Defining Chronic Pain: What Is It?


What Is Chronic Pain?

What Is Chronic PainEveryone is familiar with pain. Whether or not it is burning, shooting, or aching. We’ve all had pain at one point or another in our lives.

Acute pain is pain that lasts less than three months, and typically is the result of an injury or illness.

In contrast, chronic pain continues longer than three months, and often the pain endures even though the original injury has healed. It might be constant pain or come and go, but regardless, the pain is there for an extended period of time. This is called chronic pain syndrome.

There are different types of pain, and pain might come from various parts of your body:

  • Somatic pain. Pain from your skin and soft tissues.
  • Visceral pain. Pain from your internal organs.
  • Bone pain. For example, osteoarthritis, rheumatoid arthritis, juvenile arthritis.
  • Neuropathy. Examples include peripheral neuropathy, proximal neuropathy and autonomic neuropathy.
  • Vascular Pain. Pain caused by circulatory issues.

The conditions and symptoms that fall under the umbrella of chronic pain syndrome are vast.

The McGill Pain Index

The McGill Pain Index is a questionnaire that seeks to help the pain patient describe their pain to their doctor by picking out the words that best portray how they feel, and to point to their pain on a drawing of a person.

The Index was developed at McGill University by Melzack and Torgerson in the 1970s. It has 78 total words, spilt into 20 sections. Different sections are grouped into different aspects of pain, such as: sensory, affective (feelings), evaluative, and others.

By using a qualitative method to gather information about pain, doctors can better study pain. On an individual level, they can use the McGill Pain Index to create a better pain plan to best suit you.

What Conditions Cause Chronic Pain?

Fibromyalgia

Fibromyalgia is a pain disorder characterized by widespread pain.

The National Fibromyalgia Association estimates that about three to six percent of people worldwide have fibromyalgia. It is mostly diagnosed in women aged twenty to fifty, however, men can also get it, and it is also seen in people outside of that age range.

Currently, there are no clear causes of fibromyalgia. Researchers have theorized that people with fibromyalgia are receiving abnormal pain signals, and their neural networks are not working correctly.

Other research has found that many people with fibromyalgia have low levels of serotonin, noradrenaline, and dopamine in their brains and that these chemical imbalances are disrupting how your body regulates sleep, appetite, and mood.

Other causes being investigated are genetics, links to trigger events, sleep issues, and relationships with other medical conditions.

A key feature of fibromyalgia is not only widespread pain but specific trigger points for pain. These are spots that are intensely painful, especially if touched. There are eighteen of them, ranging from on the back of the head, to on the shoulders, hips, and knees.

Outside of pain, fibromyalgia can cause fatigue, sensitivity to touch, headaches, insomnia, cognitive difficulties (“brain fog”), and digestive issues.

Spine Pain

Pain from a back or neck issue is one of the most common complaints that a doctor might hear, with a third of the population getting some form of back pain each year. Unfortunately, sometimes that pain just does not go away.

Spine pain can come from a wide variety of causes, such as herniated discs, arthritis, degenerative disc disease, and ankylosing spondylitis.

Depending on the cause of the pain, and because of the complexity of the spine, spine pain can cause not only bone pain but nerve and muscular too.

Damaged nerves can also affect other parts of the body, and cause neuropathy, such as sciatica, which is nerve pain that affects your legs. It can make your affected limbs weak, and difficult to use.

Because your spine is so important to move around in your daily life, having an issue with it can mean that you may not be able to move it very well. It might also not be possible to sit or to be in certain positions for very long.

Osteoarthritis

Osteoarthritis attacks the cartridge in the lining of the joints.

This makes it begin to wear out, and this can lead to the bones of the joint laying on each other and this can be painful. It can also change the shape of the joint, and also affect the tendons and ligaments around, which can also lead to pain.

Risks for osteoarthritis developing include age, injury, obesity, joint abnormalities, genetics, and gender (it is more common and severe in women).

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is an autoimmune condition. It affects the synovium or the outer covering of the joint. That spreads to other parts of the joint, which leads to the bone and cartridge to break down and change shape. That causes pain and swelling.

RA does not only affect the joints, but can cause systemic symptoms such as fatigue, fever, loss of appetite, and weight loss.

It is often seen more in women, may run in families, and there is evidence that smoking might elevate your risk of developing RA.

Juvenile Arthritis

If a child develops arthritis, they will be diagnosed with one of the types of juvenile arthritis.

Juvenile idiopathic arthritis (JIA) is the most common type, and as it is an umbrella term itself, there are several subtypes within it. Oligo-articular JIA can not only affect the joints but the eyes as well. Other types can also present with swollen joints, rash, fever, and pain.

