Chronic pain is one of the costliest health conditions in the U.S., often because of medical expenses, lost income, and lost productivity. Perhaps more important than the financial cost, chronic pain can have very real effects on a person’s daily activities, mental health, and quality of life.
Just about everyone feels pain from time to time. Whether it is a cut finger or pulled muscle, pain is the body’s way of telling us something is wrong. Once an injury heals, the pain usually goes away. With chronic pain, though, the body keeps hurting for weeks, months, and even years after an injury. Doctors often define chronic pain as any pain that lasts for 3 to 6 months or more.
Chronic pain is ongoing pain that either persists beyond the usual recovery period (3 to 6 months), or is the result of a chronic health condition (like arthritis). Chronic pain can be a continuous sensation, or it can be intermittent (“on” and “off”) pain.
Pain starts in receptor nerve cells beneath the skin and in organs throughout the body. When a person is sick or injured, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the message to the brain. There can be an ongoing cause of pain, such as arthritis or cancer. However, some people may suffer chronic pain in the absence of any past injury or evidence of illness.
“Pain” can be difficult to define, since everyone experiences and expresses pain differently. Two people with the same injury, for example, may feel and show their pain in unique ways. Pain can be a slightly bothersome annoyance, like a mild headache. And, pain can be something excruciating and evolving, such as the chest pain that accompanies a heart attack or the pain of kidney stones.
Previously, the medical profession thought pain was always a manifestation of an underlying injury or disease. Doctors would focus on treating the cause of the pain, believing the chronic pain would disappear once the injury or disease was cured. If no underlying cause was found, the patient might be told there were few treatments available; or worse, “the pain must be in your head.”
Today, though, advanced neuroimaging shows that chronic pain can cause structural changes in the brain. These changes can add to the risk of cognitive problems as well as anxiety and depression. As a result, the medical community now understands that if a patient’s pain is not a function of a healthy nervous system, the chronic pain itself is the problem.
What Causes Chronic Pain?
Typically, chronic pain begins after an injury (such as a back sprain), or as a result of an ongoing health problem (such as illness). However, chronic pain may also occur without any apparent cause.
Some of the leading causes of chronic pain include:
Chronic pain can range from mild to severe. It can continue day after day, come and go, or even persist for months and years. Chronic pain can feel like:
A dull ache.
Other health problems often accompany chronic pain. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and stamina. Sometimes pain is just one of many symptoms, which can also include:
Fatigue or feelings of being ‘wiped out.’
Decrease in appetite.
A general lack of energy.
Chronic pain may lead to disability and despair because patients find it difficult to carry out activities they consider important and enjoyable. When chronic pain becomes such a problem it interferes with normal activities, work, and life, patients enter a vicious circle called the “terrible triad” of suffering, sleeplessness, and sadness.
Chronic pain may cause preoccupation with the pain, causing depression and irritability. Depression and irritability often lead to insomnia and weariness, which leads to more irritability, depression, and pain. Furthermore, the urge to stop the pain can make some people drug-dependent and may drive others to have repeated surgeries or resort to questionable treatments.
How is Chronic Pain Diagnosed?
People experience pain differently. Chronic pain is very personal, partially because tests cannot accurately measure or locate the pain. Although technology helps, health professionals need the input of the patient to form an accurate diagnosis. Every patient is unique, and treatment plans must be tailored to the individual.
Since chronic pain may occur just about anywhere in the body, and for many different reasons, patients and their health professionals need to work together to identify the:
Causes of the pain.
Symptoms of the pain.
How the pain can be relieved.
It is also important to define pain as accurately as possible to give pain doctors the best clues as to the cause of the pain:
Sharp or dull.
Constant or intermittent.
Burning or aching.
Pain is typically divided into three categories:
Acute Pain lasts a short time (generally less than 3 to 6 months) or is directly related to tissue damage. It is the type of pain, for example, caused by a paper cut or touching a hot stove.
Chronic Pain lasts more than three to six months and continues after tissues heal. Chronic pain is usually less directly related to identifiable tissue damage and structural problems. Persistent back pain without a clearly determined cause and fibromyalgia are examples of chronic pain. Health professionals think pain can establish a pathway in the nervous system and, in some cases, become the problem in and of itself. In other words, the nervous system may misfire and send a pain signal, even though there is no ongoing tissue damage. In such cases, the pain is the disease rather than a symptom of an injury.
Neuropathic Pain is a type of chronic pain where there is no sign of the original injury, and the pain is unrelated to another condition. However, nerves continue to send pain messages to the brain. It is thought that an injury to the peripheral nervous system may cause neuropathy. Patients often describe neuropathic pain as severe, sharp, lightning-like, or stabbing. The pain may include the sensation of burning or cold, and be accompanied by numbness, tingling, or weakness. If the cause can be found and reversed, treatment may allow the nerves to gradually heal, easing the pain.
How is Chronic Pain Treated?
It is important to remember that, except for neuropathic pain, chronic pain usually cannot be cured. However, it is treatable and can be managed. The goal of pain management is to improve function, enabling the patient to resume normal day-to-day activities.
The following are among the most common treatments for chronic pain, which we list here in alphabetical order.
Acetaminophen is the basic ingredient found in Tylenol and its many generic equivalents. Available over the counter and prescription strengths, it is also available by prescription in combination with codeine.
Acupuncture is part of a general category of healing called traditional Chinese or Oriental medicine which dates back 2,500 years. The practice involves the application of needles to precise points on the body. Although controversial, acupuncture is quite popular.
