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Chronic Pain: About, causes, symptoms, and treatments

Key takeaways

  • Chronic pain is pain that persists for 3 months or longer
  • Chronic pain is biopsychosocial and is best treated with multidisciplinary care, meaning a range of therapies that may include medication, physiotherapy and psychological therapies.
  • Chronic pain affects up to one in five people in Australia and prevalence is increasing

Overview

Chronic pain is an invisible but debilitating condition that millions around the world live with every day. Unlike acute pain, which is the body’s natural response to injury and typically resolves once the injury heals, chronic pain persists long term and can significantly affect a person’s quality of life. This article aims to provide in-depth insights into understanding chronic pain, highlight the various types, and explore diagnosis, treatments, as well as strategies for managing life with persistent pain.

Chronic pain spans a spectrum of conditions and experiences. It affects each person differently, showing just how complex and personal pain can be. Understanding the nature of chronic pain is the first step toward finding effective management strategies and leading a fuller life despite its challenges.

What is Chronic Pain?

Chronic pain is a persistent pain that lasts for more than three months despite medication or treatment. It can continue even after an injury or illness that caused it has healed or gone away. The impact of living with constant pain is not just physical; it often carries emotional and psychological burdens as well.

Types of Chronic Pain

Pain is deeply subjective and comes in many forms, including neuropathic chronic pain, nociceptive chronic pain, nociplastic chronic pain, somatic pain, visceral pain, and psychogenic pain. Each type is distinct in its manifestations and underlying causes.

The International Association for the Study of Pain (IASP) provides a detailed classification of chronic pain designed to improve diagnosis and treatment strategies. This classification encompasses a broad spectrum, recognizing the diverse nature of chronic pain experiences.

Pain can be classified into different types, depending on the causes of the pain. These classifcations are very important as different types of chronic pain are treated very differently.

Chronic Primary Pain

Chronic primary pain is defined as pain in one or more anatomical regions that is persistent or recurrent for more than three months, significantly impairing emotional well-being or daily functions without another diagnosable chronic pain condition.

Chronic Cancer-Related Pain

This category addresses pain associated with cancer or its treatment. It acknowledges the unique and often severe nature of pain that cancer patients endure, requiring specialized management strategies.

Chronic Post-Surgical Pain

Chronic post-surgical pain persists beyond the expected healing period after surgery, differing from acute post-operative pain in its duration and potentially in its nature as well.

Chronic Secondary Musculoskeletal Pain

This type of pain is a consequence of a health condition that significantly impacts the musculoskeletal system, leading to long-term discomfort and impairment such as arthritis or some types of lower back pain.

Chronic Secondary Visceral Pain

Chronic visceral pain originates from the internal organs. This pain might be more diffuse, harder to localize, and often associated with other non-pain symptoms.

Chronic Neuropathic Pain

Resulting from damage to the nervous system itself, chronic neuropathic pain presents unique characteristics like burning, tingling, or shooting sensations that set it apart from other pain types.

Chronic Secondary Headache and Orofacial Pain

This category acknowledges chronic pain localised to the head, face, and neck areas, which may result from or be secondary to another chronic pain condition or disorder.

Prevalence of Chronic Pain

Chronic pain is a pervasive issue. It affects a staggering number of individuals, changing how they live, work, and enjoy life. According to Painaustralia, 3.37 million Australians were living with chronic pain in 2020. The Australian Institute of Health and Welfare reports significant figures indicating its widespread nature. In Australia, the prevalence of chronic pain is increasing as the population ages. Chronic pain affects millions globally, prompting healthcare professionals to see it as a public health concern.

Symptoms and Causes

The causes of chronic pain can be complex and multifaceted, intertwining physical and psychological factors. Sometimes, chronic pain emanates from an identifiable cause, serving as a symptom of an underlying disease — this is referred to as chronic secondary pain. Conditions such as arthritis, cancer, and injuries are forms of chronic secondary pain.

However, in some instances, chronic pain exists without a discernible structural or pathological cause. This kind of pain, called chronic primary pain, is recognized as a disease in its own right. It occurs when the nervous system becomes dysfunctional or overactive, without any evidence of injury or inflammation.

