What is the purpose of physical pain in someone who doesn't really seem to have anything wrong with them?

At first pain has the purpose of warning the person. It protects us from further injury or harm. The body is saying, "Stop whatever you are doing -- it hurts." Escape is the next step: get away from whatever is causing the pain. This is also a protective mechanism.

Expressions of pain (facial or verbal cues) are a way to seek help. They also have the effect of causing empathy on the part of others. Our own distress in seeing someone in pain motivates us to help or assist that person. Pain helps the sufferer get the care he or she needs.

If the pain signals are not turned off early on, they can get stuck. Someone with chronic pain that doesn't go away may not have anything wrong biologically. The pain system has set up a circuit or loop that can't get turned off. The natural purpose for pain has been overridden.

In some people there may be a psychologic or emotional need for pain. This type of pain is called a behavioral response. The traditional medical model of treatment may not help this person. Until we learn how to stop chronic pain, treatment has become a management issue. We help the patient do more within the confines of their pain. Pain may be reduced but not eliminated.

Despite having chronic pain for six months now, I'm still working and keeping up. The doctor thinks it might help me to see a physical therapist. But how can they help? I can run 10 miles, pump iron, and keep up with the best of them?

It's clear that some people cope with pain using endurance strategies. They increase rather than decrease their exercise and activity. If this describes you, you may not benefit from a rehab program that focuses on increasing your physical fitness. That type of program would just overload your muscles even more.

You may need a specialized program. The therapist will assess you for specific disabling activities or changes in activity pattern that you may not even be aware of. The therapist may be able to help you learn better ways to move that won't load your spine as much.

And it's possible there are ways to modulate your pain so that you can continue doing what you want to do activity-wise with less pain and/or discomfort. Chronic pain has a way of changing how your body moves and perceives movement. Based on this fact, you may be at increased risk for future injury.

The therapist can help you regain normal proprioception (sense of joint position) and kinesthesia (awareness of movement). If there is a movement impairment of any kind, the therapist can guide you through specific exercises and patterns of movement to restore full and normal motion.

How are pain and depression connected?

Although pain and depression are two completely different things, they can be connected very closely. When someone experiences chronic pain, they can find themselves not doing many of the activities they enjoy doing, or they may not do them as well as they used to. Chronic pain can keep them from going out to social activities, or spending time with family and friends. Just moving around the home or concentrating on a favorite television show may become difficult.

When someone is used to being active, but the pain keeps them from participating, they can become frustrated or angry at themselves. This can lead to sadness, or depression. We then begin to see a cycle. As someone gets more depressed, they are less likely to try harder to do things, and the cycle continues.

How can you tell if you're addicted to painkillers? I'm taking a morphine-based drug (OxyContin) and I'm worried about becoming addicted.

OxyContin (also known as Oxycodone) is a schedule II opioid pain reliever. That means it's a drug that can only be obtained from a doctor by prescription. It was first brought onto the market in 1996 so it is a relatively new drug.

OxyContin is a highly effective pain reliever used by millions of chronic pain patients. Unfortunately it does have a down side with long-term use because it is morphine-based and can be addictive. Morphine-based drugs bring pain relief but also a sense of euphoria and pleasure that can lead to abuse and addiction.

Long-term use of OxyContin leads first to tolerance. This means you must take larger amounts over time to get the same pain relieving (or euphoric) effects. Tolerance is not the same thing as addiction.

The next step is physical or psychologic dependence. Dependence means that without this drug, the body starts to go into withdrawal symptoms. The person is considered addicted when the drug is needed for the person to function normally and when withdrawal symptoms occur if the drug is stopped.

Talk to your doctor about your concerns. Find out how to manage your dosage to get the maximum benefit with the minimum amount of risk.

I am one of those Baby Boomers who likes to take charge of my own life. I think of myself as a consumer of health care. Most recently, I've started looking into better ways to deal with my chronic low back pain. I've been told by several doctors there's nothing more that can be done. Where can I look for some answers?

Chronic back pain can be very difficult to evaluate and treat. There are many things we still don't know about pain, what causes pain, and how to stop it. In many ways, the nervous system in charge of perceiving pain and sending pain messages remains a complex mystery.

Many pain clinics use a management approach to chronic back pain. The combined efforts of the doctor, psychologist, physical therapist, nutritonist, and others are used to find the best program of intervention and management for each patient.

If you haven't been working with a team of pain experts, that may be your next step. You may live in an area where a pain clinic has not been developed yet. As a consumer, you may have to put together your own team.

Instead of the physician coordinating all of the services, you would have that role. It will be up to you to communicate with each individual member on the team.

There are many traditional and complementary techniques available now for pain management. On the traditional side, medications are often the first-line of treatment. They range from mild analgesics to powerful narcotics.

From a less traditional approach, there is acupuncture, hypnosis, massage, relaxation therapy, and biofeedback to name just a few. It may take a while to find the right one or the right combination to get maximum benefit, but it can be done.

I broke my wrist last fall and ended up with CRPS. Can you explain to me what went wrong? It was a simple fracture of the radius?

