What is pain?
Pain is an unpleasant sensory and emotional experience. Pain can be mild or severe. But almost always it warns us about danger. Pain alerts us about harmful changes in our body, e.g., inflammation or cancer, or keeps us away from threatening situations, like touching hot surfaces.
On the other hand, sometimes pain has no reason.
What is chronic pain?
Pain that lasts longer than 12 weeks or continues even after the healing process is called chronic pain. Based on time and frequency of pain, there are also acute and episodic types of pain.
What is the difference between acute and chronic pain?
Acute pain is usually brief, sharp, and ends when its cause is treated. Common causes of acute pain are strained muscles, broken bones, toothache, surgery, infection, and burns.
What causes chronic pain?
The origin of chronic pain is complex. It may have started from illness and continued after healing of injury or be a symptom of a chronic condition, like cancer. Sometimes, the underlying cause is not obvious. Common causes include:
nervous system damage or malfunction
This type of pain is called neuropathic pain. Examples include peripheral neuropathy and trigeminal neuralgia.
bone, joint, ligament, muscle, and tendon injuries (musculoskeletal pain)
Examples include tendonitis and back pain.
pain from internal organs (heart, lungs, bladder, intestines, reproductive organs)
This pain is called visceral pain. The causes of pain are diverse. Examples of visceral pain include, but are not limited to, stomach pain from gastric ulcers, menstrual cramps, and pain in your abdomen if you have a UTI.
inflammation and tissue damage (inflammatory pain)
Both chronic conditions and short-term illnesses can cause this type of pain. For instance, you may have pain in your joint because of autoimmune diseases, e.g., rheumatoid arthritis.
changes in the brain and spinal cord (central sensitization)
Your central nervous system becomes more sensitive to pain.
What are the symptoms of chronic pain?
Chronic pain feels different for each person. You may describe your pain as:
- aching
- burning
- shooting
- squeezing
- stiffness
- stinging
- throbbing
Long-term pain can lead to other symptoms, like:
- anxiety
- poor sleep
- feeling very tired
- mood changes
- feeling lonely, sad, hopeless, or overwhelmed
- finding it hard to do usual activities, socialize, and go to work
What is a “terrible triad”?
Chronic pain can lead to a condition of sleeplessness, suffering, and emotional distress. Pain starts to interfere with your life and work and leads to suffering and distress. Insomnia, in turn, causes irritability and depression and intensifies pain. This condition is called the “terrible triad.”
What are the risk factors for chronic pain?
As the causes of chronic pain are diverse, risk factors are also numerous. Here are some common risk factors for chronic pain.
- Genetics (some causes of chronic pain, e.g., migraine, run in families)
- Aging (the risk of injuries is higher in the elderly age group)
- Previous injury
- Having a manual labor job
- Frequent and severe stress
- Smoking (smoking is associated with a high prevalence of lower back pain)
- Obesity (this condition may worsen several diseases and cause pain, e.g., arthritis or back pain).
When to contact a physician?
You should always see a doctor and not try to live with your pain if:
- You have been in pain for more than three months.
- Over-the-counter medication isn’t working.
- Your pain affects your daily activities.
- You have mood changes and tiredness because of your pain.
- Your pain gets worse and worse.
Who treats pain?
First, you should refer to your GP. In some cases your GP may refer you to another specialist, e.g., a neurologist, pain specialist, rheumatologist, psychologist, etc.
How is chronic pain diagnosed?
As mentioned above, we talk about chronic pain if it lasts longer than three months. For diagnostic purposes, a healthcare provider may carry out a physical exam and ask questions about your pain history. Sometimes tests or other imaging studies may also be needed.Here are questions that your physician will ask you.
- Where is your pain?
- How intense is your pain, on a scale of 0 to 10?
- How often does it occur?
- How much does it affect your life and work?
- What makes it better or worse?
- Is your life full of stress and anxiety?
- Do you have any diseases, chronic conditions, or surgeries?
How to treat chronic pain?
The treatment options for chronic pain are diverse. The results vary from person to person, but the combination of different approaches is more effective than pain management with a single approach. The latter include:
- Treating the underlying cause.
- Lifestyle changes (e.g., weight and stress management).
- Physical therapy and occupational therapy.
- Psychological therapies for pain.
- Complementary medicine therapies (like massage therapy and meditation).
- Medical procedures (surgeries, botulinum toxin injections, etc.).
- Medications (e.g., NSAIDs, opioids).
- Clinical trials.
What is the prognosis of chronic pain?
Chronic pain usually is not treatable. Pain management approaches are addressed to treat the underlying cause, reduce a person’s pain score, improve quality of life, and lessen the stress.
Sources:
Stanford Health Care
Cleveland Clinic
International Association for the Study of Pain
John Hopkins Medicine
National Institute of Neurological Disorders and Stroke