Many people have elements of both kinds of chronic pain – primary and secondary. This is referred to as ‘mixed pain’.

Understanding these differences in types and causes of chronic pain is essential as treatment approaches to primary and secondary pain vary widely.

What does Chronic Pain Feel Like?

Pain feels different for everyone and it can be very challenging to explain how pain feels to someone else. Common words used to describe pain include aching, throbbing, stabbing, tearing, cramping, sharp, burning, dull, electrical shooting, stinging, squeezing and radiating. Other sensations associated with pain include tingling, numbness and ‘pins and needles’.

Chronic pain often leads ot other symptoms as well, including fatigue, sensitivity to light and loud noises, insomnia and trouble sleeping, anxiety, depression and mood swings. Chronic pain is a personal and often isolating experience, profoundly affecting an individual’s mood and quality of life.

Which Conditions are Commonly Associated with Chronic Pain?

Chronic pain can come in many different forms and can occur in almost any part of the body. Common causes and diseasese associated with chronic pain include:

  • Arthritis, or joint pain: This condition causes inflammation and pain in one or more joints, leading to stiffness and reduced movement over time.
  • Back and neck pain: Often resulting from strain, overuse, or underlying conditions affecting the spine, these types of pain can significantly impair daily functionality.
  • Cancer pain near a tumour: Pain can occur in cancer patients due to the tumor pressing on bones, nerves, or other organs in the body.
  • Headaches, including migraines: These can range from moderate to severe pain and can significantly impact an individual’s ability to perform daily tasks.
  • Endometriosis and adenomyosis: the pain from endometriosis can be mild, moderate severe and for some is not just limited to the menstrual cycle
  • Widespread pain syndromes: Conditions like fibromyalgia cause muscle pain all over the body, often coupled with fatigue and memory issues.
  • Neuropathic chronic pain: This results from damage to the nerves or other parts of the nervous system, leading to a variety of symptoms, including burning, tingling, or shooting pains.

Diagnosis and Tests

How is Chronic Pain Diagnosed?

Identifying the exact cause of chronic pain is often a complex and nuanced process, necessitating a multifaceted approach in diagnostic testing to find the root causes of chronic pain. Given the subjective nature of pain and its myriad causes, medical professionals leverage a battery of diagnostic tests and investigations, aiming to pin down the root cause(s) with precision.

These may include comprehensive blood tests to look for markers of inflammation or disease, advanced imaging tests such as X-rays and MRI scans to provide detailed pictures of the body’s internal structures, and nerve conduction studies to evaluate the effective transmission of nerve signals. Additionally, Electromyography (EMG) is employed to assess muscle activity and health, while reflex and balance tests scrutinize the nervous system’s integrity. In certain cases, analyzing spinal fluid might also be useful, offering clues hidden within the body’s central nervous system. Together, these diagnostic tools paint a clearer picture, guiding healthcare providers toward tailored treatment strategies that address the unique aspects of each individual’s chronic pain.

Questions your doctor may ask

If you have long-lasting pain, its important to see a pain management specialist doctor to assess and find the sourse of your pain. . Your doctor will ask many questions, so its helpful to think about hte answers to the below questions before you see your heatlh care practitioner.

  • Where is your pain located? Where do you feel pain?
  • How intense or severe is the pain, on a scale of 0 to 10.
  • How often does the pain occur? Is it intermittent, does it vary in intensity, or is it constant?
  • How much does your pain affecting your life? Are you able to function, work, exercise?
  • Has your social life been affected?
  • What makes pain worse or better?
  • Whether there is a lot of stress or anxiety in your life.
  • How well (or otherwise) you are sleeping?
  • They may also ask about your exercise habits, and general nutrition.
  • They will ask what treatments, procuedures or surgeries you have already tried.

Management and Treatment

The best outcomes in the management and treatment of chronic pain are achieved by taking a multidisciplinary approach, aimed at alleviating pain and improving function and quality of life. An integrative strategy is best, incorporating various healthcare professionals, including physicians, physiotherapists, psychologists, occupational therapists and even nutritionists, all working together to devise a tailored treatment plan.

