– I am treated like a child who tries to pretend he is sick to avoid going to school. It doesn’t feel good, says Zain Rage. He has long-term pain throughout his body, for which no one can find a cause. Pain that does not appear. Pains he’s been told repeatedly he’s imagining. Also in the healthcare system. From a large resource to disability benefits In 2001, he was involved in a serious car accident. – After this, I was diagnosed with damage to my neck and system, says Rage. This is long-term pain Long-term pain is defined as persistent or constantly recurring pain that lasts three months or more. We can distinguish between three main types of long-term pain: Nociceptive pain (pain caused by tissue damage) Neuropathic pain (pain caused by dysfunction in the nervous system) Idiopathic pain/compound pain (pain of unknown cause) Approximately one in three Norwegian adults has long-term pain, and two thirds of these are composite. Long-term pain is common at all ages – even in children and young people, and women are most at risk. Source: FHI The accident has still not been found to be the cause of the pain. – Before I was a big strong man, I was a resource, says Rage. Previously, he has worked in the oil industry, with long-distance transport and as a cook. Now he is on disability benefits. – If you’re not quite tough in the head, then it’s easy to just find the spade and dig as deep a hole as you can and jump into that hole. That’s how everyday life feels, says Zain Rage. Photo: Malika Normann / news To no longer be able to go to work or participate in society on an equal basis with everyone else is a big strain, Rage thinks. – It was the biggest blow in the face I have ever received in my life, he says. It hurts not to be believed Talking about his pain seems difficult to him. Only those closest to them get to hear about how serious Rage’s situation really is. – Being believed in is the most important thing in the world, he says. Being accused of pretending to be in pain is a response from several in society Rage is no stranger to. Refuted psychic explanation Petter Christian Borchgrevink is a senior physician at St. Olav’s hospital and professor of anesthesia and pain medicine at NTNU. He has led a study in connection with the Health Survey in Nord-Trøndelag, where they found that the participants with long-term pain without a known cause did not imagine their pain. They examined 551 participants with long-term pain of both known and unknown causes. Both a doctor, psychologist and physiotherapist carried out the examinations. Petter Christian Borchgrevink, senior physician at St. Olav’s hospital and professor of anesthesia and pain medicine at NTNU. Photo: Bjørn Hval In almost two-thirds of the participants, they could not find a cause for the pain. The psychologists carried out an investigation into whether the participants had diagnoses of mental illness. – We thought that those with long-term pain of unknown cause would have more mental disorders than those with known cause, but to our surprise it was not like that. In addition, it was revealed that the pain without a known cause was not exaggerated. – So the assumption that so many people have, that those with long-term pain of unknown cause are psychological, was very accurately and well refuted, says Borchgrevink. Difficult to get help Although he has experiences with doctors who do not believe his pain, Rage has also met doctors who do not doubt that he is in pain. Nevertheless, there is little these have been able to do for him, as there are not many concrete aids to treat patients like Rage. As of now, he uses pain patches that inject doses of morphine into his body. This is an opioid medication. This is what one of the pain patches that Zain Rage has on his arm looks like. Photo: Malika Normann / news The treatment of long-term pain with opioids is much debated, as it has several side effects, some of which are very serious when used over a long period of time. More about opioid use Opioids (morphine-like substances) have a significant effect on short-term pain and are absolutely essential in, for example, cancer treatment and palliative care. More people use opioids to treat long-term pain as well, but this is debated. Summaries of knowledge indicate that these drugs have little and uncertain effect on long-term pain, while the side effects, on the other hand, are well documented and are sometimes very serious. Risks can be increased and abnormal pain sensitivity (even with normal pain stimuli), overdose and the development of addiction. Today, there are more overdoses linked to painkillers containing opioids than to heroin. In the national guide for the use of addictive drugs published in 2021, it is recommended to avoid continuous treatment with opioids beyond four weeks. Nevertheless, there is increasing use of opioids in Norway and the number of patients with long-term pain who are treated with opioids. In some other countries, use has gotten out of control, including in view of the so-called “opioid epidemic” in the USA. We do not have an opioid epidemic in Norway similar to the one in the USA, but the increasing use is reason for monitoring the development. Source: FHI Has created an alternative Because there is a need to limit opioid use, Borchgrevink has developed an alternative treatment plan. A treatment regimen Rage has never been introduced to. The scheme has been named Nomed. Borchgrevink has led the project in collaboration with GPs, among others. – Nomed is non-medicinal measures to tackle 17 reinforcing and maintaining factors that can worsen long-term pain, he says. The factors include sleep problems, poor physical condition, anxiety and depression. These are the 17 factors Persistent desire for painkillers Sleep problems Persistent desire for more investigation Fear and avoidance Exhaustion Poor physical shape Health anxiety Social isolation Worse-case thinking Anxiety Worry about work and hubs Depression Rumination Feeling of rejection Experience of injustice Difficult relationship with those closest to you Serious life events Through mapping and conversation with a doctor, you can find out if there is one or more of the 17 factors that are relevant for the patient to work with. – It is important to point out that these factors are not the cause of the pain, but are factors that can intensify it. For example, if you sleep very badly night after night, it goes without saying that the pain gets much worse, explains Borchgrevink. Nomed has been tested on a group of patients and was published on Norsk Helseinformatikk (NHI) a year and a half ago, available to everyone. In addition, they are in the Norwegian Electronic Medical Handbook (NEL) for GPs. Trying to make the best of the situation Rage tries to stay active as much as he can, both with sports, hunting and nature management as well as voluntary work. Some days go better than others, but some days he is in so much pain that he can’t do anything. Don’t even walk the dogs or vacuum. Zain Rage’s two dogs are a great comfort in everyday life. Here he is petting the dog Khali. Photo: Malika Normann / news – On average, I sleep two to three and a half hours a night, says Rage. The roommate Henriette Schibstad is a good supporter. She finds it terribly difficult that there are people who do not believe that her partner is in as much pain as he is. Zain Rage’s roommate, Henriette Schibstad, is a good and important supporter in his life. Photo: Malika Normann / news – It’s very lonely, it’s really quite horrible, says Schibstad. Despite a very challenging everyday life, Rage tries to live his life in the best possible way, and tries to smile as best he can every day. – I have to be my own medicine, he says. Zain Rage tries to smile as often as he can, despite the pain. Photo: Malika Normann / news Published 11.06.2024, at 19.58
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Prolonged pain with an unknown cause is not imagination, study shows – news Rogaland – Local news, TV and radio
