Chronic Pain Defined

OVERVIEW

Chronic pain is persistent and long-lasting pain that can last weeks, months and even years. Pain signals continue to fire in the nervous system for prolonged periods of time.

chronic pain_fibromyalgiaChronic pain is different than acute pain, which is a normal sensation triggered to alert you to a possible injury. In people with chronic pain, there may have been an initial traumatic injury or chronic illness. However, some individuals have chronic pain without a past injury or condition.

Chronic pain is defined as pain lasting more than 12 weeks. It is often severe and not easily managed.

SYMPTOMS

Individuals may have chronic and persistent pain even without an obvious cause or preexisting condition. Chronic pain symptoms vary from person to person depending on cause, age and other factors.

Symptoms may include headache, pain in the lower back, pain in the neck, arthritis pain, cancer pain, neurogenic pain and psychogenic pain.

woman_headache-templesA person can have two or more co-existing chronic pain conditions. Such conditions include chronic fatigue syndrome, endometriosis (when tissue lining the uterus grows outside the uterus), fibromyalgia, inflammatory bowel disease (IBD), interstitial cystitis, temporomandibular joint dysfunction (TMJD) and vulvodynia.

DIAGNOSIS

It may be difficult for a doctor or health care professional to make an accurate diagnosis of a condition causing chronic pain. Often, there is not a preexisting condition or past injury to explain the pain a person is feeling.

Chronic pain often shows no outward signs or symptoms; it is something felt by you and you alone. A diagnosis can only be made if you seek out medical assistance and treatment from your doctor or health care professional. If you are experiencing pain that you cannot explain or pain that you cannot easily manage, schedule a physical exam with your doctor to see if there may be an underlying cause.

TREATMENTS

Medication

There are literally hundreds of different medication options available to treat chronic pain, from simple over-the-counter (OTC) aspirin and ibuprofen to extremely potent opioid narcotics.

Most OTC medications are based on one of the following active ingredients, sometimes in combination:

  • Aspirin
  • Acetaminophen (Tylenol)
  • Naproxen (Aleve)
  • Ibuprofen (Advil, Motrin)

Always read the label of any OTC medication to make sure the active ingredient is the correct medication for you. Many OTC medications have more than one of these ingredients or other additives such as caffeine or diphenhydramine (Benadryl).

The fact that OTC medications are not restricted by prescription does not mean they are safe for everyone to take. Acetaminophen and aspirin can both cause serious liver damage if taken improperly. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can cause stomach and kidney diseases over time. Always discuss dosing and use of any OTC medication with your doctor before using such medications.

There are also several different NSAIDs that are prescription strength and sold in different formulations. Some are made specifically to protect the stomach, and others are in gel form to be applied directly to the skin or in an intravenous formulation to be infused directly into the bloodstream. Examples of prescription NSAIDs include Celebrex, Daypro, and Voltaren, among others. Other prescription NSAIDs are simply higher doses of medications that can be bought over the counter.

opioid pillsOpioid analgesics are potent pain relievers that can be extremely effective when used properly. For many patients, opioids can significantly improve functional ability, provide pain relief and reduce the depression and hopelessness that can come with constant pain. Unfortunately, long-term use of opioids can also lead to tolerance and addiction. Other side effects include decreased testosterone levels in men, decreased libido and sex drive, irregular menses, depression, impaired sleep patterns and suppression of the immune system. One should never take any opioid analgesics without consultation and direction from a physician.

Most opioid analgesics contain one of the following active ingredients:

  • Morphine
  • Oxycodone
  • Hydrocodone
  • Tramadol
  • Methadone
  • Fenanyl
  • Hydromorphone
  • Oxymorphone

Many of these active ingredients are also mixed with non-opioid pain relievers in a combination pill. A widely used (and abused) example is hydrocodone with acetaminophen (commonly marketed as Vicodin).

There are dozens of different medication formulations that include some form of opioid analgesic. Do not take any of these medications without consulting a physician or pharmacist first.

Complementary and Alternative Medicine (CAM)

Many people with chronic pain turn to alternative medical procedures and practices to supplement other conventional medical treatment. Massage, acupuncture, yoga and tai chi are a few methods that are used.

Complementary and alternative medicine (CAM) is commonly used for chronic pain relief. However, there is conflicting evidence on whether these treatments have been scientifically shown to be successful. Using these methods, many patients find relief that they were not able to get through medication. Talk to your doctor before starting any CAM therapy.

Forms of alternative treatment include:

  • Acupuncture
  • Massage
  • Spinal Manipulation
  • Progressive Relaxation
  • Yoga
  • Mineral Baths (Balneotherapy)
  • Tai Chi
  • Cognitive-Behavioral Therapy
  • Exercise Therapy
  • Herbal Remedies (including glucosamine, chondroitin and various herbs)
  • Guided Imagery
  • Hypnotherapy
  • Meditation
  • Relaxation Therapy

CAUSES

Past injuries and preexisting conditions offer the most insight into the causes of chronic pain.

An injury does not have to be recent to cause chronic pain or lay the foundations for chronic pain to develop. After an injury, ask your doctor about steps you can take to prevent chronic pain from occurring.

Chronic pain also may result from arthritis, cancer, ear infections, chronic fatigue syndrome, inflammatory bowel disease (IBD), interstitial cystitis, temporomandibular joint dysfunction (TMJD) and vulvodynia.

woman holding lowe back signifying chronic lower back painMany people have chronic pain with no known cause. Researchers have found that some chronic pain patients have lower-than-normal levels of endorphins in their spinal fluid.

GETTING HELP

If you have pain that isn’t going away, seek medical care. Schedule a physical exam with your doctor and make sure to bring up all aspects of your pain. Explain where you hurt, when the pain began and how severe the pain is. Discuss any illnesses you may have had recently. Tell your doctor about any dietary supplements you may be taking, even vitamins. Dietary supplements can act the same way as medications — they are fully capable of causing medical problems if not used correctly or if mixed with prescription or nonprescription medicines. Do not self-medicate with alcohol or other illegal drugs, even if you feel like they help reduce the pain.

RELATED INFORMATION

I want to try an alternative form of therapy to treat my chronic pain. How do I find a reliable practitioner?

If you are considering a practitioner-provided alternative therapy for chronic pain management, such as acupuncture or massage, ask a trusted source such as your doctor or a nearby hospital for a recommendation. Find out about the training and experience of any practitioner you are considering. Make sure to ask whether the practitioner has experience working on your pain condition specifically.

Is there research for new treatment options?

In light of the human and economic costs of chronic pain, as well as evidence that many people with chronic pain turn to complementary and alternative medicine (CAM) for relief, the National Center for Complementary and Alternative Medicine (NCCAM) places a high priority on pain-related research. The ultimate goal of research on chronic pain is to build an evidence base that can guide pain management decisions tailored to individuals.

LIVING WITH

Living with chronic pain takes strength and often a great deal of patience. Because there is no universal cure or even treatment course, you may have to deal with a lot of trial and error to find a treatment plan that works well for you.

Do not get discouraged if a certain treatment does not work for you. The pain may seem never ending, but it can be eased and even eliminated if you find something that works well for you. Examine everything you do on a regular basis; that might include anything from daily activities to dietary supplements. Bring these observations up with your doctor and ask if any could be contributing to your chronic pain.