Understanding the multifaceted nature of chronic pain and that all chronic pain is biopsychosocial, is essential. This means understanding that chronic pain may be influenced and affected by biological, psycholgical and sociological factors, each of which must be addressed in a multidisciplinary treatment plan. Pain management means not only targeting the underlying physical causes, but also any maladaptive thoughts, beliefs and behaviours around pain that may be contributing. Treatment is often multimodal, involving medications, lifestyle adjustments, and both physical and psychological therapies.

It is important to remember that chronic pain can be mild, moderate or severe and pain may fluctuate and change in intensity or it may be constant and severe. Which treatments are safe and effective depend on the intensity and severity of chronic pain. Each person is individual and which therapies and strategies work best is also individual. Even two people with exactly the same disease or diagnosis will experience chronic pain differently and have a different pain managemnet plan.

Medications to Treat Chronic Pain

Many people require medications to manage chronic pain effectively, especially those who live with severe, disabling chronic pain. Your healthcare provider might suggest various medications tailored to your specific needs and the type of chronic pain you live with. These can include:

  • Anticonvulsants/gabapentinoids for nerve pain,
  • Antidepressants, particularly tricyclic antidepressants,
  • Corticosteroids to reduce inflammation,
  • Muscle relaxants for muscular relief,
  • NSAIDS (non-steroidal anti-inflammatory drugs) to reduce inflammation,
  • Paracetamol for milder pain,
  • Topical treatments that offer either analgesic medications or comforting warmth or coolness to the affected area,
  • Medical marijuana or cannabis oil and
  • Opioids for moderate to severe pain that has not responded to other analgesics

Opioids are potent pain relievers, and they have shown to be safe and effective long term in well selected, well monitored chronic pain patients. However, in recent years they have fallen out of favour due to a media-inflated risk of addiction and tolerance. Despite recent, large scale studies showing that addition and overdose are very rare in chronic pain patients, opioids are generally considered a treatment of last resort. Some people gain significant releif from long term opioid therapy, and these medications must always remain an option for those with the most severe pain.

Procedures

Nerve blocks: For this treatment, your healthcare provider injects an anesthetic near the site of your pain to reduce feeling in the area. Nerve blocks can also sometimes provide diagnostic information and locate the source of your pain.

Steroid injections to relieve pain and inflammation. This in turn can reduces swelling and can improve mobility. The beneficial effects may last for several months.

Radiofrequency ablation is a procedure where a pain specialist accurately positions needles directly to the nerves responsible for transmitting pain. By generating heat at the needle’s tip, this method effectively disrupts the nerve’s ability to send signals to the brain which can result in substantial and enduring pain relief, spanning from six months up to several years.

Epidural steroid injections: This procedure is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the space around your spinal nerves known as the epidural space to treat chronic pain caused by irritation and inflammation of spinal nerve roots.

Self-management strategies for Chronic Pain

Medication is only part of a multimodal pain management regimen.  There is much more that can be done to manage pain that are non-medication based.   And research shows that people who actively self-manage their pain with active approaches generally do better than those who rely on passive therapies. 

Active self-management strategies include:

  • Seeing a physiotherapist or exercise physiologist and committing to regular exercise
  • Seeing a psychologist for strategies and techniques to manage pain.
  • Learning mediation and relaxation strategies and living mindfully
  • Using pacing techniques to manage energy and avoid a ‘boom / bust’ cycle
  • Some people benefit from learning about pain and pain science education, although this has only been shown to be effective when combined with an exercise program
  • acupuncture has been shown to be effective for some
  • TENs (transcutaneous electrical nerve stimulation)

Lifestyle Changes

Lifestyle adaptations—like diet, exercise, and sleep routines—play a fundamental role in managing chronic pain.

Adopting healthier lifestyle habits can significantly impact the management of chronic pain, creating a holistic approach to pain relief. By incorporating modifications in daily routines, individuals can enhance their body’s resilience and reduce the intensity of pain experiences. These lifestyle changes not only address physical aspects but also contribute to improving psychological well-being.

