Chronic Pain:
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What is Chronic Pain?

Chronic Pain is a Chronic illness and is one of the most common medical problems in the world; it not only causes millions of Britons to suffer terribly on a daily basis, negatively impacting on their quality of life, it also affects the country's economy as well; the exact cost of Chronic Pain is unknown; however, the cost of back pain alone, to the exchequer, is estimated to be over £5billion per annum and this doesn't take into account any other placement of Chronic Pain.

Pain can be described as an unpleasant sensory and emotional experience, a symptom of illness or injury in the part of your body that is having the pain and is associated with actual, potential or perceived tissue damage; the sudden onset of pain is called Acute pain and is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, it gets your attention and prompts you to take action to prevent further worsening of the condition causing the pain; this could be a simple reflex action such as making you jerk your hand off a hot stove, or it could be more complex such as getting you to cool, rest, or elevate an injured ankle, or the pain could even prompt you to see a doctor; pain is the body's way off letting you know that something is wrong.

Chronic Pain however, is different, it persists and pain signals keep on firing in the nervous system for days, weeks, months and sometimes even years; in medical terms, the distinction between Acute and Chronic Pain has traditionally been determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 and 6 months since onset, though some theorists and researchers have placed the transition from acute to Chronic Pain at 12 months; others apply acute to pain that lasts less than 30 days, subacute to pain that lasts from 1 to 6 months and chronic to pain of more than 6 months duration; a popular alternative definition of Chronic Pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."

Pain normally starts with an initial mishap such as a an injury, a serious infection, a joint pain, a sprained back or a whiplash; there may even be an ongoing cause of pain such as arthritis, cancer or an ear infection; once the cause of your pain has been found and properly treated, the pain may still serve as a useful function of keeping you at rest until the injury or illness has healed, but if the pain comes from an illness that is incurable and will never heal, the pain loses its usefulness and instead becomes harmful; this type of pain keeps you from normal activity and inactivity decreases your strength; some people even suffer from pain in the absence of any past injury or evidence of any bodily damage, making it harder to treat.

With constant pain there is a 'Wind-Up Phenomenon' that causes untreated pain to get worse; the nerve fibers transmitting the painful impulses to the brain become trained to deliver pain signals better than they did; just like Muscles getting better at sports with training, the nerves become more effective at sending pain signals to the brain; the intensity of the signals can also increase over and above what is needed to get your attention; to make matters even worse, the brain becomes more sensitive to the pain, so your pain feels much worse even though your injury or illness is not getting any worse; at this point, the pain may be termed as Chronic Pain and the pain is no longer useful as a sign of illness or injury.

General Somatic Pain - From the Outer Body:

Pains from your skin and Muscles are easily localised by the brain because these pains are common; you will have experienced general somatic pain since childhood when you have fallen or been hit by a person or an object; normally, somatic pain gets better in a few days; though, some people develop pain that never goes away, Fibromyalgia and Chronic Back Pain are in this category.

General somatic pain is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Naprosyn) or with acetaminophen (Tylenol); sometimes, opioids, such as morphine, may be needed.

Visceral Pain - From the Internal Organs:

Pain in your internal organs is more difficult for you to pinpoint because your brain doesn't get much experience feeling pain from internal organs; the connections from pain sensors in your internal organs to your brain are less sophisticated than the nerve connections from your outer body; you will have experienced some visceral pains such as acid indigestion or constipation; these pains are easily treated and get better quickly, either on their own or with treatment using non-prescription medicines.

However, the pain from chronic pancreatitis, an inflammation of the pancreas, or chronic active hepatitis, an inflammation of the liver, can last a long time and be difficult to treat; visceral pain from gallstones or appendicitis, for example, can be treated with surgery; other visceral pains can be treated with various non-opioid pain medications; although, opioids are sometimes needed.

Bone Pain:

Pain in the Bones from a bruise or a fracture is temporary, but pain from bone cancer, osteoporosis, softening of the bones that often appears in older people, osteomyelitis, an infection in a bone, or arthritis, inflammation of the joints, can last a long time and bone pain is gnawing and throbbing; if you suffer from this, you may need long term pain treatment.

Bone pain may be treated with hormonal therapy or with bisphosphonates, such as alendronate (Fosamax), which strengthen the Bones; the NSAIDs, such as ibuprofen are often used and sometimes opioids are needed.

Muscle Spasms - Cramps:

Muscle spasm, like a Charley Horse, can cause severe pain especially in the back; pain medication alone may not be able to cure the pain, so muscle relaxants such as cyclobenzaprine (Flexeril), or baclofen (Lioresal) may be needed to relax the muscles.

Peripheral Neuropathy - Pain arising in the Nerves leading from the Head, Face, Trunk, or Extremities to the Spinal Cord:

In a sense, all pain comes from nerves because the nerves transmit painful impulses to the brain, but some painful impulses do not arise from the nerve endings that normally sense injury or illness; some painful impulses come from irritation to the nerve along its length instead of at the nerve ending; Sciatica, for example, is caused by pinching of the sciatic nerve, which goes from the leg to the spine; the pinching often takes place near the lower part of the spine, but the brain thinks the pain comes from the nerve endings in the leg because the sciatic nerve usually transmits feelings from the leg.

Other examples of illnesses that cause peripheral neuropathy or 'Nerve Pain' are ruptured discs in the spine, which pinch nerves; cancers that grow into nerves and cause irritation, or infections, such as shingles, which can cause irritation to nerves.

