Chronic Pain—Conditions, Causes and Treatment
According to an Institute of Medicine study, an estimated 100 million Americans suffer with chronic pain every day, making it the biggest cause of adult disability and the number one reason for healthcare in this country. All of this costs somewhere between $500 and $650 billion annually, including the cost of disability days, lost wages, and lost productivity. Chronic pain is also one of the most costly problems concerning health in the U.S. today.
What is pain?
When illness or injury inflicts the body, receptor nerve cells located under the skin and in organs send messages via nerve pathways to the spinal cord. This in turn, sends messages to the brain. Pain medication reduces or blocks these messages before reaching the brain.
Pain can range from mild to excruciating and can be either acute, (or of abrupt onset), subacute, which lasts for a few weeks, or chronic lasting over 3 months.
Pain can be intermittent or continuous. It can seriously impact people to the point where they cannot work, eat, or enjoy physical activity as they once did.
Chronic vs. Acute Pain
While acute pain is a normal response to illness or injury brought about by the body’s nervous system, chronic pain is very different. Acute pain can be caused from inflammation, damage to tissues, injury, illness, or a recent surgery. Generally, it lasts for less than one or two weeks and stops hurting when the underlying cause has been resolved.
Chronic pain is pain that persist for weeks, months, and even years. Even when the initial cause for the pain is resolved, the nervous system continues to send signals to the pain centers of the brain. While chronic pain is usually found in older adults, sometimes there is no evidence of earlier trauma to the body, or injury.
In other cases, an earlier mishap or illness may be the initial cause. Back and neck pain from arthritis, or a serious sprain, or whiplash in those areas, when patients were younger may be the root of chronic pain much later in life. Sometimes, secondary factors such as anxiety, depression, and lack of exercise can make conditions worse and exacerbate pain.
Common Causes and Conditions Creating Chronic Pain
- Neuropathic pain
- Tension headache
- Post-surgical pain.
- Lower back pain.
- Cancer pain.
- Neurogenic pain (nerve damage)
- Psychogenic pain (pain not caused by illness, disease or injury)
- Temporomandibular TMJ
- Immflamatory bowel syndrome
- Rheumatoid arthritis
- Irritable bowel syndrome
- Interstitial cystitis (painful bladder syndrome)
Several chronic pain conditions may occur together.
Treatment options for chronic pain
Treatment for chronic pain may combine more than one modality including, medication, exercise, rest, nutrition, or surgery.
Medication— Non-steroidal Anti-inflammatory Drugs (NSAID), pain relievers such as acetaphenamin, and opioids may be taken orally for pain relief. Oral Antidepressants at low doses, anti-convulsants, and muscle relaxants work to resolve or minimize pain. Transdermal patches placed on the skin, topical ointments or creams containing numbing agents may be used to treat pain as well.
Alternative complementary therapies—Acupuncture, acupressure, Transcutaneous Electro-Nerve Stimulator (TENS) units, using pads that stimulate area where pain is present, physical therapy, and massage treat pain by exercising tight muscles, bringing blood to the tissues and releasing pressure points called meridians within the body. Psychotherapy, relaxation, yoga, biofeedback, and behavior modification are alternative therapies to treat chronic pain as well. Natural dietary supplements that support the body’s own healing abilities may also be used by individuals for pain. Many psychological approaches focus on changing an individual’s perception of pain, giving back control to the patient, education, and helping them understand how unconscious forces affect pain management.
Some medical centers offer chronic pain, self-management programs where individuals learn how to cope with various aspects of their conditions including fatigue, frustration, lack of sleep quality, exercise, medication and new treatments.
Injections—These involve muscle injections referred to as trigger point injections or epidurals for pain in the arm, leg, back, or neck.
Surgery—Surgical options may help to relieve chronic pain though it is usually a last resort. Surgery can also destroy certain sensations within the body as well.
Electroaccupuncture—Recent studies reveal that individuals who suffer chronic pain may have lower than normal levels of endorphins in their spinal fluid. Experiments with electroaccupuncture, where needles are wired to electrically stimulate nerve endings have shown promise in raising endorphin levels in spinal fluid and mitigating pain.
For individuals who live with chronic pain daily, there is hope. New alternative treatments and pharmacological advances are made every day. Many times, no single treatment approach is effective for pain relief. Often, a combination of medical and alternative therapies, along with lifestyle changes, is needed. Finding the right program or health regimen is key to successful treatment.
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4 NINDS chronic pain information page (2016) Available at: http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm (Accessed: 15 December 2016).
5 Stanford (2009) Chronic pain self-management program – patient education – department of medicine – Stanford University school of medicine. Available at: http://patienteducation.stanford.edu/programs/cpsmp.html (Accessed: 15 December 2016).
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