  • Reducing Stress:  Practice mindfulness and deep breathing exercises.  Consider engaging in yoga or tai chi to harmonize body and mind.  Allocate time for hobbies and activities that bring joy.
  • Regular Exercise:  Incorporate low-impact exercises like walking, swimming, or cycling.  Focus on stretching and strength training to improve flexibility and muscle tone.  Work with a physical therapist to customize a safe exercise plan.
  • Diet and Nutrition:  Adopt an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids.  Limit processed foods, sugars, and saturated fats.  Stay hydrated and consider supplements after consulting with a healthcare provider
  • Quality Sleep: Establish a regular sleep schedule to improve circadian rhythms.  Create a restful environment, free from electronics and distractions.  Consider techniques like progressive muscle relaxation before bedtime to promote relaxation

All of these changes can seem overwhelming but the idea is to make small chnages, one at a time. And over time, they will gradually contribute to better fucntion and improved qualtiiy of life. And less pain!

What Alternative Treatments are Available for Chronic Pain?

Alternative treatments, such as chiropractic care, herbal remedies, and yoga, may complement traditional treatments and offer some relief. However, chronc pain is a target of some shady operators selling their ‘miracle cures’. Always be wary of any standalone treatment that claims to cure chronic pain and if you do try any alternative pain management treatments, discuss them with your doctor as well.

Can Chronic Pain be Prevented?

While not all chronic pain can be prevented, understanding the risk factors, making healthy lifestyle choices, and managing acute pain effectively can reduce the likelihood or severity of chronic pain.

What are the Risk Factors for Chronic Pain?

Multiple factors contribute to the onset of chronic pain. Understanding risk factors, including age, occupation, and lifestyle habits, helps identify those at higher risk for developing chronic pain. These include:

  • Genetics: Certain types of chronic pain, such as migraines, have a genetic predisposition and may run in families.
  • Obesity: Excess weight can exacerbate conditions linked to pain by increasing pressure on the joints, notably in cases of arthritis.
  • Age: Ageing increases the likelihood of suffering from conditions like arthritis and neuropathy, commonly associated with chronic pain.
  • Previous Injuries: Individuals with a history of traumatic injuries may face a higher risk of enduring chronic pain subsequently.
  • Occupation: Engaging in physically demanding work increases the risk of developing chronic pain.
  • Stress: Research indicates a strong correlation between chronic pain and stress levels, including conditions like post-traumatic stress disorder (PTSD).
  • Smoking: Smoking not only impedes recovery from injuries but also increases the probability of medical conditions that necessitate chronic pain management.

Understanding these risk factors can help in early detection and prevention strategies for chronic pain.

Outlook / Prognosis

What is the Prognosis (Outlook) for People with Chronic Pain?

White the prognosis for chronic pain varies widely, depending on cause, many can find their symptoms manageable with the right combination of therapies and lifestyle changes.

Medical research and technology are constantly contributing to the development of new treatments and therapies for chronic pain, allowing for more personalised and effective approaches to pain management. It is a field that benefits greatly from interdisciplinary research, combining insights from genetics, neuroscience, psychology, and physical therapy to explore innovative solutions.

It’s vital for individuals living with chronic pain not to lose hope. The landscape of pain management is evolving, and with ongoing research, new therapies and approaches are continually emerging, offering renewed hope for improved quality of life. Staying informed and working closely with healthcare providers and chronic pain advocacy organsitations, can open up avenues to new treatments that were not available or known before. Highlighting the importance of maintaining hope and seeking out support when needed.

What are the Complications of Chronic Pain?

Complications can include reduced mobility, dependency on medications, depression, and anxiety, showcasing the need for comprehensive treatment plans.

The complications arising from chronic pain extend far beyond physical symptoms, affecting various aspects of an individual’s life. These complications may include:

  • Reduced Mobility: Chronic pain can limit one’s ability to move freely and engage in physical activities, diminishing overall quality of life.
  • Dependency on Medications: Long-term use of pain medication may lead to physical or psychological dependency or tolerance, complicating pain management strategies.
  • Depression and Anxiety: Persistent pain can take a toll on mental health, leading to conditions such as depression and anxiety, which in turn can exacerbate the experience of pain.
  • Fatigue: The constant battle against pain can drain energy, leading to pervasive fatigue, which affects an individual’s daily functioning and well-being.

These complications underscore the need for a multidisciplinary approach to treatment, emphasizing the importance of addressing both the physical and emotional dimensions of chronic pain. Its important to remember that help is available and that while pain often cannot be cured, with mulimodal treatment, quality of life can be much improved.

