Chronic pain is a common condition that affects millions of people worldwide. Chronic Pain is defined as pain that occurs every day (or most days) and persists for three months or longer. Some types of chronic pain have a structural cause, for example a disease process, inflammation, or injury. In other types of chronic pain, no structural cause for the pain can be found. Chronic pain can be influenced by a variety of factors, including physical, psychological, and environmental.
There are two main kind of chronic pain – chronic primary pain and chronic secondary pain. It’s very important to make the distinction between primary and secondary pain because Chronic Primary Pain and Chronic Secondary Pain require very different treatment approaches.
Chronic Primary Pain
The definition of chronic pain that is most commonly used is ‘pain that has persisted after the normal healing time of an injury’. This is Chronic Primary Pain, so called because the pain is the ‘primary’ problem. Chronic Primary Pain is also called non-specific pain, because no structural or pathological cause for the pain can be found on scans or bloodwork. Chronic Primary Pain is generally mild pain that is amplified by maladaptive thoughts and behaviours, which increase the person’s experience of pain. This kind of pain is best treated not with medications, procedures and surgeries but with education and psychological therapies. Opioids should not be prescribed for chronic primary pain.
Chronic Secondary Pain
The other common kind of chronic pain is Chronic Secondary Pain which is pain where there IS a structural or pathological cause for the pain. In chronic secondary pain there is an underlying disease process, or injury, that causes ongoing pain. It is called ‘secondary’ pain because the pain is secondary to another physical process – a disease, inflammation, or injury. People with chronic secondary pain treat their primary disease as well as the secondary pain caused by it. Examples of secondary pain include cancer, arthritis, spinal injuries etc. Chronic Secondary pain may be mild, moderate or severe. Chronic secondary pain is most often treated with medications, surgeries and procedures aimed at treating the underlying disease. When pain is severe, opioids are often the only treatment that brings some relief and gives people some quality of life. Opioids are safe and effective in a well-screened and well-monitored patient.
According to the National Institutes of Health, chronic pain affects an estimated 20% of adults in Australia, making it one of the most common reasons people seek medical care. Chronic pain can significantly impact a person’s quality of life, affecting their ability to work, participate in daily activities, and enjoy hobbies and relationships.
Causes of Chronic Pain
Chronic pain can be caused by disease, inflammation, injury or damage to the nerves or nervous system. Sometimes no cause for chronic pain can be found at all.
Chronic pain is extremely variable from one person to the next, or even for the same person on different days. It can be intermittent or constant. It can be mild, moderate, or severe. The severity of pain a person feels at any given monent is influenced by a variety of factors, including theor emotional state, their thoughts and beliefs around pain, fears and anxiety around movement, or causing damage and more pain.
Ironically, fear of causing pain can itself increase pain.
It’s important to remember that just because anxiety, fear and emotions can increase pain, this is not the case for everyone. Some people have very good coping skills, are very health literate, highly educated, are not depressed or distressed and still experience high levels of chronic pain.
The first step in evaluating causes of pain is always to assess the person and what factors are contributing to their pain. For some trauma and poor mental health play a large role. For others, their chronic pain is almost 100% due to injury and disease. Most lie somewhere in between, but properly assessing the causes of chronic pain is the essential first step to treating chronic pain.
Common Types of Chronic Pain
Chronic pain can present in different forms and affect different parts of the body. Some of the most common types of chronic pain include:
Lower back pain is the leading cause of disability in the world. Back pain can be simple, caused by muscle strain or minor injury or it can be much more complex. It’s rare that back pain is a sign of a serious health problem, but all severe back pain that goes on for longer than a few weeks should be assessed by a doctor.
The most common cause of back pain is minor mechanical or ‘non-specific’ back pain where there is no serious underlying pathology. While non-specific back pain is not dangerous, it can be very painful and disabling. Non-specific back pain typically results from poor posture, sedentary lifestyle, lack of exercise, or overexertion during physical activities. These factors can lead to muscle spasms, strained ligaments, or irritated nerves, resulting in localized or radiating pain in the back that can be severe. Most often this kind of pain is not seroius though and will resolve on its own. If the pain persists for more than a few weeks, the best course of action is to see a physiotherapist who can assess the pain and design a program to help in recovery from back pain.
