome" that I have written about in this column: That puzzling situation where you wake up one morning and your back aches, the next day, it's a shoulder, or a hip that screams out at you. He has a name for it and an explanation. He calls it a "pain sensitivity disorder" and believes that when pain becomes chronic we can end up with a deconditioned nervous system that leads to greater pain sensitivity.

I told the doctor that I felt a great relief knowing there was a syndrome and an explanation for my migrating pain. I was beginning to think that my friends and I were head cases.

Actually, pain can be very much a mental condition, claims Dr. Errico. And much of the treatment of it will involve working with the pain sufferer's coping skills and mental attitudes.

Dr. Errico is likely to focus his patients on finding alternative coping skills for managing their pain and reconditioning their nervous system. As he explains, when we are processing chronic pain, our nervous system becomes imbalanced, with the sympathetic (arousal) branch of our nervous system getting a constant workout. Many of his interventions are designed to enhance the parasympathetic (calming) branch so that it can get us back into balance. Diaphragmatic breathing, self hypnosis and imagery are some of the techniques of deep relaxation that he teaches to bring about these changes.

Mental and physical strategies for decreasing depression are often a major focus in treatment. According to Dr. Errico, "It's all about taking our lives back from the pain. Mental attitude is really important. Pain as a problem to be solved, rather than a tragedy to be endured."

Dr. Michael O.L. Seabaugh is a Cape Girardeau native who is a licensed clinical psychologist with over 20 years experience helping individuals and couples with their emotional and relationship issues. He has a private practice in Santa Barbara and Santa Monica, Calif. Contact him at mseabaugh@semissourian.com.