What Is Chronic Pain? Conditions & Long Term Effects

Chronic pain describes pain that lasts longer than three months; a persistent long lasting sensation of pain and discomfort. It is often confused with acute pain, that is short lasting pain, a sensation triggered in the nervous system. Acute pain serves as an alert to possible injury, following damage to the body, such as a cut finger, or a sprained ankle.suffering with chronic pain Chronic pain is different, pain signals fire repeatedly in the nervous system for extended periods of time, making it difficult to perform even the most simple day-to-day routines. Severe pain interrupts everything, it can seriously affect an individual's quality of life and have an extremely negative overall impact.

Pain can be categorised into 3 categories:

Nociceptive – tissue pain, pain caused by a cut finger for example

Neuropathic – caused by disease or injury to the nervous system or spinal cord

Psychogenic – no discernible physical origin

Pain is a subjective sensation, a very personal experience, felt differently in each individual. Pain signals are processed initially in the spinal cord, then in the brain; where there are connections with areas of the brain associated with emotions, memory, sleep and appetite.

Many chronic pain complaints include either back pain or nerve pain.

Common Chronic Pain Conditions

Back Pain

This is one of the most common causes of chronic pain, back pain can be felt at any point along the spine from the region of the neck, the mid back, down to the lower back. Spinal pain is generally classified into either mechanical or referred symptoms. Mechanical symptoms are found only in the area of the spine itself, whereas referred symptoms radiate away from the spine to other parts of the body, at a distance from the source of pain. Sciatica is a classic example of this, symptoms of sciatica can usually be traced back to the compression or irritation of the sciatic nerve in the region of the lower back. The pain however, is often felt in the legs and not in the back.

chronic back painDifferent types of back pain include:

Nerve Pain

Nerve pain, or neuralgia as it is also known as, is caused by problems with one or more of the nerves. Nerve pain differs from nociceptive pain (tissue pain) as it requires different types of medication for treatment. Nociceptive pain will respond to medication such as paracetamol or asprin, whereas different medications are needed in the treatment of neuralgia, such as antiepileptic and antidepressant drugs and or opiates.

There are various conditions that can cause neuropathic pain.

Headache - The Trigeminal Cephalalgias

Short Lasting Unilateral Neuralgia with Conjunctival Tearing, (SUN CT), Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache are a group of primary headache disorders, they are associated with excruciating pain caused by the distribution of the trigeminal nerve (the nerve responsible for powering mastication as well as sensations in the face).

Phantom Pain

Patients that have lost a limb, commonly report sensations of pain in either the stump of the missing limb, or the actual missing limb itself; even though the body part is no longer there. This is known as phantom pain or sensation. Some theories suggest that phantom pain is caused by the brain's memory of the missing limb and the nerve signals associated with it.

Scar Pain

This is a common complaint at the pain clinic, causes are generally operative or traumatic. Frequently noted symptoms include: skin colour changes, swelling, itching, hypersensitivity to touch, Allodynia (pain is worsened by a touch or stimulus that would not normally cause pain) and Hyperalegesia (a touch or stimulus that would usually only cause slight discomfort, such as a light tap, causes severe pain in the case of Hyperalegesia.

Complex Regional Pain Syndrome CRPS

Often associated with either an injury or trauma such as surgery, CPRS can occur after musculoskeletal trauma causing severe and debilitating pain. CPRS is usually divided into two categories:

  • CRPS type 1 describes the condition where there is no associated nerve damage
  • CRPS type 2 describes the condition where there is associated nerve damage

Trigeminal Neuralgia

In the majority of cases, this condition is caused by compression of the trigeminal nerve, it is characterised by severe facial pain, usually only in one side of the face and often described by patients as a stabbing pain.

Shingles Postherpetic Neuralgia

After an initial infection, the Varicella-Zoster virus (chicken pox virus) lies dormant in the immune system, Shingles is the reactivation of the virus. The virus damages nerves, causing a painful rash in the affected area. Postherpetic neuralgia is pain felt on and around the area that was previously affected by shingles. Pain can vary from mild to severe depending on the patient.

Arthritis

chronic painA common condition causing pain and inflammation of the joints. There are two main types of arthritis: Osteoarthritis and Rheumatoid arthritis.

Other Chronic Pain

Other chronic pain complaints can be caused as a result of trauma, injury, diseases such as cancer or post operative. Some chronic pain related conditions have no diagnosable cause, such as Fibromyalgia.

Fibromyalgia is a mysterious disorder whose symptoms include widespread musculoskeletal pain, causing pain in the fibrous tissues of the body. There is however, no evidence of tissue damage, but patients often feel constant pain and fatigue. It is not yet fully understood what causes Fibromyalgia, some theories suggest that patients suffering from this condition have developed changes in their central nervous system, due to chemical imbalances, this in turn has affected the way the nervous system processes pain messages carried around the body. This brain malfunction could explain the heightened sensitivity to physical pain.

Brain scans of patients suffering from fibromyalgia show highly active pain centers, the disorder is closely associated with depression. Fibromyalgia could be caused by a brain malfunction that heightens sensitivity to both physical discomfort and mood changes.

Long Term Effects of Chronic Pain

Chronic Pain and Depression

Pain triggers an emotional response in everybody, it is not uncommon for those suffering from constant pain to feel tense and stressed. Chronic pain and depression are often intrinsically linked. In fact, people suffering from depression have a tendency to experience pain that is more severe and long lasting. According to the NHS, chronic pain is one of the most common causes of depression with 65% of depressed people suffering from some form of pain. This can be something of a vicious circle; those with chronic pain become less independent, this lack of independence can lead to depression. There are theories suggesting that pain shares some biological mechanisms with depression, such as an alteration in neurotransmitter regulators.

