Chronic Pain

Last Updated: April 15, 2023

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Pain is a subjective experience in which actual or potential physiological damage occurs. This feeling is different for everyone and can be misunderstood and misinterpreted.

Pain becomes chronic when it is consistently present for longer than three months; one of the reasons it is so controversial is that many find it hard to believe that pain can persist for so long, even in relatively healthy people.


Definition of Chronic Pain

chronic-pain-first-websiteTo understand chronic pain, one must first understand what pain is in its' original sense. Pain occurs when there is potential or actual physiological or emotional damage to the body. Nerve receptors receive the sensation of physical pain in the body, which sends pain signals back to the brain. Things such as burns, cuts, bruises, headaches, and stomachaches can all cause physiological pain.

Chronic pain is when a person experiences pain for an extended time. Many researchers have debated the exact amount of time to qualify pain as "chronic," but there are agreements on criteria for chronic pain. Pain considered chronic usually persists longer than it is clinically supposed to, may have an unclear diagnosis, and usually is resistant to treatment.


Chronic Pain vs. Acute Pain

The difference between chronic pain and acute pain is the duration of each. Chronic pain is either pain that has persisted for over three months or pain that continues past the healing phase following the original physiological problem. On the other hand, acute pain usually results from physiological injury. It typically lasts a short time, usually only as long as it takes for the underlying and causal issue to resolve. If the underlying cause resolves, acute pain may remain for up to three months. It is considered chronic pain when it surpasses this timeline.


Causes of Chronic Pain

Just like acute pain, chronic pain has many potential causes. Studies have shown that the most frequent and common cause of chronic pain is osteoarthritis, a condition causing the cartilage in the joints to break down. It is most commonly in the hips, knees, and hands. Other common causes of chronic pain include various back problems and general musculoskeletal conditions like tendonitis and osteoporosis. Chronic pain may also be due to neurological disorders caused by damage to the nervous system, including the brain and spinal cord, such as migraines, neuralgia, and many more.


Risk Factors

Since chronic pain is not fully understood yet, it can be challenging to pinpoint what predisposes an individual to develop chronic pain. Still, research has thoroughly developed some theories on people who seem to be at an increased risk for this condition.

Firstly, pain is a considerable component in the risk of developing chronic pain; the worse the initial pain is, the more pain sites there are, and the more likely the individual is to develop chronic pain. Research shows that when severe short-term pain occurs, anatomical changes are made in the brain, predisposing the person to chronic pain afterward.

Another risk factor is mental health. Conditions like anxiety, depression, and catastrophizing can be associated with chronic pain and lead to poor outcomes in those experiencing it. Mental health and chronic pain are connected, as chronic pain can be challenging to deal with, leading to mental health problems and vice versa. Proper management of both is an effective way to improve the prognosis for chronic pain.

When people are dealing with multiple health conditions, the body can be overwhelmed, causing a breakdown on the physical level and leading to chronic pain. Whether related to their pre-existing chronic disease or not, someone with a chronic illness can experience chronic pain on a musculoskeletal level.

Like mental health conditions and their relationship with chronic pain, chronic physical diseases can also cause a vicious cycle of worsening both conditions. Pain management is essential to give the body a break and to be able to manage the pre-existing chronic condition.

Other modifiable risk factors contributing to chronic pain include smoking, alcohol, obesity, physical activity level, sleep, nutrition, occupational, environmental, and psychological factors. Like many chronic diseases, changing these modifiable factors can help avoid chronic pain or improve prognosis.

On the other hand, many risk factors are not modifiable; age, sex, cultural and socioeconomic background, history of trauma, injury or violence, and heritable factors can put an individual at a greater risk for developing chronic pain. These factors are difficult to change, but prevention on other levels and early diagnosis and management are great tools to improve the overall outcomes for these people.


Common Areas of Chronic Pain

Chronic pain does not look the same in every person. However, it can follow common patterns more common in some regions of the body, including; joint pain in the hips, knees, and hands, back pain, neck pain, headaches, and migraines are some of the most common musculoskeletal chronic pain areas.

Although common, people experience different sensations, frequencies, and pain patterns. Neurological disorders which cause chronic pain will result in burning, tingling, and numbing sensations due to damage to the spinal cord, spinal nerves, and the overall nervous system. The big lesson to learn here is that no pain is the same for anyone, and it is essential to treat it as such.