There are many other types of arthritis and conditions related to it.

Chronic Migraines

The Migraine Trust reports that migraines are the third most common disease in the world, with tension headaches being ahead.

Chronic migraines affect about one to two percent of the world’s population, with women making up three times the number of migraineurs than men. The Migraine Trust explains that this is likely due to hormonal differences between the sexes.

The International Headache Society defines chronic migraines as getting more than 15 migraines a month over a three month period. People who get migraines might progress to a chronic level over time, however, if you are a chronic migraineur, you might also start getting fewer migraines over time as well.

Different things can trigger migraines for different people, although some consistent things can often set off migraines such as light, sound, smells, medications overuse, caffeine, weather changes, hormones, sleep deprivation and certain foods

There might also be genetic causes, especially for certain types of migraines.

Next page: Learn about more types of chronic pain, how to treat chronic pain, and find out if chronic pain is a disability.

What Conditions Cause Chronic Pain?

Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is probably one of the one painful conditions documented. On the McGill Pain Index, it scores a huge 42 out of 50, which is higher than amputation, childbirth, and cancer.

It usually affects one limb, often after an injury. CRPS type I involves an injury with no nerve damage, such as a fracture or sprain. It is sometimes called reflex sympathetic dystrophy (RSD) or Sudeck’s syndrome. CRPS type II involves nerve damage to a limb, and might sometimes be called causalgia. Rarely, it occurs without an injury.

There aren’t any known, specific causes of CRPS, however, it’s speculated that the nerves in the affected limb are too sensitive, and that is part of the problem.

CRPS pain can be described as burning, stabbing, or throbbing. The limb can also swell, become discolored, stiff, change temperature, and you might have difficulty moving it. It can be so sensitive that even light touch can be unbearable.

It is diagnosed through a process of elimination, and through your symptoms. The International Association of for the Study of Pain created the Budapest Criteria, which are a set of symptoms to help doctors to diagnose CRPS.

There are various types of physical, occupational, and psychological therapies that can be helpful for CRPS, alongside medications such as pain relief, and medicines that target nerve pain, like gabapentin and pregabalin. A spinal cord stimulator might also be beneficial for some.

Multiple Sclerosis

Another condition that can cause chronic pain is Multiple Sclerosis (MS). MS can cause several different types of pain, including muscular, neuropathic, headaches, and a particular type of eye pain called optic neuritis (ON).

MS can cause muscle weakness and imbalance, which can cause pain. Imbalance issues can also lead back and hip pain because the body’s posture is not in proper alignment. MS can also cause painful muscle spasms that can be very severe.

Physical therapy and appropriate exercise will help treat your muscle pain by addressing the core issues that are causing it. Baclofen, tizanidine and ibuprofen are commonly prescribed medications to help with muscle spasms.

Between five and ten percent of people with MS deal with nerve pain, such as facial pain known as trigeminal neuralgia. Some may also have a severe stabbing, nerve pain in their neck that causes their neck to bend forward. This is known as lhermittes. If you have MS, you may also get neuropathic pain elsewhere in your body, especially in your limbs. This may feel like burning, stabbing, tingling, pins and needles, numbness, and/or aching.

There are a variety of medications for neuropathic pain that can be used to help treat your MS pain, for example, carbamazepine, and amitriptyline.

One of the first signs of MS in many people is optic neuritis (ON). ON happens when the nerve going to your eye becomes inflamed. This leads to pain, and often temporary vision loss or reduction in one eye. You might also not be able to see color or see flashing lights. It can be treated with steroids, and by treating your MS.

Other Chronic Types of Chronic Pain

The above conditions are by no means an exhaustive list of chronic pain conditions. They are just a few of the many illnesses and diagnoses that make up chronic pain syndrome. Many other conditions and illnesses can cause pain.

For example, chronic fatigue syndrome/myalgic encephalomyelitis is a disorder that is characterized by overwhelming fatigue, fever, and pain. Multiple sclerosis can cause both nerve and muscular pain, and inflammatory bowel disease can also cause a lot of visceral pain.

Complex regional pain syndrome is probably one of the one painful conditions documented. On the McGill Pain Index, it scores a huge 42 out of 50, which is higher than amputation, childbirth, and cancer.

General Chronic Pain Treatments

The conditions discussed above are by no means the only chronic pain conditions. There are many others, and many other ways to treat and manage chronic pain.

