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When a person is injured, a certain period of pain is to be expected. Pain can be a helpful way for the body to limit activity and ask for rest. However, sometimes pain lasts longer than is necessary for healing, moving quickly from becoming an acute, protective response to a long-term, chronic condition. For the approximately 100 million people in the U.S suffering from chronic pain, many of them with no outward injury, this condition affects all aspects of daily life. Here’s what you should know about this condition.
While acute pain alerts you to an injury and typically lasts for 30 days or less, chronic pain lasts for longer than three months. Or, for a simpler approach, chronic pain is any type of pain that lasts longer than is reasonably expected for the injury.
This type of pain does not have one single characteristic. It can be mild, moderate, or severe. It can be unceasing or sporadic. Further, it can range in intensity from mildly irritating to severely disabling.
Chronic pain is commonly rooted in musculoskeletal, neurologic, urologic, gastrointestinal, or reproductive disorders. It also has associations with psychological disorders such as major depression, conversion disorder, hypochondriasis, and somatization disorder.
People typically experience pain in the following areas:
Most importantly, chronic pain is a mystery, even among people who study it. Why does one person develop chronic pain from an injury when another with the exact same injury does not? It can be an enigma due to pain’s complicated natural history, vague etiology, and poor response to treatment. There may be an inciting incident (as in acute injury), an ongoing cause of pain (like arthritis), or an absence of both.
While researchers and doctors can make reasonable guesses about pain’s characteristics and how it works in and moves through the body, the human response to pain remains a complex and evolving science.
Chronic pain takes a toll both physiologically and psychologically. In addition to the pain itself, patients may experience other side effects as a result, including:
Most certainly, chronic pain restricts the activities of daily living and decreases the quality of life in those who experience it. It can be a contributor to family or marital problems (with spousal disagreements making the pain worse), and those with chronic pain face higher levels of unemployment and challenging side effects that result from their treatments for pain.
Some primary risk factors include:
The risk factors may have to do with the inhibition of endorphins, natural pain-relieving (and mood elevating) hormones. Clinical studies have shown that those with chronic pain have lower than normal levels of endorphins in their cerebrospinal fluid (CSF).
There are five general categories of conditions that contribute to the development of this type of long-lasting pain.
Let’s look at these in more detail.
Musculoskeletal disorders are the most common cause of chronic pain. Often, people may have these conditions and recover after the acute phase, but those with chronic pain struggle to find relief.
These conditions include:
Neurologic disorders that cause chronic pain generally involve the brain (perhaps in addition to other body systems).
These include:
The most frustrating type of pain is that which cannot be traced to any one cause. Neuritis, or nerve inflammation, is a condition that causes chronic pain with no clear trigger.
Urologic conditions can occur in some individuals as an acute pain incident (e.g., kidney stones) without becoming chronic, while for others the pain persists.
Common urologic disorders that can lead to chronic pain include:
Many GI disorders come in a flare-up and remission cycle with intervals that vary from person to person. Those associated with chronic pain include:
Reproductive disorders that lead to chronic pain are not well understood and lack proper research in terms of funding and time spent on these conditions.
However, some conditions that may contribute include:
There are other pain conditions that defy classification. These include long-lasting pain after injuries, trauma, and infections.
A diagnosis is crucial for proper treatment. Key factors a physician will want to know about when taking your pain history include:
A detailed physical examination is also helpful at pinpointing potential causes of your pain. Imaging studies such as X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) may also be helpful for diagnosis.
The best treatment for chronic pain is one that takes a multidisciplinary approach that includes coordination between primary care physicians, pain specialists, psychologists, and therapists.
Treatments fall into three general categories:
Medications are the cornerstone of treating chronic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) that have been used include:
These medications act to reduce inflammation, thereby reducing pain.
Even though it is unclear exactly how they work on the brain, antidepressants are also commonly used. These include:
It is important to note that there is no research that supports the long-term use of narcotic analgesics in the treatment of chronic pain. Best prescribed for acute injury, surgery, or end-stage cancer pain, narcotic medications such as oxycodone, hydrocodone, and fentanyl carry more risk of side effects and dependence and can cause more problems than they solve. Additionally, new research has found that they don’t work to relieve pain any better than over-the-counter or non-opioid medications.
Various procedures and surgeries are also available to manage your pain. There are a few common surgeries or procedures that may help when other treatments have been unsuccessful.
Many therapies can also be integrated into your treatment plan. In many cases, patients experience more relief from pain when non-traditional therapies are also incorporated in their treatment plan.
The most common therapies include:
If you have any questions or are simply looking for more information please contact us and our friendly team will be happy to answer your questions and help in any way we can.Â