Chronic Pain Diagnosis

Chronic pain is typically a result of an underlying condition or issue. When diagnosing chronic pain, the healthcare provider will try to determine what is causing it. However, it does not take any specific tests to decide whether or not one has chronic pain, but rather a few questions to figure out the location, origin, intensity, frequency, and many other factors contributing to pain.

The doctor may ask where the pain is located, if it radiates to other areas of the body, how intense this pain is on a scale of zero to ten, how often it occurs, whether or not it is affecting activities of daily living, and if there's anything that can make it better or worse. With this information, the physician can diagnose the chronic pain condition.

By checking off specific criteria, the healthcare provider can decide whether or not it is considered chronic pain. Since pain is subjective, only the person experiencing it can describe it, causing many difficulties in diagnosing chronic pain alongside an underlying condition.

Chronic pain can be psychogenic or without a known physical cause. Many healthcare providers have difficulty understanding how someone can experience pain for such a long time without a visible or found cause. The psychogenic cause results in misdiagnosis, improper treatment and management of pain, and a challenging experience for the person living it. Diagnosing chronic pain and its type will lead to proper treatment and overall pain management.


Tests Used to Diagnose Chronic Pain

Although there are very few specific tests to diagnose the pain itself, usually a symptom of a causal condition, the healthcare provider's next step is to diagnose a condition that may be causing persistent pain.

Depending on presenting symptoms and the individual's pain level, the physician will decide which tests are necessary and appropriate. Common ones include blood tests, muscle activity tests, imaging tests like X-rays and MRIs, nerve conduction studies, reflex and balance tests, spinal fluid tests, and urine tests.

These are broad examples of what can diagnose chronic pain, but a doctor may order many other tests to confirm a diagnosis. The type of tests ordered depends on presenting symptoms and the answers to questions about the pain.


Treatment of Chronic Pain

The initial goal of chronic pain treatment is first to treat the cause as soon as possible. Whether it is arthritis pain, cancer pain, chronic headaches due to a neurological condition or severe trauma, back pain, or any other chronic pain, the prognosis and outcome of treatments are improved when pain is treated promptly. By treating the underlying cause, there is hope for chronic pain to disappear.

Chronic pain can persist long after the reason is gone. It is also possible that they are unable to find an explanation. In both cases, the goal is no longer to treat the condition but to manage pain, develop pain control, and implement overall pain relief.

The list would only continue if we were to name how to treat underlying conditions. Each condition is different and requires a different approach and solution. However, treating chronic pain without any known cause can be narrowed down a little easier but still complex and confusing.


Pain Management

pain management for chronic painChronic pain management requires a multidisciplinary, complementary, and integrative health approach. Neurologists and neurosurgeons can be necessary when the pain is neurological. Orthopedists and orthopedic surgeons can be needed when it is of musculoskeletal type. The list goes on for specialists able to help manage chronic pain.

Effective pain management is done by a team of healthcare professionals, communicating and coordinating care and therapies. In these cases, various physical medicine, pain relievers, medical treatments, and psychological therapies are used and required to relieve chronic pain. Healthcare professionals like neurologists, pain specialists, occupational therapists, and physical therapists work together to make a thorough and effective plan.


Physical Therapy

Physical therapy treats chronic musculoskeletal pain, chronic low back pain, muscle tension, general chronic back pain, and anything similar. The goal of physical therapy is to maintain and even restore physical function. Physical therapy will, in turn, maintain a healthy musculoskeletal system throughout chronic pain conditions and restore any loss of muscle and movement.

These interventions are usually low impact and tailored to the individual for optimal results; progressing in range of motion and weight bearing every session will relieve pain. Even people with tension headaches can benefit from this therapy; although neurological in its presentation, people can get some relief by releasing muscle tension.


Cognitive Behavioural Therapy and Other Therapies

Chronic pain can negatively affect mental health, productivity, and overall quality of life, especially psychogenic pain. Chronic pain can affect sleep, mental status, and overall functioning. Occasionally physical pain management is not enough to help with the secondary psychological effects of this condition.