  • Hot and cold packs can help reduce inflammation and soothe sore spots. Massages can work out painful muscles, and you might benefit from seeing a professional as an osteopathic doctor or physiotherapist. Some chronic pain patients report that acupuncture has reduced their pain levels too.
  • Transcutaneous electrical nerve stimulation (TENS). TENS machines are little battery-operated devices that use sticky pads that go on the area of your body that is painful. It then supplies small electrical shocks that help disrupt the pain signals you feel.
  • Lifestyle modifications can also help. Having a good sleep routine has been proven to help with chronic pain, so working on practicing good sleep hygiene is key. Certain foods have been said to help with inflammation, and as your symptoms might be flared by eating particular items, it is best to focus on eating the best diet for you.
  • Focusing on relieving stress through meditation, self-care, and mindfulness has been shown to assist chronic pain warriors with their pain levels. Pacing your activity is another important lifestyle modification to ensure that you don’t get too tired, and can avoid flare-ups.
  • Exercise, appropriate to you, is also a great idea to keep yourself strong. There are all sorts of chair workouts that you can do, plus there are gentle stretches, yoga, and walking. If you find weight-bearing difficult, head over to your local pool for water workouts. It’s a bonus if you can find a heated pool to do it in! Check with your doctor or physiotherapist first to make sure you have a programme that is safe for you to do.
  • Over-the-counter painkillers and NSAIDs can be used to treat chronic pain. It is always good to talk to your doctor to see if prescription painkillers or other prescription medications might be appropriate for you.
  • Depending on your condition, injections might exist to ease your pain. Some examples are epidural steroid injections for back pain, nerve and joint block injections, botox injections for migraines, and corticosteroid (cortisone) injections, which are helpful to act as a strong anti-inflammatory for soft tissue injuries.
  • Talk to your doctor about prescription pain relief. If your pain is more severe, then speak to your physician about medication options for pain relief that might be appropriate for you.
  • Cannabidiol oil (CBD oil) has been shown to help many with pain. CBD is derived from either cannabis or hemp plants but has the THC removed, which is the element that causes the “high” that typically comes from cannabis. That means it can give you the health benefits, without the psychoactive side effects. It is becoming legal in many areas but is not legal in all places, so do check the laws where you live before buying or trying CBD.
  • Other procedures like radiofrequency ablation (RFA) can also help. During RFA, electrical waves create heat in a targeted area, which decreases the pain signals.

If your doctor thinks that surgery is your best chance of achieving less pain, and a better quality of life, then it is worth discussing that option with them.

Is Chronic Pain a Disability?

Living with chronic pain is extremely debilitating. When someone gets hurt, they expect that their pain will have an end date. That their distress will cease after a short period of rest and healing.

This doesn’t happen with chronic pain.

When you live in pain, you find it hard to sleep. You find it difficult to get comfortable. You find yourself fatigued very easily.

The lack of sleep makes your fatigue worse, and your pain levels then get higher. That makes sleep worse, and the cycle continues.

Your pain makes it impossible to carry out daily tasks, and you might struggle to work. After all, your brain is so foggy because of the pain, lack of sleep, and medication that you can’t think straight, or perhaps your job is physical, so you can no longer do it.

Tasks around the home are a problem because of your body no longer worse as well as it used to. You may need adaptive devices because you have lost your grip strength and can’t open bottles or jars. The pain makes to the bedroom feel like climbing a mountain more than climbing a flight of stairs.

Because of your pain, you might have trouble walking. You might even rely on a mobility device. That can make going out full of potential issues. Is the place accessible? Will you have to walk far? Will people be understanding?

What Is a Disability?

The World Health Organisation (WHO) says that a disability is a term for any impairment, activity limitation, or participation restriction.

It notes that it is more than a health issue regarding a cognitive or physical impairment, but that if someone has a problem that prevents them from being able to participate in regular life situations, or limits their activities, then that is considered a disability.

By the definition WHO has given, chronic pain is a disability because the symptoms of chronic pain are disabling. And the symptoms are disabling because they fit all three of the WHO’s criteria.

There Is Hope

Chronic pain is a very complicated issue. It is a long-lasting disability that affects your quality of life.

The causes are vast, the treatments vary, and the only symptom that is constant amongst the different conditions is pain.

The good news though, is that if you are living with chronic pain, that there is hope. There are treatments, and there are ways to you can manage it at home.

The medical field is also working to find more treatments and breakthroughs every year, so even if there isn’t an ideal solution for you now, there is hope that it will come soon.

Resources

EMedicineHealth (Chronic Pain)

NFA (FM Fact Sheet)

SPINE-health (Lower Back Pain Symptoms, Diagnosis, and Treatment)

NHS inform (Arthritis)

The migraine trust (Chronic migraine)

Healthline (Chronic Pain Treatment Options)

World Health Organisation (Disabilities)

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