Pain is a sensation that is uncomfortable or unpleasant. While acute pain occurs suddenly and has a specific and identifiable cause, chronic pain lasts for a long time, usually more than six months. It is estimated that over a quarter of American adults have chronic pain.
The presence of chronic pain can greatly reduce the enjoyment of life, by altering the range of activities, interfering with normal routines, preventing proper sleep, and depressing the mood.
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Background
Acute pain can become chronic pain if not properly treated. The greater the duration of untreated pain, the higher the chances of chronic pain are.
Pain lasting beyond three months is considered to be chronic pain. With chronic pain, the pain may be constant or it may wax and wane. Sometimes, the cause of chronic pain is unidentifiable. It may continue to hurt even after the original cause no longer exists.
When the nerve signals that cause pain persist in the nervous system for too long a period, they can modify the nerves or the brain to become hypersensitive to the pain, or to interpret other nerve signals as pain. Chronic pain is often found to occur with medical conditions such as headache, arthritis, nerve pain, back pain, neuralgia, and cancer. The result is often stress.
Stress, in turn, manifests as tense muscles, restriction of movement, low energy levels, and loss of or gain in appetite. The patient is often depressed, anxious and over-cautious because of the fear of further injury. Sometimes the mood may be angry.
Insomnia may supervene, aggravating the pain due to the resulting tiredness and frustration. This vicious cycle may be hard to break. The John Hopkins website calls this the “terrible triad" of suffering, sleeplessness, and sadness.”
Causes
With illnesses like cancer or arthritis, the cause of chronic pain may seem to be obvious. However, sometimes injuries and disease processes cause invisible or subtle changes to the body that increases its pain sensitivity. This residual effect may be the cause of chronic pain even after the injury has healed.
Psychogenic or psychosomatic pain is another cause of chronic pain and is typically found in association with stress, anxiety, and depression. The underlying mechanism may be the low endorphin levels in the blood. Endorphins are natural pain-relieving molecules that trigger positive feelings.
Sometimes chronic pain may be caused by multiple conditions as well. The type of pain experienced may range from aching, burning, shooting, or stinging to throbbing or tightening pain.
Risk factors
Chronic pain reduces the quality of life significantly and justifies a visit to a healthcare professional. A careful history, physical examination and laboratory tests of the blood, voluntary muscles, imaging of the body, nerve conduction studies, and other neurological tests may be necessary, depending on the presentation and symptoms.
Sometimes, chronic pain is a diagnosis in itself, as with fibromyalgia or chronic low back pain without a specific cause.
Some factors may increase the risk of chronic pain, such as conditions like migraines that run in the family, obesity which worsens the load on vulnerable and potentially painful points, age which increases the risk of arthritis and nerve conditions, and previous trauma.
Occupations that involve a great deal of physical or emotional stress, and smoking, are also linked to an increased risk of chronic pain. These conditions should be modified as far as possible to prevent chronic pain.
Managing chronic pain
Management of chronic pain demands identification of the cause if possible, followed by specific treatment. If the cause remains unknown or untreatable, a combination of medications, changes in lifestyle, and various therapeutic measures may be used to control the pain.
Simultaneously, the patient’s emotional and psychological pain must be dealt with to prevent exacerbation of the physical component. Importantly, patients who take charge of managing their pain from day to day do better at containing it than those who merely pop pills or opt for surgery to get rid of their pain.
Pain management programs at pain clinics are of help in dealing with such a situation.
Medications used to relieve pain may include anticonvulsants that modulate nerve impulses, including pain signals; mood-elevating drugs like antidepressants; muscle relaxants and anti-inflammatory drugs; rubefacients and topical pain reliever gels; narcotic pain-relieving drugs such as opioids for severe pain; and medical marijuana.
Opioids can cause habit-forming addictions, and an overdose may be deadly; overdosing on paracetamol can fatally injure the liver cells; medications that act on the transmission of nerve impulses in the brain may cause changes in mood, disorientation, and breathing difficulty. Finally, devices that stimulate the spinal cord may cause damage to these nerve bundles or introduce infection.
Non-pharmaceutical therapies involve transcutaneous electrical nerve stimulation (TENS), where small electric shocks stimulate the skin receptors, thus relieving pain; nerve-blocking injections near the painful spot; and injections of corticosteroids, which have a powerful anti-inflammatory action, into the space around the spinal nerves called the epidural space, to relieve pain due to the compression and inflammation of these nerve roots.
Lifestyle modifications are crucial to the management of chronic pain. First and foremost comes stress relief, beginning with simple techniques such as deep breathing. Exercise is the next intervention, either by relieving stress or by endorphin-mediated positive feelings.
A healthy diet is anti-inflammatory, with minimal amounts of red meat and processed carbohydrates. Sleep hygiene is essential to overall good health, and especially in preventing and relieving chronic pain.
Psychologists may help with techniques like cognitive behavioral therapy that help the patient acquire a new perspective on pain. Talking things over with a counselor can help relieve negative feelings, and reduce pain, especially of psychogenic origin.
Occupational therapy may be invaluable in helping to cope with daily disabilities caused by pain, by changing the conditions of a task or introducing protective measures to prevent injury. Physical therapy will tone and stretch the muscles, to get rid of spasms and knots, to reduce the pain.
Alternative medicine practitioners often suggest acupuncture, biofeedback, relaxation techniques, and aromatherapy, along with or independent of music, art and pet therapy.
References:
- Acute vs. Chronic Pain (2021). Available at: https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain. Accessed on 14 September 2021.
- Chronic Pain (2021). Available at: https://my.clevelandclinic.org/health/diseases/4798-chronic-pain. Accessed on 14 September 2021.
- Chronic Pain (2021). Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-pain. Accessed on 14 September 2021.
- Chronic pain (2021). Available at: https://www.healthdirect.gov.au/chronic-pain. Accessed on 14 September 2021.
Further Reading
- All Chronic Pain Content
- A Guide to Managing Chronic Pain
Last Updated: Dec 7, 2021
Written by
Dr. Liji Thomas
Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.
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