Dr. Sharon Orrange
Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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LOCATION: Santa Monica, CA, USA
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  • Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California
YEARS IN PRACTICE: 15
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Chronic Pain: Not, "All in Your Head," as Many Believe
15
Posted in Chronic Pain by Dr. Sharon Orrange on Nov 01, 2011
Most of what we have learned about pain in the last few years has helped answer why patients with some pain syndromes, have pain. Fibromyalgia, irritable bowel syndrome, interstitial cystitis, TMJ, chronic low back pain, and tension headaches have associated pain that is difficult to treat with traditional medications. Specific options for treatment of this kind of pain are now available with many more on the horizon.

Think of neuropathic pain as being driven either by the peripheral or central nervous system.

Central neuropathic pain states are conditions such as fibromyalgia, irritable bowel syndrome, TMJ, interstitial cystitis, tension headache, chronic low back pain and even osteoarthritis of the knee. The overwhelming evidence has shown that the pain in these conditions is occurring primarily because of altered pain processing, without there necessarily being any damage or ongoing pain from the periphery. Does that mean “it’s all in your head?” Absolutely not.

There is now overwhelming evidence for a strong biologic reason for these symptoms. Everyone needs to look at the central problem in these patients and guide treatment as such. For example, altered levels of neurotransmitters are found in fibromyalgia patients leading to the change in sensory transmission.

Central pain (as in the above listed conditions) is typically characterized by:
- Multifocal pain (pain in lots of areas.)

- Multiple other symptoms: fatigue, memory difficulties and sleep disturbances.

- A higher level of current and lifetime history of pain.

- A family history of pain (there is evidence of a genetic component in chronic pain.)

- Hyperalgesia: patients have increased pain to normally painful stimuli.

- Allodynia: pain from normally non-painful stimuli.

- On history or on physical exam, these individuals will often have pain just with light brushing of the skin, light pressure or may even report pain from wearing tight-fitting clothes, for example.
What medications don’t work for treatment of these conditions:
- Opioids are not effective in central pain states and have shown no benefit in treatment of fibromyalgia patients.

- NSAIDS (naproxen, Advil, ibuprofen, Celebrex) and acetaminophen (Tylenol) primarily work peripherally and don’t have much benefit in central pain states.
What medications have been shown to work (Centrally acting analgesics):
- Drugs that enhance the effect of the GABA receptors: benzodiazepines (Ativan. Xanax), muscle relaxants like Baclofen or cyclobenzaprine (Flexeril.)

- SNRI’s (serotonin norepinephrine reuptake inhibitors): Cymbalta, Savella.

- Tricyclic antidepressants.

- Alpha-2-delta ligand drugs: Lyrica or Neurontin (gabapentin.)

- Anticonvulsants: like carbamazepine (Tegretol.)
Tell us what your experience has been. The addition of Savella, Lyrica, and Cymbalta, among others, has been encouraging for people suffering with these difficult conditions.

- Dr O.



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CATEGORIES: Answers
CONDITIONS AND COMMUNITIES: Arthritis  •  Arthritis - Juvenile  •  Back Pain  •  Chronic Fatigue Syndrome  •  Chronic Lymphocytic Leukemia (CLL)  •  Chronic Myelogenous Leukemia (CML)  •  Chronic Pain  •  Fibromyalgia  •  Interstitial Cystitis (IC)  •  Irritable Bowel Syndrome (IBS)  •  Migraine Headaches  •  Multiple Sclerosis (MS)  •  Myofascial Pain Syndrome  •  Osteogenesis Imperfecta  •  Osteoporosis  •  Rheumatoid Arthritis  •  Sleep Apnea  •  Sleep Problems - Childhood  •  TMJ
TAGS: Therapies

MEMBER COMMENTS
TOTAL COMMENTS: 15 - View All Comments »

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Displaying comments 15-1 of 15
15
This article like so many coming out of medicine these days is mostly marketing for the pharmaceutical companies. Indeed it doesn't talk about cause of pain which I find is completely lacking in the medical community. They almost never no cause. I know what causes my pain. I was poisoned by pharma. I was injected with a toxic metal used for MRIs, MRAs and CT scans. They call they gadolinium based contrasting agents. It causes a new disease that is not RARE. Your pain may be caused by them even if you have only had one injection. Read the interview with Dr. Abraham where he says that millions will need to be followed. hemodialysis.com/author_interview_gd_deposition_in_pt_with_nsf.html" title="http://www.hemodialysis.com/author_interview_gd_deposition_in_pt_with_nsf.html" target="_blank">http://www.hemodialysis.com/author_...
By gasf  Apr 04, 2012
14
Bull crapp I have tried gabbapenton lyrica and tons of migrane medication I'm on opiates tagged along with savella and antidepressants and that helps me evry great once in a while and I'm a 28 yr old vetaran from the united states army which I got diagnosed with fibromyalgia neuralgia cervicalgia lubago lower chronic back pain and other stuff . So for each person its different
By trinidadjrr  Apr 03, 2012
13
Interesting article. I have been reading about chronic pain related to arthritis on http://www.bettermedicine.com/topic... and it has been interesting to hear about ways to control it.
By shelleytowns  Feb 25, 2012
12
Where does Dr O find these stats?????

