Understanding Chronic Pain


The International Association for the Study of Pain (IASP) defines pain as:

An unpleasant sensory and/or emotional experience associated with actual or potential tissue damage or described in term of such damage.  Pain is actually a message sent along the nerves to let the brain know that something is damaging the body. The brain responds by sending a message to the muscles or organ to take action.

In the medical world, all pain is divided into two categories: acute pain and chronic pain.

Acute pain is temporary, and goes away quickly. It's useful, since it usually warns you of sources of harm and tells your body to protect itself while it's healing.

Chronic pain is pain that is unpleasant and lasts for prolonged periods of time. Generally, if you've been experiencing pain in the same place for 3 months or more, that pain is likely to be classified as chronic. Since it lasts so long, it does not serve as a useful warning.

Pain Treatment Options

Pain relief treatment and chronic pain management begins with an assessment of the severity of the pain. Typically, the first step of treatment is rest, application of cold or heat and intake of OTC (over the counter) medication.

The next step in the treatment of chronic pain is a combination of physical therapy and prescribed pain medication. It is important to note that sometimes, interventional pain management needs to be started prior to Physical Therapy in order to stop acute pain (i.e. acute radiculopathy) and allow the patient to comply with necessary exercise. Alternative therapies such as massage treatments, hypnosis, meditation and yoga can be used as a adjunctive therapy for the treatment of pain.

If prescribed pain medications, physical therapy and alternative treatments don't work, the next step usually involves interventional pain management, unless the patient has acute loss of function or acute neurological deficit (in which case surgery is needed). In many instances chronic pain can still persist even after surgical intervention. After several treatment options have been explored, if the pain still persists, the next option is medical management for chronic pain.

Common Areas Causing Chronic Pain:

Head and Neck Pain
The most common origins of head and neck pain are neurogenic (nerve root compression, peripheral neuropathy, herpetic neuralgia), soft tissue pain (cervical strain, myofascial pain), musculoskeletal pain (degenerative joint disease, fracture, neoplasm, degenerative disk disease), or sympathetic pain. Depending on pain origin, there are different treatment options.

Low Back Pain
Low back pain originates from any of four major structures: bone (degenerative joint disease, spinal stenos, facet arthropathy, metastatic malignancy), lumbar disk (herniated nucleus pulposus, degenerated ruptured disk), musculoskeletal system (muscles and ligaments strain, muscular spasm), and nerves (neuropatic pain).

One of the most difficult types of chronic pain to treat is post-surgical arachnoiditis (failed back surgery syndrome). Up to 85% of patients with low back pain cannot be given a definitive diagnosis because of the poor association among symptoms, pathological findings and imaging results.

Upper Back and Thoracic Pain
Although upper back pain and thoracic pain are not very common spinal disorders, they tend to result in significant discomfort and chronic pain. Thoracic pain may be caused by internal organ pathology (lung cancer, esophageal disorders, heart disorders), referral pain (cardiac angina, cholecistitis), muscular irritation (myofascial pain), joint dysfunction of thoracic cage and upper back, pain from herniated or degenerated disk, nerve pain (intercostal neuralgia, herpes zoster), pain from osteoporotic vertebra body collapse.

Abdominal Pain
Abdominal pain is usually caused by disease of internal organs of the abdominal cavity and is treated by a gastroenterologist or surgeon. Interventional pain management is offered to patients who suffer from advanced cancer of internal organs (especially pancreatic cancer) or other chronic conditions (chronic pancreatic, abdominal angina). Most of the time, treatment is very successful.

Chronic Pelvic Pain
Chronic pelvic pain may occur in the presence of known or suspected organic pathology, or without any evidence of an underlying physical cause. Pelvic pain is more common in women, with most common reasons being endometriosis, endometritis, pelvic inflammatory disease, pelvic adhesions, neoplasm, and myofascial pain of the pelvic floor muscles. Pelvic pain may persist even after total hysterectomy.

Central Pain
Central chronic pain is produced by lesions of the central nervous system: spinal cord, brain and brain stem. Examples of central pain are: multiple sclerosis, neoplasm, patients with stroke.

Peripheral Nervous System Pain
Peripheral nervous system chronic pain (peripheral neuropathy) results from peripheral nerve lesions. This peripheral nerve lesion may be caused by Herpes Zoster (postherapuetic neuropathy), diabetes (diabetic neuropathy), entrapment neuropathy (pain after inguinal hernia repair), and chronic alcoholism (alcoholic neuropathy).

Reflex Sympathetic Dystrophy
Reflex Sympathetic Dystrophy (RSD), or Complex Regional Pain Syndrome (CRPS I), applies to a variety of seemingly unrelated disorders having similar clinical feature and manifesting the sane fundamental disturbed physiology. Causalgia or Complex Regional Pain Syndrome (CRPS II) is a historical term describing a RSD that follows partial or complete injury to peripheral nerve trunk. This chronic pain is characterized by constant, spontaneous, severe burning pain. If persistent, it results in trophic changes.

Phantom Limb Pain
Phantom Limb Pain describes painful sensations that are perceived to originate in the amputated portion of extremity.  In addition, patient may have localized chronic pain following amputation, which originates from the stump itself.