There isn't an easy or simple answer to the question of complex regional pain syndrome (CRPS). Scientists are conducting many studies to sort out all the variables and factors that go into a condition like this. So far there isn't agreement about the mechanism of cause.

It may be that nerve damage after an accident or injury occurs setting off this extreme response. Some doctors and scientists think the central mechanisms of the nervous system are triggered by the injury. Their signals get mixed up and reorganized in a chaotic way.

For now it seems that there' isn't a single one-way to explain what went wrong. Once the underlying pathology is discovered treatment will be able to address the cause instead of just the effects (symptoms).

I had a steroid injection for chronic sciatica. I got about 50 per cent improvement but it's slowly coming back. Should I have another injection? How many does it take to lick this problem?

Sciatica or pain in the low back, buttock, and down the leg is caused by irritation of the sciatic nerve in the lower extremity. It usually only affects one side.

Steroid injection into the epidural space around the spinal nerve can give pain relief. There is some debate about whether or not the results are short-term or long-lasting.

Routine use of epidural steroid injections is not advised. Usually only one to three injections are given. The patient should be informed that these injections may not improve function. They may end up having surgery anyway.

Epidural steroid injections are considered safe. There are a few possible complications. Headache is the most common but doesn't last more than a few days.

Pain specialists advise patients to keep a pain log. Frequency, intensity, location, and duration of pain are recorded before and after the injection. The pain can be rated each day on a scale from zero (no pain) to 10 (most pain).

Even though this is a subjective measure, it can help you decide if you are getting pain relief, how much, and how long it's lasting. With repeated injections, you should see continued improvement that lasts and pain doesn't come back.

I have a back problem, a slipped disk that happened at work a few years ago. But that's not what hurts me now. Instead, I have a very sharp pain about a quarter of the way down my buttock and it shoots up into my back or down my leg from time to time. Is that sciatica?

The sciatic nerve runs from your lower back, down through the buttock to the leg, on both the left and right sides. Sciatica isn't really a disorder itself, but a symptom of a problem, like the back pain you describe. If you have a slipped disk that is pressing down on a sciatic nerve root, this can cause the pain that you are feeling lower down.

There are several treatments that may help relieve sciatic pain, but since the pain is a symptom, before doing anything you should see your doctor. It's not safe to assume that it's your old back injury that is causing this problem because it could be something new. Some of the stretching exercises that work wonderfully well for some people can actually make it worse for others, depending on the cause.

Once your doctor has confirmed the reason for the pain, you might be treated through medications for pain and/or inflammation, physical therapy, back bracing, or even surgery.

I want to go for acupuncture for my back pain. How does acupuncture work?

Researchers don't quite understand how acupuncture works, but there are several theories. One theory is that the introduction of the needles releases chemicals and endorphins that help manage the pain, while another theory says that the needles affect a patient's pain threshold. However it works, the Chinese belief is that the body's health is a balance of two forces, the yin and the yang.

If the forces are not in balance, as would happen with illness or accident, this must be fixed and acupuncture is able to fix this.

The acupuncturist locates various points that are believed to be responsible for certain areas of the body and by inserting the acupuncture needles into these points, balance is achieved.

I was recently tested for psychological problems related to my chronic low back pain. The test showed I am seriously depressed. But who wouldn't be depressed after months and months of back pain everyday?

It's true that quality of life does suffer when a person is faced with chronic pain. Depression can be a natural response to the downward spiral of pain, deconditioning, loss of function, and more pain. But studies show over and over that certain personality types are more likely to become depressed after an injury or problem with back pain.

Some researchers have linked this response to patients who are more likely to catastrophize an event in their lives. This means they blow it out of proportion. Pain and other symptoms escalate and don't respond to treatment with medications, injections, exercise, or rest. Results don't improve with physical therapy or even surgery.

A recent study from the University of Texas (Arlington) used a personality inventory called the MMPI to test almost 1,500 patients with chronic occupational spinal disorders (COSDs). Almost two-thirds had some type of personality disorder. Half had a significant depressive or anxiety disorder. Only seven per cent were in the normal profile (NP) category.

If you tested positive for depression, you may benefit from medical treatment for this condition. Ignoring depression won't make it go away and will almost certainly keep you in the downward spiral mentioned. Starting a course of anti-depressants along with an exercise program could be the start to restored function and improved quality of life.

At 78 years old, my father has his share of aches and pains. But lately he's been complaining more and more about back pain. X-rays show he has mild spinal stenosis. We think he would do better and have less pain if he would take an antidepressant, not have another surgery. Is it possible that an antidepressant could help?

There are two sides to every coin. Whereas depression has become a very common disorder, especially in older adults, anti-depressants aren't always the quick and easy answer.

On the other hand, depression is known to cause joint and/or muscle aches and pains. An antidepressant is certainly less invasive than surgery to correct the problem. And if the X-rays show a mild case, then other conservative measures might be helpful.

Besides antidepressants, nonsteroidal antiinflammatory drugs (NSAIDs) may be helpful. Physical therapy to improve posture and spinal alignment may also help. Sometimes a local injection of steroids gives patients long-lasting pain relief.

Surgery is the most successful treatment for moderate to severe cases. But if there is a mental disorder of any type, surgery isn't likely to make a big difference.