Chronic Pain

What is Chronic Pain?: While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults.

Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system). A person may have two or more co-existing chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.

Types of Chronic Pain: Chronic pain is different than acute pain. Acute pain is experienced rapidly in response to disease or an injury. Acute pain serves to alert you that something is wrong and an action should be taken, such as seeing a healthcare provider or stopping an activity that is causing the pain. Chronic pain persists beyond this window and continues even after steps have been taken to address the cause of the pain. Chronic pain can also be psychogenic pain. Psychogenic pain is not due to any discernable injury or disease process

Symptoms of Chronic Pain: Symptoms of chronic pain can differ in intensity, frequency, and duration amongst individuals. Symptoms can be minimal to intense and include joint pain, muscle, headache, neck pain, low back pain, pain due to cancer, neurogenic pain (pain due to nerve or central nervous system damage) and visceral pain (pain that comes from the body's organs). Because of the long-term, unrelenting nature of chronic pain, it can also result in additional symptoms or complications, such as anxiety, depression and even suicidal thoughts. The risk of these complications is greater when chronic pain is not treated adequately. Chronic pain is frequently linked to depression.

The two are connected closely because the mood and pain perception centers are both located in the same areas of the brain. Both chronic pain and depression can deplete the body's sores of endorphins and other neurochemicals that regulate mood and sensation and result in an exacerbation of the other condition. Seventy-five percent of patients with clinical depression also have complaints of physical symptoms, especially chronic pain. In addition, clinical depression occurs in about 30% of patients with chronic pain, and anyone in pain can experience some level of mood change, according to the National Pain Foundation

There are a wide variety of chronic pain symptoms. Common chronic pain complaints include joint pain, muscle, headache, neck pain, low back pain, pain due to cancer, neurogenic pain (pain due to nerve or central nervous system damage) and visceral pain (pain that comes from the body's organs). Because of the long-term, unrelenting nature of chronic pain, it can also result in symptoms, such as anxiety, depression, and even suicidal thoughts. This risk of this is greater when chronic pain is not treated adequately.

Treatment of Chronic Pain: With a well integrated, multifaceted treatment plan, chronic pain can be effectively controlled and minimized. A good treatment plan is individualized to a person's medical history, severity of chronic pain, the specific cause, and other factors. Common treatments include medications and alternative therapies to address and control pain and treatments to address the specific cause of pain, such as shingles. Medications commonly used for treatment include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and celecoxib (Celebrex). Narcotics, such fentanyl are also used. All these medications have potentially serious side effects. Placebos, inert medications that do not contain any pain relieving ingredients, may also be used by some healthcare providers in some cases. Antidepressants, such as amitriptyline (Elavil), venlafaxine (Effexor), and duloxetine (Cymbalta), may also be used to treat both chronic pain and depression, which often occur together. Antidepressants may help reduce the need for pain medications. Sometimes surgical procedures may be used to relieve chronic pain, such as the removal of a cancerous mass which is causing pain in a patient with terminal cancer. Some alternative or complementary therapies also used in the treatment of chronic pain. These can include electroacupuncture, in which tiny electrified needles are inserted under the skin at specific points to stimulate nerves. This may activate the body's production of endorphins, a natural pain killer.

Traditional acupuncture, without electrical stimulation, is also effective for some people. Relaxation therapies, such as music therapy an aroma therapy are other examples of alternative therapies.Today chronic pain can be managed very successfully with a variety of treatments. The treatments are as varied as the causes of chronic pain, and the most successful treatment plans usually use a multipronged approach. After a complete evaluation, your health care professional will work with you to develop treatment goals and a treatment plan that will be most effective for your specific condition, type of pain, and lifestyle. Common treatments include medications and alternative therapies to address and control pain. Treatment should also address the specific cause of your pain.For example, treatment for chronic pain due to deterioration of the cartilage of a joint and arthritis may include surgery to help correct the problem, physical therapy, and medications that help to grow new cartilage, such as chondroitin and glucosamine, as well as pain medications. Medications commonly used for treatment include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and celecoxib (Celebrex). Narcotics, such fentanyl are also used. All medications have potentially serious side effects, so it is important that you do not start a medication regime before consulting a health care professional who will evaluate your individual case and needs. Even over-the-counter NSAIDs and other pain relieving medications, such as aspirin and acetaminophen (Tylenol) can have serious, even life threatening side effects, especially when they are not taken as recommended or if taken frequently.

Placebos, inert medications that do not contain any pain relieving ingredients, may also be used by some healthcare providers. Antidepressants, such as amitriptyline (Elavil), venlafaxine (Effexor), and duloxetine (Cymbalta), may also be used to treat both chronic pain and depression, which often occur together. Antidepressants may help reduce the need for pain medications.Sometimes surgical procedures may be used to relieve chronic pain. For example, surgery may be performed but as a palliative treatment to remove a cancerous mass which is causing pain in a patient with terminal cancer. Palliative treatments are aimed at improving pain and increasing function, not providing a cure. Chemotherapy may be also used for the same purpose.There are many other treatments that are often known as alternative therapies for chronic pain. These can include electroacupuncture, in which tiny electrified needles are inserted under the skin at specific points to stimulate nerves. This may activate the body's production of endorphins, a natural pain killer. Traditional acupuncture, without electrical stimulation, is also effective for some people. Relaxation therapies, such as music therapy an aroma therapy are other example of alternative therapies.