Analgesic is a word from the Greek word meaning to reduce or stop pain. It is a class of drugs that includes most painkillers, such as aspirin, acetaminophen, and ibuprofen. Nonprescription (over-the-counter) pain relievers are available for mild to moderate pain. Prescription pain relievers, sold through a pharmacy under the direction of a physician, can treat moderate to severe pain.
Anticonvulsants are usually for the treatment of seizure disorders but are also sometimes prescribed for the treatment of pain. Carbamazepine is used to treat many painful conditions, including trigeminal neuralgia.
Antidepressants are sometimes used along with anti-anxiety drugs, which act as muscle relaxants, and can be effective in relieving pain. Physicians usually try to treat the condition with analgesics before prescribing these types of drugs.
Antimigraine medications are used specifically for migraine headaches, but can also be helpful treating chronic pain. They also can have serious side effects; therefore, as with all prescription medicines, these medications should only be used under a doctor’s supervision.
Biofeedback is often used to treat many common pain problems, most notably headache and back pain. Using specialized equipment, the patient learns to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature. The individual can then learn to effect a change in pain responses, for example, by using relaxation techniques.
Capsaicin, the chemical found in chili peppers, is a primary ingredient in many pain-relieving creams.
Chiropractic care. Chiropractic treatment may ease back and neck pain, headaches, and musculoskeletal conditions. Chiropractic spinal manipulation includes the adjustment and manipulation of the joints and adjacent tissues. Sometimes this treatment will also involve therapeutic and rehabilitative exercises.
Cognitive. Behavioral therapy uses a variety of coping skills and relaxation methods to help patients cope with pain. It is especially helpful for postoperative pain and cancer pain.
Counseling. Family, group, and individual support groups can be a valuable addition to drug or surgical treatment when coping with pain. Counseling can also help patients learn about the physiological changes produced by pain.
COX-2 inhibitors. Effective as morphine, but without the adverse side effects, COX-2 inhibitors can be helpful for individuals with chronic arthritis pain. Newer COX-2 inhibitors are less likely to have the gastrointestinal side effects sometimes produced by NSAIDs.
Electrical stimulation sends signals to the brain that block or scramble normal pain signals. Devices that are implanted are like a pacemaker for chronic pain, modifying pain messages before they reach the brain. For less severe pain, an external Transcutaneous Electrical Stimulation (TENS) can be used to interrupt or mask pain signals, preventing them from reaching the brain.
Exercise. There is a known link between many types of chronic pain and exercise. Even light to moderate exercise, such as walking or swimming, can contribute to an overall sense of well-being by improving blood and oxygen flow to muscles. We know that exercise, sleep, and relaxation can help reduce stress, which can help alleviate pain. It is important that patients carefully follow a properly prescribed exercise routine.
Hypnosis. Initially approved in medical practice by the American Medical Association in 1958, hypnosis continues to grow in popularity. Hypnosis can help a patient control the amount of pain they can withstand. Although not fully understood, some believe hypnosis may result in relief of pain by acting on chemicals in the nervous system, slowing impulses.
Low-power lasers are occasionally used by some physical therapists as a treatment for pain, but like many other treatments, this method is controversial.
Magnets. Proponents of magnet therapy support the theory that magnets may affect changes in cells or body chemistry, thus producing pain relief. Usually worn as magnetic bracelets and jewelry, or magnetic straps, the use of magnets as a treatment dates back to the ancient Egyptians and Greeks. Magnets are increasingly popular with athletes, who say they are useful for pain control.
Nerve blocks are accomplished by the injection of nerve-numbing medication into a specific area of the body. There are different types of nerve blocks, depending on the part of the body in which the procedure is performed.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed non-narcotic analgesics, which include aspirin and ibuprofen. NSAIDs work by reducing inflammatory responses in tissues. Many of these drugs irritate the stomach, and for that reason are usually taken with food. Although acetaminophen may have some anti-inflammatory effects, it is generally distinguished from traditional NSAIDs.
Opioids, derived from the poppy plant, are among the oldest known drugs. Opioids have a narcotic effect which induces sedation as well as pain relief; therefore, stimulants are sometimes prescribed to counteract the sedative side effects. Some patients may become physically dependent on opioids, so anyone taking this medication should work closely with their doctor.
Physical therapy. Physical therapy and rehabilitation come from ancient practices of using physical techniques and methods (heat, cold, exercise, massage, and manipulation) to treat pain as well as other physical conditions. These may also help increase function and speed recovery.
R.I.C.E. – Rest, Ice, Compression, and Elevation are four components prescribed by many professionals for temporary muscle or joint pain. Many chronic orthopedic pains can be controlled with these four simple steps, especially when combined with over-the-counter pain relievers. More serious conditions may require physical therapy, exercise, joint movement or manipulation, and stimulation of muscles.
Self-Management. In self-management programs, the patient is an active participant in the treatment of pain. Although self-management programs differ, some common features include learning to think and feel better, despite the persistence of pain. Improving communication with the healthcare provider is part of that empowerment. Patients participating in these programs significantly increase their ability to cope with pain.
Surgery. Although not always an option, surgery may be necessary to relieve chronic pain from back problems or serious musculoskeletal injuries. As an example, surgery may be necessary to relieve the pain from a bulging disc.
Perhaps the most promising research today is on the body’s natural painkillers. The brain can signal the release of painkillers found in the spinal cord, including serotonin and endorphins. The natural painkillers are responsible for the “feel good” effects experienced by many people after rigorous exercise. Many pharmaceutical companies are working to synthesize these substances as possible future medications.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating chronic pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN):