Chronic Pain

February 1, 2017

Chronic pain is a persistent pain that adversely affects your well-being, level of function, and quality of life. It can be the result of an injury or infection, or there may be an ongoing cause of pain. It is an ongoing or recurrent pain lasting longer than the time of normal healing for an illness or injury, or more than 3 to 6 months.

Chronic pain is a disease of the central nervous system. It is defined as “pain without apparent biological value that has persisted beyond normal tissue healing time” It is also defined as pain that either persists beyond the point that healing would be expected to be complete (usually taken as 3-6 months) or that occurs in disease processes in which healing does not take place. The pain may be continuous or intermittent. Chronic pain can be experienced by those who do not have evidence of tissue damage or biological reason for pain.

Some forms of chronic pain can be linked to an identifiable cause, like degenerative disc disease, spinal stenosis, or spondylolisthesis. Other forms of pain have no known or understood cause, such as fibromyalgia or neuropathic pain (nerve pain). Fighting chronic pain is a lifelong struggle for many.

Chronic pain is not simply a physical problem. It is often associated with severe and extensive psychological, social and economic factors. Apart from poor general physical health and disability there may also be depression, unemployment, and family stress. Many of these factors interact, and the whole picture needs to be be considered when managing individual patients. The impact of chronic pain on patients’ lives varies from minor restrictions to complete loss of independence.

Types of Chronic Pain

Nociceptive pain is caused by damage to body tissue and usually described as a sharp, aching, or throbbing pain. This kind of pain can be due to benign pathology; or by tumors or cancer cells that are growing larger and crowding other body parts near the cancer site. Nociceptive pain may also be caused by cancer spreading to the bones, muscles, or joints, or that causes the blockage of an organ or blood vessels.

Neuropathic pain occurs when there is actual nerve damage. Nerves connect the spinal cord to the rest of the body and allow the brain to communicate with the skin, muscles and internal organs. Nutritional imbalance, alcoholism, toxins, infections or auto-immunity can all damage this pathway and cause pain. Neuropathic pain can also be caused by a cancer tumor pressing on a nerve or a group of nerves. People often describe this pain as a burning or heavy sensation, or numbness along the path of the affected nerve.

Causes

Anyone can develop chronic pain, although it most commonly affects older adults and people with health conditions like diabetes, arthritis, or back problems. Persistent pain is not a normal part of ageing and treatment for it should be sought.

Chronic pain cannot be prevented in every case. However, early, aggressive treatment of sudden and severe pain may reduce the odds of it developing into chronic pain.

The amount of pain that different people experience as a result of apparently identical injuries can vary a great deal. One person may suffer greatly, while another does not even need minor pain relievers. Sometimes a seemingly minor injury, perhaps just a paper cut, can lead to severe and persistent pain. We don’t know why this happens – some people just appear to be predisposed to pain, while others seem to be immune. These individual differences may reflect upbringing or cultural traditions. However, there are more and more indications that pain response may be affected by our genes. And we have no control over our genes.

Chronic pain often sets the stage for a complex set of physical and psycho-social changes that are an integral part of the chronic pain problem. These ancillary effects, which add greatly to the pain patient’s burden, can include:

Immobility and consequent wasting of muscle, joints, etc.
Depression of the immune system and increased susceptibility to disease.
Disturbed sleep.
Poor appetite and nutrition.
Dependence on medication.
Over-dependence on family and other caregivers.
Repeated and/or inappropriate use of professional healthcare services.
Poor performance on the job or inability to work.
Introspective isolation from friends, family and society.
Anxiety and/or fear.
Bitterness, frustration, depression, and even suicide.

With so many possible causes, the precise cause of chronic pain can be hard to pinpoint. While pain may start with a disease or injury, it can persist because of stress, emotional problems, improper treatment, or persistent abnormal pain signals in the body. Chronic pain can even occur without any previous injury, illness or known cause.

Symptoms

The symptoms of chronic pain include –

Mild to severe pain that does not go away.
Pain that may be described as shooting, burning, aching, or electrical.
Feeling of discomfort, soreness, tightness, or stiffness.

Pain is not a symptom that exists alone. Other problems associated with pain include –

Withdrawal from activity and increased need to rest.
Weakened immune system
Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress.
Disability

Treatment

Medications – Some general categories for medications used for chronic pain are –

