What is Chronic Pain?
Chronic Pain is a Chronic illness and is one of the most common medical problems in the world; it not only causes millions of Britons to suffer terribly on a daily basis, negatively impacting on their quality of life, it also affects the country's economy as well; the exact cost of Chronic Pain is unknown; however, the cost of back pain alone, to the exchequer, is estimated to be over £5billion per annum and this doesn't take into account any other placement of Chronic Pain.
Pain can be described as an unpleasant sensory and emotional experience, a symptom of illness or injury in the part of your body that is having the pain and is associated with actual, potential or perceived tissue damage; the sudden onset of pain is called Acute pain and is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, it gets your attention and prompts you to take action to prevent further worsening of the condition causing the pain; this could be a simple reflex action such as making you jerk your hand off a hot stove, or it could be more complex such as getting you to cool, rest, or elevate an injured ankle, or the pain could even prompt you to see a doctor; pain is the body's way off letting you know that something is wrong.
Chronic Pain however, is different, it persists and pain signals keep on firing in the nervous system for days, weeks, months and sometimes even years; in medical terms, the distinction between Acute and Chronic Pain has traditionally been determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 and 6 months since onset, though some theorists and researchers have placed the transition from acute to Chronic Pain at 12 months; others apply acute to pain that lasts less than 30 days, subacute to pain that lasts from 1 to 6 months and chronic to pain of more than 6 months duration; a popular alternative definition of Chronic Pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."
Pain normally starts with an initial mishap such as a an injury, a serious infection, a joint pain, a sprained back or a whiplash; there may even be an ongoing cause of pain such as arthritis, cancer or an ear infection; once the cause of your pain has been found and properly treated, the pain may still serve as a useful function of keeping you at rest until the injury or illness has healed, but if the pain comes from an illness that is incurable and will never heal, the pain loses its usefulness and instead becomes harmful; this type of pain keeps you from normal activity and inactivity decreases your strength; some people even suffer from pain in the absence of any past injury or evidence of any bodily damage, making it harder to treat.
With constant pain there is a 'Wind-Up Phenomenon' that causes untreated
pain to get worse; the nerve fibers transmitting the painful impulses
to the brain become trained to deliver pain signals better than they
did; just like Muscles getting
better at sports with training, the nerves become more effective at
sending pain signals to the brain; the intensity of the signals can
also increase over and above what is needed to get your attention; to
make matters even worse, the brain becomes more sensitive to the pain,
so your pain feels much worse even though your injury or illness is
not getting any worse; at this point, the pain may be termed as Chronic
Pain and the pain is no longer useful as a sign of illness or injury.
General Somatic Pain - From the Outer Body:
Pains from your skin and Muscles are easily localised by the brain because these pains are common; you will have experienced general somatic pain since childhood when you have fallen or been hit by a person or an object; normally, somatic pain gets better in a few days; though, some people develop pain that never goes away, Fibromyalgia and Chronic Back Pain are in this category.
General somatic pain is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Naprosyn) or with acetaminophen (Tylenol); sometimes, opioids, such as morphine, may be needed.
Visceral Pain - From the Internal Organs:
Pain in your internal organs is more difficult for you to pinpoint because your brain doesn't get much experience feeling pain from internal organs; the connections from pain sensors in your internal organs to your brain are less sophisticated than the nerve connections from your outer body; you will have experienced some visceral pains such as acid indigestion or constipation; these pains are easily treated and get better quickly, either on their own or with treatment using non-prescription medicines.
However, the pain from chronic pancreatitis, an inflammation of the pancreas, or chronic active hepatitis, an inflammation of the liver, can last a long time and be difficult to treat; visceral pain from gallstones or appendicitis, for example, can be treated with surgery; other visceral pains can be treated with various non-opioid pain medications; although, opioids are sometimes needed.
Pain in the Bones from a bruise or a fracture is temporary, but pain from bone cancer, osteoporosis, softening of the bones that often appears in older people, osteomyelitis, an infection in a bone, or arthritis, inflammation of the joints, can last a long time and bone pain is gnawing and throbbing; if you suffer from this, you may need long term pain treatment.
