L–M

living with pain Approaches and methods for
improving QUALITY OF LIFEwhen PAINis part of daily
living. For one in five Americans, pain is a daily
experience. Nearly 60 million people in the United
States have OSTEOARTHRITIS, 45 million experience
frequent headaches severe enough to interfere
with regular activities (28 million of them have
chronic or recurrent migraine headaches), and 5
million have chronic low BACK PAIN.
Living with pain requires an integration of med-
ical and lifestyle methods. There are many kinds of
ANALGESIC MEDICATIONS, some of which provide gen-
eral pain relief and others that target specific kinds
of pain. Research over the past 10 years has pro-
vided significant insight into the mechanisms of
pain, resulting in new classifications of drugs that
intercede at different junctions along pain path-
ways. ROUTES OF ADMINISTRATIONsuch as transdermal
patches (SKINpatches) or long-acting oral formula-
tions can deliver a steady rate of pain medication,
smoothing out the ups and downs that accompany
other dosage forms such as short-acting tablets and
pills. Though most people do not want to take med-
ications on a regular basis, medications may be nec-
essary to slow a disease process (such as RHEUMATOID
ARTHRITIS) or to alleviate enough pain to allow par-
ticipation in daily activities.
Daily physical exercise, such as walking, bene-
fits nearly every condition in which there is pain.
Physical activity stimulates the body to release
endorphins, enkephalins, and other biochemicals
that act as natural pain relievers or otherwise
influence the body’s inflammatory response and
pain mechanisms. Regular activity also improves
MUSCLE STRENGTHand JOINT FLEXIBILITY, helps main-
tain healthy body weight, and relieves stress.
Alternative methods such as ACUPUNCTUREand CHI-
ROPRACTICcan provide extended pain relief (days

to weeks). BIOFEEDBACK, VISUALIZATION, andMEDITA-

TIONare additional methods for coping with and

managing pain.

See also ACUTE PAIN; CHRONIC PAIN; EUDYNIA;

HEADACHE; MALDYNIA; MASSAGE THERAPY; STRESS AND

STRESS MANAGEMENT.

maldynia CHRONIC PAIN that exists without

apparent organic or physical cause. The defining

characteristic of maldynia is that the PAINdoes not

activate specific pain receptors (nociceptors) or

follow conventional pain pathways. Some

researchers believe maldynia represents a mal-

function of the BRAIN’s pain interpretation

processes, likely an imbalance among brain neuro-

transmitters. Other researchers believe maldynia

represents disturbances in the body’s pain sensory

mechanisms, perhaps changes at the level of the

NEURONthat alter the sensitivity of pain signals.

Maldynia is an extraordinarily frustrating con-

dition. Beyond the limitations on enjoying life

that continual pain imposes, there are the psycho-

logic ramifications of the perception that the pain

is not real. Doctors who are unfamiliar with

chronic pain syndromes may be suspicious of

reported pain without apparent cause that persists

despite efforts to resolve it and may dismiss the

person’s symptoms as “psychosomatic” or emo-

tional in its basis. Research suggests that though

emotions influence pain perception, this occurs

through biochemical and physiologic pathways in

the body and the CENTRAL NERVOUS SYSTEM.

Symptoms and Diagnostic Path

The primary symptom of maldynia is pain that

does not go away and has no apparent cause. Doc-

tors do not generally consider chronic health con-

ditions for which pain is a component, such as

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