Rarely, low back pain is a sign of a serious disease or condition. GPs and physiotherapists are well trained to assess low back pain and look for ‘red flags’ that point to an underlying condition. Unless a person is displaying these red flags, or signs of a more serious condition, scans or MRIs are not needed.
Joint Pain / Arthritis
Joint pain refers to discomfort, soreness, or inflammation in the joints. It can be caused by a variety of factors, including injury, overuse, inflammatory conditions, and degenerative diseases. The severity and persistence of joint pain can vary, ranging from mild discomfort that resolves on its own to chronic, debilitating pain that affects daily activities.
If joint pain that worsens over time, limits mobility, or is accompanied by other symptoms like swelling, redness, warmth, or fever, it is recommended to consult your GP for an accurate diagnosis and appropriate management. This may include a referal to a specialist.
Neuropathic pain, also called ‘nerve pain’, is caused by damage to the nerves that transmit pain signals to the brain. It can be caused by conditions such as diabetes, multiple sclerosis, or shingles. It is often described as a burning or tingling sensation.
Migraines are a type of chronic pain that affects the head and can be accompanied by nausea, vomiting, and sensitivity to light and sound. They can be caused by a variety of factors, including genetics, hormonal changes, or environmental triggers.
Fibromyalgia is a condition that causes widespread musculoskeletal pain, as well as fatigue, sleep disturbances, and cognitive difficulties. Its cause is unknown, and it can be difficult to diagnose.
Endometriosis is a condition where cells similar to those that line the uterus, called the endometrium, grow in other parts of the body. They usually grow in the pelvis, but can move to almost any part of the body. These cells respond to the hormones in the menstrual cycle and this process causes inflammation, scarring and pain.
Diagnosis of Chronic Pain
Diagnosing chronic pain can be challenging, as there is often no specific test or imaging study that can definitively identify its cause. Diagnosis usually involves a thorough medical history, and physical examination. Sometimes further diagnostic tests are required, including X-rays, and MRI scans, and/or blood tests. In some cases, a referral to a specialist may be necessary.
Treatment Options for Chronic Pain
Treatment for chronic pain always depends on the underlying cause and the severity of the pain. Some common treatment options include:
Medications, such as simple analgesics, anti-inflammatories, anticonvulsants, antidepressants, and opioids may be prescribed to manage chronic pain. Which medications are prescribed will depend on the severity and type of pain.
Physical therapy may help reduce pain and improve mobility by incorporating exercises and stretches designed to target specific muscles and joints. Physical therapy improves strength, balance and general fitness and enables a person with chronic pain to improve their function, and may decrease pain.
Psychological therapies such as cognitive-behavioural therapy (CBT) and acceptance and commitment therapy are types of therapies that focuses on changing negative thought patterns and behaviours that may be contributing to chronic pain.
Complementary and Alternative Medicine
Complementary and alternative medicine, such as acupuncture, massage therapy, or chiropractic care, may provide symptomatic relief for some people with chronic pain.
Coping Strategies for Chronic Pain
In addition to treatment, there are a variety of coping strategies that can help manage chronic pain. These may include:
Lifestyle changes, such as regular exercise, healthy eating habits, and stress management techniques, can help reduce the severity of chronic pain. Any life style changes that are good for improving general help may be effective for reducing chronic pain.
Joining a support group can provide a sense of community and help individuals with chronic pain feel less isolated.
Mindfulness techniques, such as meditation, deep breathing, or visualization, can help individuals manage stress and reduce the impact that depression anxiety and poor mental health has on chronic pain.
Chronic pain is a common and often challenging condition that can significantly impact a person’s quality of life.
There is no one-size-fits-all approach to managing chronic pain, and each person’s pain and pain management plan is individual. Even people who have the same disease or diagnosis will not have the same experience of pain.
Often, it’s not possible to ‘cure’ chronic pain, however, a combination of treatments and coping strategies may help a person achieve a better quality of life. It is important to seek medical care if chronic pain persists, as early intervention can improve outcomes and prevent further complications.