Research suggests that psychological treatments, including cognitive behavioral therapy, cause small but significant improvements in pain, sleep, mental status, functionality, and overall well-being, with cognitive behavioral therapy having the most significant impact.

These clinical trials are done to learn the effects of psychological treatment for pain disorders and have helped healthcare professionals everywhere be more open to these treatments than in the past and are now more commonly involving this treatment for chronic pain in the rehabilitation plan.

The effects of chronic pain on an individual's everyday life are other psychological aspects that must be considered. People with chronic persistent pain may be unable to complete daily activities like cooking and cleaning. In some instances, pain can become so severe that they aren't even able to perform essential activities like eating, bathing, or clothing themselves.

It is also essential to consider the mental consequences of frustrating circumstances; psychogenic pain, or pain without known physical cause, can result in many mental issues. This is another example of how cognitive behavioral therapy and other therapies can help manage this stress and these emotions.

The individual's health can deteriorate without a robust support system. Occupational therapy is considered in these cases to coordinate care for the person, come up with solutions to these problems and work with the person and their support system to overcome these hurdles secondary to chronic pain.


Medications For Chronic Pain

With the help and advice of the other health team members, doctors will prescribe pain medicine to help relieve some of the pain. These can be used in combination with other non-pharmacological methods listed as well. Pain relievers such as nonsteroidal anti-inflammatory drugs, NSAIDs like Advil, opioids, and muscle relaxants medications are included in medical treatment to manage pain. Taking these either routinely or as needed, based on what the doctor prescribes, can be a great way to relieve the body and help it rest and heal itself instead of constantly fighting the pain.


Medical Procedures For Chronic Pain

Alongside prescribed medications like nonsteroidal anti-inflammatory drugs, NSAIDs, opioids, and various therapies, a few standard medical procedures exist to help manage and treat chronic pain. Again, these are frequently done alongside other medical interventions in a pain management plan to relieve pain by approaching it from different angles.

Transcutaneous electrical nerve stimulation, or TENS, is a procedure where small shocks are delivered through electrodes placed on the skin. These electrical impulses are delivered to the nerve endings under the skin, continuously firing up nerve signals to the brain and spinal cord. These impulses usually have the effect of treating pain and relieving it through the nervous system.

Another central nervous system approach to relieving chronic pain is through nerve blocks. A medical provider will inject an anesthetic near the site of pain to provide pain relief in that area. People with chronic pain can benefit from this as it blocks pain signals sent through the nerve endings to the spinal cord and brain into the nervous system.

When the body touches something hot, for example, the pain nerves send pain signals up the spinal cord to the brain and central nervous system to tell the brain that the body is in pain and to act accordingly by removing the hand. With nerve blocks, the anesthetic takes away that initial pain reaction; therefore, no pain signals arrive in the brain; the brain is unaware of any pain in that area.

Another effective pain-relieving procedure is epidural steroid injections. This is performed for people experiencing moderate to severe pain and combined with other medical treatments. It is done by injecting anti-inflammatory medications, such as a steroid or corticosteroid, into the space around the spinal nerves in the back for pain treatment. Steroids are medications that have the role of reducing inflammation and, in turn, will reduce pain.


Lifestyle Changes and Chronic Pain

lifestyle changes adjusting to chronic painPeople with pain disorders benefit from lifestyle changes to help with pain management. This, alongside the proper medical treatments, can provide enough pain relief to have a high quality of life and participate in daily activities. Occupational therapy is helpful to help build an effective and fulfilling lifestyle around chronic pain conditions.

Firstly, stress is a massive contributor to chronic pain. By engaging in stress management through different means, pain is reduced substantially. As mentioned, different types of psychological therapy can help relieve any mental stress in day-to-day life and the general stress of having a chronic condition. People have many ways to reduce stress; practicing effective techniques can help relieve and avoid worsening chronic pain.

Exercise is a risk factor for many health issues, including chronic pain. Although this condition can make it difficult to exercise due to high pain levels, reduced mobility, and overall fatigue from dealing with a chronic issue, physical exercise is known to reduce pain and relieve stress simultaneously. Working with a physiotherapist is a great way to develop an exercise plan suited for a specific type of chronic pain. Even low-impact exercises like walking or dynamic stretching could benefit chronic pain, and restorative or gentle yoga.

