Chronic Pain

Chronic pain is a symptom manifestation of a dysfunction of the nervous system and normally lasts longer than 3 months. In simpler terms, it occurs when the primary cause of the pain has been treated already, but the pain continues to linger on.  In some cases, people with chronic pain must accept that their pain will never be explained. This does not mean that they have to accept their pain. It just means that they have to work with their healthcare team to address the pain, even if they don’t know its cause. Other times the cause of the pain is known but cannot be cured. In any scenario, there are ways a healthcare professional can help the patient to deal with the chronic pain.

Some people have aches deep inside their muscle or bone. Some people have stabbing or shooting pain, often with tingling or numbness. And others have dull, throbbing pain. People living with chronic pain often suffer allodynia (heightened pain response to usually non-painful stimuli), hyperalgesia (increased sensitivity to pain), or dysaesthesia (unpleasant abnormal sensations).

Chronic pain can stop a patient from living their lives normally. They may have difficulty performing their daily chores such as bathing or dressing and it can even lead to mental health issues like depression and insomnia.

Types of Pain

• Nociceptive – pain based on an anatomical part of the body and can fluctuate in severity. It is normally worsened with movement. Examples include trauma, burns, fractures or osteoarthritis.
• Neuropathic – any altered sensations like insect crawling, numbness, tingling, or stabbing that is due to damage to the spinal cord, nerves or brain. Examples include carpal tunnel syndrome or phantom limb syndrome after an amputation where pain signals have been abnormally processed.
• Visceral – pain coming from inner organs that is difficult to localize.
• Psychogenic – pain which manifests physically but may actually be of psychological origin.
• Mixed – any combination of the above, normally a combination of nociceptive and neuropathic.

Examples of conditions that can lead to Chronic Pain Syndrome

• Cluster headaches and migraines
• Giant cell arteritis
• Fractures which are poorly healed
• Arthritis
• Infections that affect the neurological system like HIV, Herpes Zoster
• Multiple sclerosis
• Polyneuropathy
• Spinal injuries and stenosis
• Malignancy
• Fibromyalgia
• Polymyalgia rheumatica
• Anxiety and depression

These are, by no means, the only conditions that can lead to chronic pain. The first step for any patient is to seek the appropriate help.

Pain Diary

It is important to note down an accurate description of the pain. The following details should be recorded in a pain diary and shown to the doctor treating him or her:

• When the pain began
• Whether the onset was gradual or sudden
• The nature of the pain – i.e. sharp vs. dull
• Where the pain occurs
• How frequently it occurs
• How intense the pain is on a scale of 1-10
• How the pain has affected the patient’s life
• What activities increase the pain
• What medications the patient has taken so far

Accurate descriptions will allow the doctor to be in a better position to begin treatment or refer the patient to a pain specialist. A thorough physical examination should be conducted to rule out certain conditions. Further tests may be conducted to determine the underlying cause of the pain. These may include:

• Blood tests – to exclude infection and inflammation
• X- rays – to exclude fractures, cancer, or joint damage
• Nerve tests – to assess the proper conduction of neural signals.

Treatments Available

Treatments for chronic pain include both medicines and activities. No single treatment works for everyone. Your doctor or nurse will help you find the right combination of treatments for you. Treatment options include:

• Medications to relieve pain, improve sleep or mood including potentially injections (shots) of numbing or pain-relieving medicines into the spine or area with pain
• Stretching, tailored exercise programs and other physical therapy
• Hot and cold pack application to the area of pain
• Relaxation techniques like meditation
• Massage therapy
• Acupuncture
• Transdermal electronic nerve stimulation (TENS)
• Counseling and behavioral therapy
• Anesthetic injection into the spine or area of pain
• Devices that modulate nerve signal and reduce pain
• Surgery

Set realistic goals for your treatment

Even if you can’t completely get rid of your pain, you might be able to control it enough so that you can do the things you want to do. A team of people is normally involved in the care of patients with chronic pain because a combination of treatments will be required. Different patients will find that different things work for them and new patients are asked to be open to trying treatment methods.  If your doctor suggests a medicine that seems out of place, keep an open mind. Sometimes, doctors treat pain with medicines made to treat other medical problems. For example, doctors can use medicines for depression to treat pain because they work on areas of the brain that process pain. Doctors can also use medicines for seizures to treat pain, because they help with overactive nerves. Another important thing to remember is that depression can sometimes accompany chronic pain. Patients should be encouraged to talk to a mental health professional because chronic pain and depression can make each other worse. Talking to a trained counselor and getting treatment for the depression can make it easier to cope with the pain, even without medications.