If you are experiencing depression or anxiety, its important to seek support and seek care as these can significantly worsen chronic pain.

Living With Chronic Pain

Living with chronic pain presents a unique set of challenges that can significantly impact an individual’s quality of life. The constant presence of pain can make it exceedingly difficult to maintain regular employment, leading to financial stress and poverty. Social interactions and relationships often suffer as the ability to participate in activities, gatherings, or simple outings becomes limited, isolating individuals from their community and support networks. Chronic pain’s invisible nature contributes to widespread misunderstanding and misinformation, sometimes resulting in skepticism or dismissal by peers and even healthcare professionals, which can intensify feelings of loneliness and despair. However, it’s crucial for those affected to hold onto hope and to persist in seeking out understanding and comprehensive treatment options. While the road may be fraught with challenges, advancements in pain management, alongside a supportive community, can pave the way to a more fulfilled, active life, even amidst chronic pain.

Almost half of all people who live with chronic pain experience anxiety and depression, both from the physical pain and from the emotional consequences of chronic pain. Its important to seek support, from friends and family as well as professionals, including your GP who can refer on to psychologists and counsellors training in chronic pain.

Seeking out online communities can be an important source of support, as often only other people who live with chornic pain can truly understand all the limitations and implications of chronc pain. The sense of community and understanding that online forums can offer can significantly improve mental health and qualtiy of life for people living with pain.

What Questions Should I Ask My Doctor?

Being proactive in your health care by asking informed questions can help you better understand your pain and the options available to you.

Its a good idea to make a list of questions and bring that list to your appointments, as its very easy to forget and appointment time is limited. Go through your questions, and ask them in order of priority, just in case there is not enough time to get to them all. Common questions to think about include:

  • Can you explain what is causing my pain?
  • Will it eventually subside, or is it a permanent condition?
  • What medication options are available for managing my pain?
  • Can you detail their potential side effects?”
  • What non-medication options are there to treat my pain?
  • Would you recommend physical therapy or psychological therapy for my condition?
  • Is exercising safe for me? If so, are there any exercises that you recommend?
  • What steps should I take when I experience a sudden increase in pain (a flare up)?”
  • Can you outline the treatment options available to me, including what happens if I do nothing?  i.e. we just watch and wait?
  • What are the potential benefits and risks of these treatments?
  • What can I do independently to self-manage my symptoms and improve my quality of life?”

Resources and Support

Offering a list of resources and support groups provides readers with additional avenues for help and information beyond what’s provided in the healthcare setting.

Conclusion

In conclusion, chronic pain remains a complex, deeply personal experience calling for a thoughtful and comprehensive approach to treatment and management. By understanding more about chronic pain, its causes, and the available treatments, patients and their caregivers can reclaim their quality of life and face their condition with renewed hope and determination.

FAQs

  1. What are some common causes of chronic pain?

Chronic pain can stem from a variety of sources, including injuries, chronic illnesses, nerve damage, and conditions like fibromyalgia. Understanding the root cause is crucial in tailoring an effective treatment plan.

  1. How can I differentiate between acute and chronic pain?

Generally, pain that persists for 3 months or longer, is considered chronic. Acute pain is immediate and usually diminishes as the body heals.

  1. What are the treatment options available for managing chronic pain?

Treatment plans are multifaceted and can include medications, physical therapy, behavioral therapy, and in some cases, surgery. The approach depends on the underlying cause and the patient’s specific needs and conditions.

  1. Can lifestyle changes impact chronic pain?

Yes, lifestyle modifications such as regular exercise, maintaining a healthy diet, and managing stress can significantly affect chronic pain management and overall well-being.

  1. Is it common to experience emotional effects due to chronic pain?

Absolutely. Chronic pain can lead to a range of emotional effects, including depression, anxiety, and sleep disturbances. Addressing these emotional aspects is a vital component of comprehensive pain management.

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Sign up to receive information on our campaigns, including stopping the forced opioid tapers, rebutting the false narratives and flawed science promoted by the media, some universities and politicians, and even raising awareness amongst our peak bodies who are suppoed to be fighting for us!

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