Bone pain may be treated with hormonal therapy or with bisphosphonates, such as alendronate (Fosamax), which strengthen the Bones; the NSAIDs, such as ibuprofen are often used and sometimes opioids are needed.
Muscle Spasms - Cramps:
Muscle spasm, like a Charley
Horse, can cause severe pain especially in the back; pain medication alone may not be able to cure the pain, so muscle relaxants such as cyclobenzaprine (Flexeril), or baclofen (Lioresal) may be needed to relax the muscles.
Peripheral Neuropathy - Pain arising in the Nerves leading from the Head, Face, Trunk, or Extremities to the Spinal Cord:
In a sense, all pain comes from nerves because the nerves transmit painful impulses to the brain, but some painful impulses do not arise from the nerve endings that normally sense injury or illness; some painful impulses come from irritation to the nerve along its length instead of at the nerve ending; Sciatica, for example, is caused by pinching of the sciatic nerve, which goes from the leg to the spine; the pinching often takes place near the lower part of the spine, but the brain thinks the pain comes from the nerve endings in the leg because the sciatic nerve usually transmits feelings from the leg.
Other examples of illnesses that cause peripheral neuropathy or 'Nerve Pain' are ruptured discs in the spine, which pinch nerves; cancers that grow into nerves and cause irritation, or infections, such as shingles, which can cause irritation to nerves.
Common diseases that often cause peripheral neuropathy are Diabetes and AIDS; nerve pain can feel like a painful pins and needles sensation; this kind of nerve pain can be treated with tricyclic antidepressants; other, more severe nerve pain can be described as a sharp, stabbing, electric feeling and Anticonvulsants, medicines that treat seizures, are used for this kind of nerve pain; some nerve pain is due to the loss of a limb; the arm or leg that has been lost feels like it's still present and hurts severely; this kind of nerve pain, called deafferentation, or 'Phantom Limb Pain', can be treated with clonidine (Catapres), a blood pressure medicine that also relieves nerve pain; Herpes zoster (shingles) causes an infection of the nerve endings and of the skin near the nerve endings; local application of Capsaicin, an over-the-counter pain medication in the form of an ointment, is sometimes helpful for this; in addition, opioids may be needed.
Poor circulation is often a cause of Chronic Pain and is usually caused by Tobacco use, smoking, sniffing or chewing, Diabetes, or various autoimmune diseases, diseases where the body makes antibodies that fight against itself, such as lupus or rheumatoid arthritis; partial blockage of arteries by fatty deposits called plaques is also a common cause of poor circulation; the reason for the pain from poor circulation is that the part of the body that does not get good blood circulation becomes short of oxygen and nourishment and the lack of oxygen and nutrition causes damage to that part of the body and the damage causes pain.
Pain from poor circulation may be treated by surgery to bypass the clogged arteries with artificial arteries in order to improve the blood circulation; sometimes this is not possible and blood thinners or opioids may be needed to control the pain instead; another common cause of poor circulation is reflex sympathetic dystrophy (RSD); this is a problem of both circulation and nerve transmission because painful nerve transmissions cause the blood vessels to get narrower; the narrowing prevents enough oxygen and nourishment from getting to the part of the body that is affected; RSD can sometimes be treated with a surgical sympathectomy, an operation to stop the nerve impulses from causing a narrowing of the blood vessels; non-opioid medication, either with or without surgery, is needed; though in some cases opioids are also needed.
Headaches can be caused by many illnesses and there are several types of headaches, including migraine, tension and cluster headaches; headaches can also result from sinusitis, trigeminal neuralgia, giant cell arteritis or brain tumors; the treatment of the various kinds of headaches varies depending on the kind of headache and the severity of the pain; non-opioid medicines are used, but, in some cases, opioid therapy is needed also.