Depressive symptoms are very common in physically ill patients. Chronic pain can in some cases induce clinical depression, feeling constant pain is depressing; likewise, severe depression can cause you to feel physically unwell. In other cases, clinical depression may initiate psychosomatic pain. The Annual Report of the Chief Medical Officer 2013 Public Mental Health Priorities, clearly illustrates this overlap; 46% of patients suffering from a mental illness, also have a long term condition, (this equates to approximately 4.6 million people), and 30% of patients with a long term condition, suffer from a mental illness. Interestingly pharmaceutical medications used to treat various psychiatric conditions also serve as pain medication; such as tricyclic antidepressants and anticonvulsants such as gabapentin.

Chronic pain should be thought of not only as a physical sensation but also as an emotional condition. The experience of pain, and to live in fear of the threat of pain, is a complex condition that can have multiple impacts on a patient's behaviour, mood and thought patterns. Chronic pain conditions can also be extremely debilitating, causing a lack of independence and mobility; leading to feelings of anxiety and in some cases dependence on pharmaceutical medication, it can also in some cases, lead patients to self medicate with alcohol and other substances.

depression and chronic painPatients suffering from chronic pain and or depression may experience one or more of the following:

  • feelings of anxiety
  • stress
  • low self esteem
  • altered moods
    • irritability
    • anger
    • sadness/tearfulness
  • loss of sexual desire
  • constant fatigue
  • fear of injury
  • social isolation (lack of desire to participate in social situations)
  • confused thoughts "brain fog"
  • family problems
  • work problems/loss of job
  • weight gain or loss

Treating Chronic Pain Conditions

A wide range of treatments are available for chronic pain, however these will vary considerably due to the different types of chronic pain and their causes, as well as individual patient impact.

Medication

Many may find that medication for relieving the symptoms of chronic pain, can help improve their overall quality of life, however medication will rarely completely eliminate pain. There are numerous medications used in the treatment of chronic pain. Some of them are prescription only, whereas others are available over the counter.

pain medicationMedication used in the pain clinic:

Analgesics and NSAIDS

  • Ibuprofen
  • Asprin
  • Naproxen and other anti inflammatories
  • Paracetamol
  • Codeine
  • Dihydrocodeine
  • Tramadol

Opiods

The following are all examples of stronger opiods used in the treatment of nerve pain

  • Oramorph
  • Oxynorm
  • Tapentadol
  • Methadone

Antidepressants

These are used almost exclusively for nerve pain

  • Tricyclic antidepressants such as Amitryptiline
  • Other types of antidepressants such as Duloxetine

Anticonvulsants

Also used for nerve pain related conditions:

  • Pregabalin
  • Gabapentin
  • Carbamazepine
  • Oxcarbazepine
  • Phenytoin

Other types of medication include:

  • Capsaicin creams - these can be very effective in nerve pain caused by postherpetic neuralgia
  • Lidoderm patches
  • Botox injections

Physiotherapy

Exercise and physical therapy play a vital role in the treatment of many pain related conditions. Physiotherapy has numerous benefits; it helps improve the patient's strength, improves mobility and has an overall positive influence; encouraging healthy levels of activity in day to day routines, with self management programs. It can also have psychological benefits, addressing a patient's own beliefs about their condition and its physical limitations.

Psychological Treatment

According to some studies the use of psychology in the treatment of pain related conditions became established due to the growing realisation that the extent of disability and pain related complaints reported by patients, could not be explained by the physical damage or disease to the body.

Some patients may need help understanding their condition and its causes. Patients that have a condition with no understood cause or an uncertain diagnosis, can often suffer from further distress and an increase in symptoms due to the stress caused by the lack of official diagnosis.

Cognitive Behaviour Therapy

Patients with chronic pain may also experience cognitive difficulties such as problem solving, poor memory as well as negative patterns of thought. Cognitive behaviour therapy works to try and reduce this.

The treatment of chronic pain is a complex area and psychological factors are key to the experience of pain.

Surgery

In some cases, surgery may be an option but this very much depends on the condition, it is not a common form of treatment. Spinal surgery carries with it a number of risks and there is no guarantee that the patient will feel less pain post-surgery.

Pain Management Programmes

pain management programmesA pain management program is a term used to describe a comprehensive program that incorporates a variety of different types of treatments to be used simultaneously. A pain management program will usually involve a multidisciplinary team, including physicians, psychologists, physiotherapists and other health professionals.

The emphasis in a pain management program is to help treat a patient's symptoms, but also to educate on; pain physiology and psychology, exercise and activity management, changing unhelpful thought patterns and beliefs, general health, diet, being more psychologically flexible in an overall day to day context. A pain management program is designed to help patients cope with pain, improve their mobility, sleep better and obtain an overall improvement of quality of life. This may include specific lifestyle adaptations such as diet, exercise and sleep patterns, teaching patients relaxation methods, as well as a combination of all the fore mentioned treatments.

Pain clinicians do not merely understand pain in purely biological terms, but rather adopt a biopsychosocial model. This assumes that the most effective way to determine an individual's health is by considering the biological, psychological and social. Using this approach, pain management clinics are able to make an overall assessment and tailor treatments to suit the needs of individual patients with differing situations and causes of chronic pain.

Are You Suffering With Chronic Pain?

There is no need to suffer with chronic pain, Dr Mark Miller can provide chronic back pain relief. Call 020 7060 5109 for your free consultation today.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment