Chronic Pain Definition
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Any pain that lasts more than 12 weeks is categorized as Chronic Pain. Pain reduces our productivity, our well-being, and, for many of us suffering from extended illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those who appear to have identical injuries or illnesses. Dr. Albert Schweitzer wrote, “Pain is a more terrible lord of mankind than even death itself.”
Basic Types of Pain
There are two basic types of pain, acute and chronic, and they differ greatly.
- Acute Pain. Acute pain results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.
- Chronic Painis widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can—and often does—cause severe problems for patients. A person may 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.
Causes of Chronic Pain
Many medical conditions or injuries can cause chronic pain. Some people will continue to experience pain long after recovering from an initial injury such as a back injury. Other chronic pain is caused by chronic diseases such as arthritis or cancer. Some people have pain that does not have an identifiable cause. This is not to say that the pain is not real. Whatever the cause, chronic pain is real and should be treated.
The following conditions may be associated with chronic pain:
- Spinal injury
- Back injury
- Nerve inflammation or damage
Sometimes pain can be felt in a part of the body that is no longer there. This is called phantom limb pain, and develops as a result of amputation. When pain in one part of the body is felt in another part of the body, it is called referred pain.
Acute pain results when a disease or injury sends a signal to special sensory nerve endings called nociceptors.
Nociceptors are located in the skin, as well as in other structures including blood vessels and tendons. The internal organs are not very responsive to pain. Pain signals travel from the nociceptors, through the sensory nerves, and up the spinal cord to the thalamus in the brain. The signal is then sent to the cerebral cortex, the part of the brain that processes thought. On the way to the brain, natural body chemicals can change the pain signal. Substance P makes the pain signal stronger. Endorphins make it weaker. Pain is not actually felt until the message or signals get to the brain. Chronic pain can originate at many points in the above pathway.
The cerebral cortex and the limbic system, which are the brain areas controlling emotion, process pain signals. How much pain is felt depends on a number of factors. Factors that increase how badly pain is felt include the following:
- previous bad experiences with pain
Anxiety can make pain much worse. Not knowing the cause of pain makes people anxious. The pain often seems less severe once they have a diagnosis of their medical condition. Worry about the seriousness of their condition can often also increase the severity of the pain.
Chronic Pain Symptoms
The symptoms of chronic pain include:
- Mild to severe pain that does not go away
- Pain that may be described as shooting, burning, aching, or electrical
- Feeling of discomfort, soreness, tightness, or stiffness
Pain is not a symptom that exists alone. Other problems associated with pain include:
- Withdrawal from activity and increased need to rest
- Weakened immune system
- Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress
Chronic Pain Treatment
Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.
Research on Chronic Pain
Clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid. Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture), which some researchers believe activates endorphin systems. Other experiments with acupuncture have shown that there are higher levels of endorphins in cerebrospinal fluid following acupuncture. Investigators are studying the effect of stress on the experience of chronic pain. Chemists are synthesizing new analgesics and discovering painkilling virtues in drugs not normally prescribed for pain.
Chronic Pain Management
Following precautions should be taken by patient:-
- The patient should avoid uncomfortable stressful positions and bad posture.
- Regular exercise
- Practice good sleeping habits
- Eat balanced meals are helpful in maintaining good health.
- The patient may also benefit from relaxation techniques.
- Temperament Traits and Chronic Pain: The Association of Harm Avoidance and Pain-Related Anxiety (plosone.org)
- How Chronic Pain Affects Memory and Mood (scientificamerican.com)
- Advanced Pathophysiology Class – Position Paper 1: Pain (ivythesis.typepad.com)