Migraines are often on one side of the head; they can be associated with nausea and vomiting, photophobia, where light hurts the eyes, phonophobia, where sound hurts the ears and scintillating scotomata, parallel lines that vibrate at the edges of objects, especially at the borders between light and dark places; sometimes these auras appear before the headache starts and alerts you to the fact that a migraine is coming; migraine pain can vary in intensity from mild to severe; there are many specific medications for migraine, Sumatriptan (Imitrex) is particularly useful for some, but not all, migraine sufferers.
Cluster headaches come in groups, sometimes several times a day, lasting from days to weeks; many cluster headaches are severely painful; oxygen therapy may be helpful for some cluster headaches; Sinusitis can cause facial pain and is frequently worse in the morning; this type of sinus pain may respond to antibiotic treatment along with decongestants, but sometimes sinus surgery is needed; Trigeminal neuralgia is actually a peripheral neuropathy, nerve pain, that is severe; it occurs on one side of the head and face and has a trigger point, usually on the side of the face, which causes intense pain if it is touched; Anticonvulsants, antiseizure medicines, are often helpful for this type of pain.
Chronic Pain can be mild or excruciating, episodic or continuous, described as shooting, burning, aching, or electrical and be merely inconvenient or totally incapacitating; common Chronic Pain complaints include Headaches, pain in the Back, Neck, Pelvis and Shoulder; illness related pain such as Arthritis pain, Cancer pain, Carpal Tunnel Syndrome, Sinus pain and Tendinitis; Neurogenic pain, resulting from damage to the peripheral nerves or to the central nervous system itself and even Psychogenic pain, which is not due to any past disease or injury or any visible sign of damage inside or outside of the nervous system.
A person may even have two or more co-existing Chronic Pain conditions; such conditions can include Chronic Fatigue Syndrome, Endometriosis, Fibromyalgia, Inflammatory Bowel Disease, Interstitial Cystitis, Temporomandibular Joint Dysfunction and Vulvodynia.
Chronic Pain can take both a physical and emotional toll on a person through Anger, Anxiety, Depression, Fatigue, Fear, Irritability, Sadness, Sleeplessness and Stress; they interact in complex ways with Chronic Pain and may decrease the body's production of natural painkillers; moreover, such negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain for the sufferer; even the body's most basic defenses may be compromised because there is considerable evidence that unrelenting pain can suppress the immune system.
Two types of Chronic Pain are Neuralgia, which is an extremely painful Chronic Pain condition, consisting of recurrent episodes of intense shooting or stabbing pain along the course of the nerve and Causalgia, another extremely painful Chronic Pain condition, consisting of recurrent episodes of severe burning pain and Phantom Limb Pains, which are the feelings of pain in a limb that is no longer there and has no functioning nerves.
Chronic Pain may be divided into Nociceptive Pain and Neuropathic Pain:
Nociceptive Pain may be divided into Superficial and Deep, and Deep pain into Deep Somatic and Visceral; Superficial pain is initiated by the activation of Nociceptors in the skin or superficial tissues; Deep Somatic pain is initiated by the stimulation of Nociceptors in ligaments, Tendons, Bones, blood vessels, fasciae and Muscles and is a dull, aching, poorly localised pain; visceral pain originates in the viscera (organs) and may be well localised, but it is often extremely difficult to locate and several visceral regions produce referred pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.
Neuropathic Pain is divided into Peripheral, originating in the peripheral nervous system and Central, originating in the brain or spinal cord; Peripheral Neuropathic Pain is often described as burning, tingling, electrical, stabbing or like pins and needles.
Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon; this induces pathological changes that lower the threshold for pain signals to be transmitted; in addition it may generate Nonnociceptive nerve fibers to respond to pain signals; Nonnociceptive nerve fibers may also be able to generate and transmit pain signals; in Chronic Pain this process is difficult to reverse or eradicate once established.
Chronic Pain of different etiologies has been characterised as a disease affecting brain structure and function; Magnetic Resonance Imaging studies have shown abnormal anatomical and functional connectivity, even during rest involving areas related to the processing of pain; also, persistent pain has been shown to cause Grey Matter loss, which is reversible once the pain has resolved.