Food is always linked to general health and plays a significant role in the appearance of certain health conditions. While food would not necessarily cause one to develop chronic pain, it can certainly have a widespread impact on one’s health. A poor diet causes a poor state of health and, in turn, will negatively affect the chronic pain experience. A healthy and well-rounded diet will ensure one gets all the proper nutrients to maintain a healthy body. Proper nutrition will ensure the body is in the best state possible to combat daily pain and heal from it effectively.

A doctor or nutritionist may recommend an anti-inflammatory diet. Many foods contain properties that cause inflammation. Although minor, someone with pre-existing chronic pain can feel the effects of these inflammatory-inducing foods. A diet that avoids foods such as red meats and refined carbohydrates can be very beneficial for those who experience chronic pain.

Finally, sleep is a necessary action that is very important to maintain good health. Without sleep, the body would be unable to physically and mentally restore itself. With chronic pain, the body experiences a lot of mental and physical stress that can lead to more and more medical conditions in the long run. By getting the recommended amount of quality sleep, the body can take that time to restore itself and heal minor problems on a molecular and cellular level.


Chronic Pain Prognosis

Due to confusion around symptoms, the cause, and the overall pathway of chronic pain, treatment often falls short. Many studies have been done, and research continues to help us better understand this condition.


Is There a Cure?

Currently, there is no sure cure that guarantees the disappearance of chronic pain. Thankfully, there are endless treatments to help reduce and manage this pain. Depending on the type of chronic pain one is experiencing, the healthcare team will work together to plan different treatments, medications, and other therapies that best serve the patient.

Research shows that with the proper combination of treatments and effective management of symptoms, pain can be reduced by approximately 30%. For those who experience chronic pain and high levels of pain daily, this number can be very significant and means a higher quality of life for these people. Thankfully researchers have not given up on this confusing condition; they continue to complete research and clinical studies to understand better and, therefore, better treat chronic pain with the hopes of one day finding a cure.


Complications of Chronic Pain

Chronic pain is both a mentally and physically challenging condition and chronic pain comes with its' own complications. Many are psychological; depression, anxiety, substance abuse disorders, and an increased risk of suicidal thoughts and suicide are prevalent in people with this condition. Seeking proper medical attention and participating in therapies can help prevent and reduce the effects of these complications.

Other common complications in this population include a decreased quality of life due to the inability to socialize, complete daily living activities, and decreased enjoyment of leisure activities. Chronic pain is a vicious cycle, so worsening pre-existing chronic pain is common.

Seeking the proper medical attention when experiencing chronic pain can help reduce the symptoms, improve quality of life, avoid complications, and give a prognosis. Chronic pain treatment and management have come a long way and can bring immense relief to those diagnosed with chronic pain.


Chronic Pain Prevention

As mentioned previously, maintaining a healthy lifestyle is essential to reduce the chances of developing chronic pain. An individual with a healthy lifestyle and overall good health is more likely to recover properly from illnesses and injuries without experiencing chronic health, as opposed to someone in poor health with an unhealthy lifestyle.

Maintaining good, regular sleep, a healthy, well-rounded diet, managing and treating illnesses promptly and effectively, and seeking medical attention when there are health concerns are all ways to prevent chronic pain and ensure proper pain management.


Frequently Asked Questions

What Qualifies as Chronic Pain?

Chronic pain lasts three months or persists after the underlying and causal condition is resolved. If one still has pain once an infection, injury, or condition is healed or treated, seeking medical care to receive the proper pain treatment and management is a good idea.


Does Chronic Pain Ever go Away?

There is no unique definite cure for chronic pain since it is so variable. Different underlying causal conditions, external contributing factors, and many presenting symptoms make it challenging to find an exact cure. Treatment and management can significantly improve the quality of life with chronic pain to the point where the individual no longer suffers daily. On the bright side, chronic pain has disappeared independently without reasonable explanations, and chronic pain can be stopped by treating the underlying cause.


Chronic pain - Health - Canada.ca

Chronic Pain | Johns Hopkins Medicine

Cognitive behaviour therapy, exercise, or both for treating ...

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Chronic pain epidemiology – where do lifestyle factors fit in?

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Towards a theory of chronic pain - PubMed