Why chronic pain is a neurodegenerative disease

The causes of chronic pain and the role of community paramedics in treating it as a disease with a pathophysiological process discussed at EMS World Expo


NEW ORLEANS — Treating pain and differentiating addiction disorders is one of the most significant challenges EMS providers are facing in the United States. Dan Swayze, Director for Center for Emergency Medicine, introduced EMS World Expo participants to the pathophysiology of chronic pain and why drug addiction is such a common co-occurrence in chronic pain patients.

Memorable quotes on chronic pain
Here are memorable quotes from Dan Swayze on chronic pain and opioid addiction.

"There is some evidence to suggest at least 50 percent of heroin users start out with chronic pain and became addicted to prescription medications."

Perceptions of pain are influenced by the other types of stressors in patient's lives and a physiological problem has social consequences in how the patient is perceived or treated by family, friends and co-workers. (Photo by Greg Friese)
Perceptions of pain are influenced by the other types of stressors in patient's lives and a physiological problem has social consequences in how the patient is perceived or treated by family, friends and co-workers. (Photo by Greg Friese)

"Chronic pain is at least in part a neurodegenerative disease. It is not a psychological disease. It is not a mental health disease."

"There are people where the high is the goal — they become addicted to the feeling. There are other people who want to get rid of the pain because they want to turn around, but they can't figure out how to control the pain." 

Key takeaways on understanding and managing chronic pain
Pain is a pathophysiological neurodegenerative disease and needs to be treated as such. Here are the key takeaways from Swayze's presentation.

Nociceptive and neuropathic pain
The differences between nociceptive pain and neuropathic pain were described in three instructional videos. The nocicpetive pain process can be instructional to the patient or lead to adaptive behavior change, like touching a hot stove or musculoskeletal injury. Neuropathic pain has no observable source.

Chronic pain
Swayze described chronic pain as a physiological problem, not a mental illness. As EMS providers, we see this neurodegenerative disease manifest itself with hypervigilance or hypersensitivity to stimulus. The patient develops a physiological reflexive reaction over which they have no control.

Perceptions of pain are influenced by the other types of stressors in patient's lives and a physiological problem has social consequences in how the patient is perceived or treated by family, friends and co-workers. A positive feedback loop is created with a recurrence of feeling bad and doing less.

Opioids effects
In the cells, opioids cause euphoria and lessen signals from the cellular source of the pain. But the opioids have other effects, such as slowing down the digestive process, which creates a new source of pain.

Opioid threats
Three threats associated with opioids are tolerance, hyperanalgesia and withdrawal. Tolerance requires an increasing opioid dosage to achieve the same effects. Hyperanalgesia is the worsening feeling of pain. Withdrawal is a constellation of symptoms when a patient attempts to stop taking opioids.

Addiction versus pseudoaddiction
A patient with a pseudoaddiction doesn't want to be addicted or experience the high. When the patient's pain source is controlled they can quit the addiction and no longer use opioids. Patients who want the experience of a high — that is their goal — needs a different treatment pathway and rehabilitation.

Swayze described a model for community paramedics to match a patient's needs to the appropriate interventions. This process starts with an EMS provider simply acknowledging that they care about the person and want to help the patient.

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About the author

Greg Friese, MS, NRP, is Editor-in-Chief of EMS1.com. He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by emailing him at greg.friese@ems1.com.

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