Chronic Pain
What is it?
Chronic pain is pain that lasts for weeks or months. Chronic pain is usually associated with major diseases, such as AIDS, arthritis, and cancer. It is also used to describe pain that continues beyond what is normally expected for an illness or injury, pain that occurs off and on over a period of months or years, and pain that is persistent, but has no identifiable cause. Chronic pain should not be confused with acute pain, which is pain that occurs in response to an injury or other painful stimulus, but goes away as soon as the injury heals or the stimulus is
removed.
Who gets it?
At some point, chronic pain will affect approximately one of every three people in the United States. Approximately 50 million people with chronic pain are either partially or completely
disabled.
What causes it?
Pain receptors (called nociceptors) are located throughout the human body. When a pain receptor is stimulated, it transmits a signal to nerve cells within the spinal cord, which send a pain message to the brain. When the brain processes this signal, a person becomes aware of pain. In response, the body releases natural pain killers, called endorphins. However, endorphins may not be enough to stop the pain, and the person takes action to relieve it. In most cases, the initial pain is caused by some injury to the body. Sometimes, however, the cause of chronic pain is unknown, such as with chronic lower back pain. What is known is that the brain continues to transmit the message of pain long after what is considered a normal healing time. There is evidence that the severe and constant stimulation of pain receptors caused by acute pain may cause changes in the spinal cord. The nerve cells in the spinal cord may actually produce their own pain transmitters completely unrelated to any actual pain signals coming from the body, interrupting the normal pain-signaling
pathways.
What are the symptoms?
Everyone has different tolerances to pain, so symptoms and reactions are unique to each patient. Chronic pain can occur with diseases such as cancer; persistent and degenerative conditions, such as arthritis; and in patients with nerve damage (neuropathy). In these cases, the location and severity of pain is specific to the disease and the stage it is in. Because chronic pain continues for a long period of time, it can cause depression, weight loss, loss of appetite, sleep disorders, loss of sex drive, and drug dependency, regardless of the cause of the pain. People with chronic pain may find social and workplace demands a difficult challenge, and some may even withdraw completely to focus only on their pain. Chronic pain usually does not have an effect on
heart rate, breathing rate, or blood pressure.
How is it diagnosed?
While there is no specific diagnostic test for chronic pain, the duration and source of the pain will lead your doctor to this conclusion. Your doctor will take a complete medical history and perform a complete physical examination. He or she will talk with you about how you are feeling and any medications you are taking. Your doctor may ask you to keep a journal in which you will record the type of pain you are having, how severe it is, how long it lasts, when it occurs, what you are doing when it occurs, and what you do to relieve it.
What is the treatment?
Treatment of chronic pain depends upon any known underlying cause or any other complicating factors. In general, chronic pain is treated with a combination of medication and pain management through non-drug treatments. Drug treatments for mild to moderate pain usually focus on non-prescription pain relievers such as acetaminophen, aspirin, and
non-steroidal anti-inflammatory drugs like ibuprofen. These types of drugs are non-addictive, but can have side effects that range from upset stomach to kidney and liver damage. More severe pain may be treated by narcotic drugs, such as codeine, oxycodone, and morphine. However, narcotics may have no effect some forms of chronic pain where changes in the spinal cord have altered the normal pain signaling pathways. Narcotics are addictive drugs, which means the patient can become dependent on them, and so are only used if other medications have not been effective. The side effects of narcotic drugs can range from nausea, drowsiness, and confusion, to breathing problems and hallucinations. Other drugs that have been effective in treating chronic pain include steroids, antidepressants, and anticonvulsants. Antidepressants that have pain-relieving properties include amitriptyline, trazodone, and imipramine. The anticonvulsants phenytoin and carbamazepine are frequently used to treat chronic pain associated with nerve damage.
Local and topical anesthetics, which numb the pain in a specific area, may also be effective treatments. Non-drug pain treatments include applying cold or warm compresses directly to the painful area, ultrasound deep heating therapy, exercise, physical or occupational therapy, transcutaneous electrical nerve stimulation (TENS), acupuncture, biofeedback, water therapy, hypnosis, psychological counseling, massage, relaxation techniques, and diet modifications. Chronic pain is often relieved by immersing the patient in activities that get his or her mind off the pain, such as a hobby.
Surgical procedures are only used when all other treatment methods have failed and there is a reasonable belief that the procedure will be successful in stopping or reducing the pain. Chronic pain that has a definite cause can be relieved by correcting the condition that is causing the pain. This includes decompression surgeries,
such as those used to repair a herniated disk or to treat carpal tunnel syndrome. A procedure called neurolysis may be used to destroy a portion of a peripheral nerve, also called a nerve block. The peripheral nerves are all the nerves outside the brain and the spinal cord. Another form of surgical treatment involves implanting electrodes under the skin to stimulate peripheral nerves and relieve pain. Drug delivery systems can also be implanted under the skin to deliver pain-relieving drugs directly into the bloodstream or central nervous system (the brain and spinal cord). In very few cases, pain is relieved by actually cutting the nerves that are causing the
pain.
Self-care tips
Because chronic pain has a negative effect on all aspects of your life, it is important to seek treatment as soon as you recognize that the pain has become chronic. Work with your doctor to develop a treatment plan that works for you. With effective pain management, you can regain a satisfactory quality of life. You cannot let the pain replace everything else in your life. If you know someone with chronic pain, keep in mind that support and understanding are an important part of any treatment.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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