Some of these just seem to be posted to start arguments!
By SunnyBunn  Feb 16, 2012
11
Does anyone know a doctor in central Oklahoma that understands and treats fibromyalgia?
Also is there a diet that I can consume that will help with fibromyalgia. My chinese doctor tells me that is what I have.
By Daffny  Feb 09, 2012
10
my dr. put me on ultram for pain and lyrica for my fibro. I reaaly do like this combinatio. My problem I have now is, no health insurance. Im scared to death that I cant afford my office visits or my lyrica. Ultram is only 10 dollars so I can afford that. I dont know what to do. I cant afford insurance through work it cost to much. I need blood work done I cant do that either. Im raising 3 kids.and any money I have goes to them first. I need to be healthy for them so what do I do.
By kelly41  Jan 31, 2012
9
my dr. put me on ultram for pain and lyrica for my fibro. I reaaly do like this combinatio. My problem I have now is, no health insurance. Im scared to death that I cant afford my office visits or my lyrica. Ultram is only 10 dollars so I can afford that. I dont know what to do. I cant afford insurance through work it cost to much. I need blood work done I cant do that either. Im raising 3 kids.and any money I have goes to them first. I need to be healthy for them so what do I do.
By kelly41  Jan 31, 2012
8
I have to disagree with the attitude that opoids do not work in CNS pain. That makes no sense at all. These treat post op pain because they affect the CNS. That makes these two statements mutually exclusive.
As long as doctors hold to these conflicting statments, they will continue to refuse treatments to people.
That is really sad and shameful.

Not every person treated with opiods needs ever increasing amounts of medication. If they are properly counseled about reasonalbe expectations about the amount of pain that can be resonably relieved with medication, they should do better. The ones who expect total pain relief tend to want more and more.

Then there are the addicts. BUt those people would be exposed the first time they had surgery.
If there were a blood test that showed addiction, would they be forced to tolerate surgical procedures without pain relief?
Would that be considered in humane?
Why are people in chronic pain expected to suffer constant pain levels beyond those?
By SunnyBunn  Jan 21, 2012
7
I disagree with the opinion that pain medication does not help. That is absolutely untrue. Many of us are able to continue working, caring for our families and so on BECAUSE of pain medication. Are you really suggesting taking an anxiety pill for pain like Ativan?! That stuff is INCREDIBLY dangerous. If it works for some, fine. But, it makes much more sense to take a PAIN KILLER than something for anxiety. I understand boosting noripenephrine and dopamine but that can be done by taking natural neurotransmitters with no side effects. I take them and guess what? NO PAIN RELIEF. So yes, many can benefit from pain killers. It is more likely that the pharm industry prefers to dope us up on anti depressants because A: they are more expensive and B: they can cause a host of other issues. I will stick with my pain medication as that is the ONLY thing that works for me in the 15 years I have had chronic pain.
By JellyBean25  Jan 03, 2012
6
I absolutely love Cymbalta and recommend that anyone with chronic pain talk to their dr about it. It take it daily for chronic migraines. But here is an example of how it helps with pain. If I maybe touch a hot pot while cooking I now feel the burn but after some cool water the pain just stops, even if I get a blister. Used to be it would hurt and throb for hours and hours on end. Made me a believer!!
By BethVH  Jan 02, 2012
5
I have had a friend recommend pain cream for my chronic neck and back pain. Do any of you have any experience with this type of chronic pain relief?
By EricGuttormson  Nov 29, 2011
4
It is simply not true the the two that are listed in the "What doesn't work" category which are opioids and nsaids, don't work. Each person is an individual, with individual concerns and conditions and therefore one can not discount any drug for any patient.
By evasthoughts  Nov 28, 2011
3
The Alpha 2 drugs had no positive effect on my chronic leg pain diagnosed by my doctors many as diabetic neuropathy but my diabetes was never except when first diagnosed greatly out of control. Also I have full feeling too much actually no discoloration or numbness and my weight has always been good. The only thing that helps is large doses of narcotics and vallium helps some I think my problem wad caused by intron A combo treatment for hep c in 1993 I think the more I talk to people like my self this is now coming out as a side effect of the hep treatment. After my treatment my body started to fall apart, soon after my diabetes surfaced tiredness weakness and a general sick feeling is always present. It took 15 years for my legs to get so bad that I am in my current situation on disability . Doctors just scratch there heads and think all I want is drugs, ha the drugs help the pain but are killing me faster
By MARKLEBOFF  Nov 24, 2011
2
My Thought is, That The Medications to Treat these Pain Syndromes Often is Just Trading Symptoms for Side Effects, and Some of these Side Effects can be Deadly. My Symptoms have Been Bad, But I have Tried the Meds, and the Side Effects were Actually Worse, AND Doing Damage..so, as it stands, I am All Natural..and have Found some very Effective "Hands On Treatments"...will stick with that, at least for now.
By DakotaRose  Nov 03, 2011
1
Great post Dr. O. I have chronic pain from fibro and lupus as well as some osteo arthritis and prolapsed discs in my neck. I have tried Cymbalta and Savella. Both gave me too many side effects---including Serotonin Syndrome with the Savella. I still take low dose Gabapentin and Oxycarbazapine. Both of these are helpful for pain as well as bipolar. Sometimes I wonder if my pain syndrome and bipolar all are somehow connected.
By surferchica  Nov 01, 2011
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