Nurse who suffers chronic tailbone pain

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I am a Registered Nurse who has suffered with tailbone pain for over 8 years. Like all chronic pain, it is essential that sufferers get the correct support, diagnosis and treatment appropriate for them as an individual. This blog follows my journey with chronic pain, it expresses my personal opinions and thoughts. It is not intended as a replacement for advice or treatment from your normal Healthcare Provider.

Thursday, 11 December 2014

Chronic Pain

Pain is such a complex phenomenon. I am trying to understand it more, but struggle I have to admit.

My coccydynia is chronic pain as I have had it somewhere between 5 and 7 years. My understanding of chronic pain is pain that lasts longer than  3-6 months, or longer than is considered acceptable.

Pain can be nociceptive pain, i.e. caused by nociceptors (a nerve cell or neuron in any area of the body whose tip or nearby, is sensitive to tissue damage), or neuropathic (caused by damage to the nervous system). These neurons are also known as pain receptors.

Nociceptive pain can be divided into superficial or deep, and deep pain further divided into somatic and visceral.

Superficial pain is activated by nociceptors reacting to pain in the skin or superficial tissues. Deep, somatic pain is activated by nociceptors reacting to pain in deeper tissues, such as bones and tendons. Visceral pain is when nociceptors in the organs are activated.

Neuropathic pain is divided into peripheral (pertaining to the peripheral nervous system) or central (brain and spinal cord).

Referred pain can be experienced in a completely different place to the origin of the pain. This reflects the origin of the cells involved, the route of the nerve fibres.

Continuous activation of nociceptors can cause over sensitisation of these nerve fibres. They react to lower thresholds of pain signals.

Pain can hinder circulation and therefore reduce the supply of vital nutrients to the tissues, it can trigger the stress system and release corticosteroids thereby inhibiting the immune system.

My coccydynia is chronic pain, it is deep, somatic pain. It has caused over sensitisation of nerves in that area. My nociceptors are over sensitive to stimuli. Now, my nerves are constantly 'fired up' in a state of pain when they should not be. This would be ok if it served a purpose- like a needle stick injury causing me to pull my finger away; but it now serves no purpose. For some reason at some point my acute pain became chronic. I cannot even recall how or when this happened, and do not understand the mechanisms for how this happens. I do wonder if I had been taken seriously at the beginning whether I could have avoided this downward spiral; and whether this is the case for many coccydynia sufferers.

Anyway, physio session number 4 tomorrow. I am continuing with my Tramadol, Naproxen and Paracetamol. I am still not sure it is helping. My mood remains at an all time low. I know this has a direct effect on my pain as pain is linked to the emotional centres in the brain. So I will endeavour to try and be positive. It really is a vicious circle though-

pain=depression=worse pain=worse depression. It is a cycle I need to break.

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