Chronic Pain

Chronic pain is a symptom itself, but there are different ways of experiencing chronic pain. Depending on the body system (such as the face, back or abdomen), pain can feel dull, sharp, cramping, pounding, shooting, burning or aching. It may be present all the time or only with certain activities. Chronic pain can also range from mild to severe and be very localized or radiate out to a wide area.

Chronic pain symptoms may also include:

• Decreased appetite

• Fatigue, decreased energy, and difficulty concentrating

• Limited flexibility, strength or stamina

• Mood changes including anxiety, depression and fear

• Poor quality of life and loss of enjoyment

• Sleep problems

Pain is very subjective—based on the patient’s own perspective and experience. Your doctor relies on your description of the pain and other symptoms to help make a diagnosis. These clues can determine what testing you may need to find the underlying cause. It is often helpful to keep a symptom diary to capture a true picture of your daily life. This will allow you to accurately share your experiences with your doctor.

Chronic pain can be present when an ongoing cause of pain, such as cancer, remains active. But other forms of chronic pain are still somewhat of a medical mystery. Scientists know it results when pain signals continue to fire despite healing or resolution of the original cause. They just aren’t sure why this happens. Long-lasting pain also causes changes in the way people perceive pain signals. As a result, the nervous system becomes oversensitive to pain. People can feel pain with very little or even no painful input.

The most common types of chronic pain include low back pain, headaches or migraines, neck pain, and facial pain. Chronic pain causes include various diseases, disorders and conditions including:

• Cancer and its treatment

• Diabetes

• Gastrointestinal disorders including GERD, ulcer, irritable bowel syndrome, inflammatory bowel disease, and chronic constipation

• Gynecologic disorders including endometriosis and uterine or vaginal prolapse

• Musculoskeletal disorders including any form of arthritis and overuse injuries

• Neurologic disorders including fibromyalgia, chronic fatigue syndrome, spinal stenosis, and neuralgias

• Trauma or injury including limb amputation and other surgeries

• Urologic disorders including interstitial cystitis, bladder or kidney stones, and prostatitis

• Vascular disorders including peripheral vascular disease and varicose veins

Chronic pain can also be psychogenic. This means there is no evidence of a past injury, an ongoing disease, or any damage to the nervous system

A number of factors contribute to the risk of developing chronic pain. Not all people with these risk factors will get chronic pain. But, people are more likely to report having chronic pain if they:

• Are older (older than 65), female, or obese

• Catastrophize, or have irrational thoughts about pain

• Have anxiety, depression, or sleep problems

• Have other chronic medical conditions

Lifestyle factors can also contribute to the development of chronic pain. This includes having poor nutrition, living a sedentary lifestyle, and smoking. Smokers tend to report having more pain and more intense pain than people who have never smoked. However, it is unclear whether smoking is a direct cause of this or whether smokers have something else in common that contributes to pain.

Socioeconomic factors are other contributors to chronic pain. This includes being unemployed or unable to work, having low socioeconomic status, and having low levels of education. People who have suffered from abuse or domestic violence also report having more chronic pain.

Lastly, genes can play a role in the development of chronic pain. It seems that some people are more prone to chronic pain than others. However, the response to pain may partly be acquired or adopted through lifestyle and cultural influences.

It is not always possible to prevent chronic pain. It is possible you may be able to lower your risk of chronic pain by:

• Eating a balanced diet

• Getting regular physical activity

• Quitting smoking

Treating chronic medical and mental health conditions

Because there are so many facets to chronic pain, treatment is highly individualized. Doctors must take into account the possible causes and consider the patient’s overall physical and mental health. As a result, treatment usually involves a multidisciplinary team of healthcare providers.

Chronic pain treatment may involve any of the following:

• Acupuncture, biofeedback, meditation, and relaxation therapies, such as guided imagery

• Local electrical stimulation, such as TENS (transcutaneous electrical nerve stimulation), spinal cord stimulation, and brain stimulation

• Medications including oral medicines, nerve blocks, and spinal medication pumps

• Physical, occupational and vocational therapies

• Psychotherapy including behavior modification therapy

• Surgery for identifiable physical causes

No one set of treatments will work for everyone. It may take quite a bit of trial and error to find the treatment that works best. Continue to work with your doctor until you get the right combination. Be patient, as it can take time to break long-established pain pathways. Sometimes, your brain has to “unlearn” chronic pain.

Chronic pain can cause several complications. Like the factors that contribute to chronic pain, the complications can be physical, psychological or social. Complications can include:

• Dependence on drugs or alcohol

• Disability or loss of employment

• Family or marital problems

• Mental health problems including suicidal thoughts or actions

• Sexual problems including loss of libido

Chronic pain is a complex problem with complex solutions, but there are solutions. Treating pain as soon as possible helps prevent long-term complications. But even people who have suffered for years with chronic pain have success stories. If you have chronic pain, talk with your doctor and find a specialist who can help