Anti-depressants – They can block the brain from receiving pain messages, so they are a reasonable option for chronic pain sufferers. It’s also thought that anti-depressants may increase the amount of endorphins in the body, and endorphins are a natural pain suppressant. Anti-depressants may be prescribed as part of a comprehensive treatment plan that seeks to help you deal with all components of chronic pain.
Muscle relaxants – If the chronic pain is caused by muscle sprain, strain, spasm, or tension, the patient may take a muscle relaxant. This medication may help give pain relief you needed, so that the person can work on strengthening the muscles through physical therapy and exercise.
Neuropathic agents – For chronic pain caused by nerve problems (neuropathic pain), doctors may prescribe neuropathic agents. They specifically target the nerves, and they change the way that the brain receives and interprets pain messages.
Non-steroidal anti-inflammatory drugs (NSAIDS) – NSAIDs fight inflammation, just as steroids do, but they do it without any steroids. They work by blocking certain enzymes in the body—the ones that help create inflammation.
Opioids (Narcotics) – In the most extreme cases, and only under careful supervision, the doctor may also prescribe an opioid, such as morphine or codeine. Opioids are also called narcotics. They work by attaching to opioid receptors on the surface of the brain, spinal cord, and gastrointestinal cells. They then can block pain messages from getting to the brain. Opioids also change the brain’s interpretation of pain by affecting the way that pain signals are transmitted.
Pain relievers – Prescription-strength pain relievers—also called pain killers or analgesics—do just what their name implies: they relieve pain. They don’t reduce inflammation. Instead, pain relievers work by blocking the brain from receiving pain signals from the nerves. If the nerve cells can’t transmit pain messages as they normally do, then the brain won’t be aware of the pain, and the patient either won’t feel it or won’t feel it as severely. Most pain relievers belong to one of the above categories (opioids, NSAID, etc.).
Steroid medications – Steroids are very strong anti-inflammatory medications. They stop the body from producing the chemical that cause inflammation, so they’re used for chronic pain patients with an inflammatory condition, such as arthritis.

Alternative Treatment

EPA, an omega-3 fatty acid in fish oil, is a potent anti-inflammatory. It works in a manner similar to NSAIDs, only better. Rather than dampening the production of prostaglandins across the board, it suppresses only those that cause pain and inflammation. And because inflammation is a primary cause of pain, fish oil is a great therapy for discomfort of any kind.

Glucosamine simply provides the body with the raw materials needed for cartilage regeneration. Glucosamine has been studied in scores of clinical trials.

Chondroitin sulfate is an ingredient in many joint formulas, and it appears to work well in combination with glucosamine. It inhibits enzymes that break down cartilage. It also attracts and holds water, which is very important, as water gives cartilage its resiliency and cushioning effects.

The amino acid d-phenylalanine (DPA) slows the action of the enzymes—particularly carboxypeptidase A or endorphinase and enkephalinase—that degrade the endorphins. The enzymatic degradation of endorphins and enkepinalins is a constant, somewhat indiscriminate, process. Slowing down this endorphin-reducing mechanism can diminish pain within twenty-four hours.

Calcium is critical to maintaining bone density. Many RA medications can contribute to bone loss, and inactivity from inflammation and pain can further deteriorate bone health. A calcium-rich diet along with a supplement can be an important part of treatment.

Quercetin, a plant-based flavonoid is responsible for giving many flowers, fruits, and vegetables their color. Quercetin has potent antioxidant and anti-inflammatory properties, and may benefit those with RA.

Vitamin D can contribute to the onset and progressive symptoms of RA. The vitamin significantly contributes to joint and bone health. Vitamin D is “an active steroid hormone that binds to receptors in a host of vulnerable tissues—including the joints affected by arthritis.”

White Willow Bark has a long history as an effective therapy for pain relief. In fact, aspirin was originally derived from the bark of this tree, although today’s synthesized version contains only one of its components.

Curcumin is the active ingredient in turmeric (Curcuma longa), the yellow-orange spice in curry. It has perhaps the strongest anti-inflammatory activity of all the medicinal herbs and has been compared to NSAIDs in terms of efficacy. Curcumin is also showing promise as a protector against degenerative disorders of the brain.

Bromelain is an enzyme from pineapple that acts on prostaglandin pathways to reduce pain and inflammation.

Boswellia, an extract from the Boswellia serrata tree, comes from ancient India. Studies suggest that patients with both osteoarthritis and rheumatoid arthritis have noted significant improvement boswellia.

DMSO (dimethyl sulfoxide) is a sulfur compound that is an excellent therapy for inflammatory conditions. This remarkable substance can be used orally, intravenously, or topically. Most patients with arthritis find topical application the most convenient.

MSM (methylsulfonylmethane) has many of the same properties as DMSO, minus the smell. Its potent anti-inflammatory actions blocks the pain response in nerve fibers.

Cayenne pepper (Capsicum frutescens) has been used therapeutically for centuries. Capsaicin works by depleting substance P, a neuropeptide produced by the nerves that carry pain sensation (the “p” stands for pain). Skin ointments containing capsaicin have been shown to significantly relieve arthritis pain.

Physical exercises and practicesMusculoskeletal pain, joint pain, and lower-back painBy strengthening muscles supporting joints, improving alignment, and releasing endorphins• Physical therapy: Specialized movements to strengthen weak areas of the body, often through resistance training