Join Andrea Furlan in discussing One Thing she wants people challenged by pain to know. Is Chronic pain just long-lasting Acute pain? Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Andrea.
About Andrea Furlan
Dr. Andrea Furlan is a renowned pain specialist and Professor of medicine at the University of Toronto. She has extensive experience in managing chronic pain and has authored numerous publications in the field. Find out more about Andrea here.
Transcript
David: What is one thing you want people challenged by pain to know?
Andrea: Yeah. I want people to know one thing and that is that chronic pain is not the same thing as acute pain. A lot of people confuse them and they think, uh, chronic pain is just a continuation of acute pain, but they are two different diseases. They’re two different things. And the things that we use to treat acute pain, they do not work the same for chronic pain.
And the way that I explained this to my patients is I explained to them the alarm system of a house. Uh, and, uh, this is if you put an alarm system of your house, you want it to trigger and make noise when there is a burglar, a fire, a smoke, or a flood in the basement. And so you install sensors right on the walls and the windows and on the, on the, on close to the floor.
And when they, when there’s something wrong, they will make noise. So that’s acute pain. We have those sensors in our body to make noise, which is called pain. So it has to be unpleasant. Otherwise nobody would go and seek care. And, um, but then when you have chronic pain, in a lot of cases, it doesn’t mean that there is a fire in the house.
There is, there was probably, there was a fire in the house, a lot of smoke, but now the sensors are triggering and they are going off in the absence of a new fire because there is a short circuit somewhere or they’re just sensitized. And so instead of calling the fire truck, the police or the ambulance, you need to call the alarm system company.
To come and fix the alarm system of your house. So that’s what chronic pain is in the majority of cases. And we need to stop looking for the causes, you know, in the periphery. Sometimes there is still some inflammation going on. That’s okay. But we also need to treat the pain system. Read. Retrain the pain system, how to feel pain normal again, and I tell my patients, when the pain system is dysfunctional, there is a name for this.
It’s called nociplastic pain. But then when the pain system is dysfunctional, the person is very tired of this pain. This pain is going on all the time. It’s almost like living in a house where the alarm system is going off all the time, very loud because the volume is amplified. Nobody in the house hears that noise and you go from doctor to doctor, they examine you and they say, I can’t find anything wrong.
You must be going crazy. So really, that is really what my message is. There is a real problem. If you are feeling pain, your pain is real. And if you’re feeling pain, it might be because your pain system is deregulated and the doctors, the healthcare professionals are not trained to detect that disease because it’s a new concept.
We are learning this in the last 20 years, so we didn’t make into medical school yet. So it’s a new concept. Your doctors, your healthcare professionals are trying the best, examining your joints and MRIs, but the problem may not be there. It’s in the pain system. So my message for you is a message of hope.
It is curable. It is treatable. You can retrain the pain system when you have chronic pain and feel so much better .
David: Yeah, that’s great. There’s lots of, like you said, there are lots of little messages in there in a way and many of them are really good, um, centered around, like you’re saying that this, this primary idea that it’s a different system that’s at play. I was just curious what do you mean. You talked a little bit about the fire alarm approach. What do you think is then like, if we’re gonna switch to the system, what do we need to do differently, right? If the doctors and everybody else are like, oh, we’re looking at your joints and we’re looking at, you know, your MRIs and whatever else, and we want to get to looking at this pain system where, how do you think we get there with that?
Andrea: Yeah. So when the pain system is malfunctioning, the first thing that we need to do is make that diagnosis, just by making that diagnosis is very helpful because the patients realize that there is a real diagnosis. So I tell them there are three types of pain. There is nociceptive pain, neuropathic pain, and nociplastic pain.
So nociceptive pain is when the alarm system of the house is functioning as it was supposed to, to alert you that something is wrong and the pain is just a reflection of something that is broken, injured, or diseased. Neuropathic pain is when the wires are malfunctioning or there’s a cut in the wire, there’s an injury to a nerve or to the spinal cord or to the brain like a stroke.
Multiples sclerosis, spinal cord injury, or a nerve compression or diabetes. So those, those things, nociceptive and neuropathic, they’re easy to diagnose. You can see the injury. You can see. That there is if you do a EMG nerve conduction study, you can detect where the problem is examining the patient.
You can, you know where the pain is. Now when nociplastic pain happens, which is this pain system that is malfunctioning, then the treatment is different and the diagnosis is, you look at the place where they’re saying that there’s pain, but you can’t find that nociceptive, neuropathic component there.
The pain is widespread, is not localized to an area that you would expect for nociceptive, or neuropathic pain, and there are other symptoms the because the pain system is in the emotional system. There is a lot of mood swings, there’s a lot of sleep problems, fatigue. Those are part of the syndrome. That’s all part of the nociplastic pain.
And I think just giving this diagnosis to patients, validate what they’re feeling, having, and that’s the initial, that’s the step number one to get this, uh, treatment, uh an appropriate treatment for this disease.
David: Yeah. Great. Yeah, that’s perfect. Well, thank you so much for sharing your one thing with us. We really appreciate it, and we look forward to having it posted up for this season.
Andrea: Thank you.