Chronic Pain

Chronic Pain

As has been previously discussed in this website, pain can be a symptom of illness, result from an injury, or occur with no apparent cause. Pain that results from illness or injury and tapers off, stops on its own, or stops with medical treatment is called acute pain. Chronic pain is different from acute pain and can be very debilitating and often becomes the defining factor in an individual’s life.

Chronic pain is defined as pain that persists for more than 3 months, persists for more than 1 month after fixing an acute tissue injury, or accompanies a non-healing lesion. Causes of chronic pain include long-term illnesses (e.g. cancer or arthritis), injuries (e.g. a herniated disk or torn ligament), and primary pain disorders (e.g. chronic headache). Chronic pain can also be caused by vascular conditions that reduce blood flow to areas of the body and by damage to the central nervous system (brain, brainstem, or spinal cord) and peripheral nervous system. Often, the cause of chronic pain is not known. In some cases, altered electrical and chemical nerve signals may cause pain to persist long after an injury had healed. A heightened sensitivity to pain may also be a factor, as people with chronic pain typically have lower than normal levels of painkilling endorphins. In other cases, pain signals from injured or diseased tissue amplify pain messages by activating pain circuits in the central and peripheral nervous systems.

In most patients, the physical problems are what sustain chronic pain. However, psychologic factors usually play a role. Chronic pain that is not related to physical disease or injury, or any other type of physical cause is called psychogenic pain. Psychological factors can play a big role in pain because they may cause, increase, or prolong pain. Chronic pain may cause patients to alienate those around them and it often leads to drug addiction, irritability, and depression.

Chronic pain can also be consciously or unconsciously amplified. Patients who have to continually prove that they are sick to obtain medical care or insurance coverage may unconsciously reinforce their pain perception. However, chronic pain sufferers may also consciously exaggerate their symptoms for secondary gain, such as time off work or disability payments. This conscious exaggeration of symptoms is called malingering. Factors in a patient’s environment, such as family members or friends, may also reinforce behaviors that perpetuate chronic pain.

Chronic pain often leads to sleep disturbance, decreased appetite, weight loss, constipation, diminished libido, and depression. Many patients become inactive, withdraw socially, and become preoccupied with their physical health. Psychologic and social impairment can become very severe, especially as the duration of pain increases.

Early, aggressive treatment of acute pain is the best option and may limit sensitization and hopefully, prevent progression to chronic pain. Chronic pain is diagnosed over time and the diagnosis is based on the patient’s history of symptoms, any underlying conditions, physical and neurological examinations, and diagnostic tests. It is important for patients to realize that complete chronic pain relief is not always possible but the pain can be made more tolerable. Patients are typically referred to different medical practitioners for diagnosis and treatment. Drugs and physical methods are used most often, but psychologic and behavioral treatments are also very beneficial treatment options.