Common diseases that often cause peripheral neuropathy are Diabetes and AIDS; nerve pain can feel like a painful pins and needles sensation; this kind of nerve pain can be treated with tricyclic antidepressants; other, more severe nerve pain can be described as a sharp, stabbing, electric feeling and Anticonvulsants, medicines that treat seizures, are used for this kind of nerve pain; some nerve pain is due to the loss of a limb; the arm or leg that has been lost feels like it's still present and hurts severely; this kind of nerve pain, called deafferentation, or 'Phantom Limb Pain', can be treated with clonidine (Catapres), a blood pressure medicine that also relieves nerve pain; Herpes zoster (shingles) causes an infection of the nerve endings and of the skin near the nerve endings; local application of Capsaicin, an over-the-counter pain medication in the form of an ointment, is sometimes helpful for this; in addition, opioids may be needed.

Circulatory Problems:

Poor circulation is often a cause of Chronic Pain and is usually caused by Tobacco use, smoking, sniffing or chewing, Diabetes, or various autoimmune diseases, diseases where the body makes antibodies that fight against itself, such as lupus or rheumatoid arthritis; partial blockage of arteries by fatty deposits called plaques is also a common cause of poor circulation; the reason for the pain from poor circulation is that the part of the body that does not get good blood circulation becomes short of oxygen and nourishment and the lack of oxygen and nutrition causes damage to that part of the body and the damage causes pain.

Pain from poor circulation may be treated by surgery to bypass the clogged arteries with artificial arteries in order to improve the blood circulation; sometimes this is not possible and blood thinners or opioids may be needed to control the pain instead; another common cause of poor circulation is reflex sympathetic dystrophy (RSD); this is a problem of both circulation and nerve transmission because painful nerve transmissions cause the blood vessels to get narrower; the narrowing prevents enough oxygen and nourishment from getting to the part of the body that is affected; RSD can sometimes be treated with a surgical sympathectomy, an operation to stop the nerve impulses from causing a narrowing of the blood vessels; non-opioid medication, either with or without surgery, is needed; though in some cases opioids are also needed.

Headaches:

Headaches can be caused by many illnesses and there are several types of headaches, including migraine, tension and cluster headaches; headaches can also result from sinusitis, trigeminal neuralgia, giant cell arteritis or brain tumors; the treatment of the various kinds of headaches varies depending on the kind of headache and the severity of the pain; non-opioid medicines are used, but, in some cases, opioid therapy is needed also.

Migraines are often on one side of the head; they can be associated with nausea and vomiting, photophobia, where light hurts the eyes, phonophobia, where sound hurts the ears and scintillating scotomata, parallel lines that vibrate at the edges of objects, especially at the borders between light and dark places; sometimes these auras appear before the headache starts and alerts you to the fact that a migraine is coming; migraine pain can vary in intensity from mild to severe; there are many specific medications for migraine, Sumatriptan (Imitrex) is particularly useful for some, but not all, migraine sufferers.

Cluster headaches come in groups, sometimes several times a day, lasting from days to weeks; many cluster headaches are severely painful; oxygen therapy may be helpful for some cluster headaches; Sinusitis can cause facial pain and is frequently worse in the morning; this type of sinus pain may respond to antibiotic treatment along with decongestants, but sometimes sinus surgery is needed; Trigeminal neuralgia is actually a peripheral neuropathy, nerve pain, that is severe; it occurs on one side of the head and face and has a trigger point, usually on the side of the face, which causes intense pain if it is touched; Anticonvulsants, antiseizure medicines, are often helpful for this type of pain.

Chronic Pain:

Chronic Pain can be mild or excruciating, episodic or continuous, described as shooting, burning, aching, or electrical and be merely inconvenient or totally incapacitating; common Chronic Pain complaints include Headaches, pain in the Back, Neck, Pelvis and Shoulder; illness related pain such as Arthritis pain, Cancer pain, Carpal Tunnel Syndrome, Sinus pain and Tendinitis; Neurogenic pain, resulting from damage to the peripheral nerves or to the central nervous system itself and even Psychogenic pain, which is not due to any past disease or injury or any visible sign of damage inside or outside of the nervous system.

A person may even have two or more co-existing Chronic Pain conditions; such conditions can include Chronic Fatigue Syndrome, Endometriosis, Fibromyalgia, Inflammatory Bowel Disease, Interstitial Cystitis, Temporomandibular Joint Dysfunction and Vulvodynia.

Chronic Pain can take both a physical and emotional toll on a person through Anger, Anxiety, Depression, Fatigue, Fear, Irritability, Sadness, Sleeplessness and Stress; they interact in complex ways with Chronic Pain and may decrease the body's production of natural painkillers; moreover, such negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain for the sufferer; even the body's most basic defenses may be compromised because there is considerable evidence that unrelenting pain can suppress the immune system.

Two types of Chronic Pain are Neuralgia, which is an extremely painful Chronic Pain condition, consisting of recurrent episodes of intense shooting or stabbing pain along the course of the nerve and Causalgia, another extremely painful Chronic Pain condition, consisting of recurrent episodes of severe burning pain and Phantom Limb Pains, which are the feelings of pain in a limb that is no longer there and has no functioning nerves.

Chronic Pain may be divided into Nociceptive Pain and Neuropathic Pain:

Nociceptive Pain may be divided into Superficial and Deep, and Deep pain into Deep Somatic and Visceral; Superficial pain is initiated by the activation of Nociceptors in the skin or superficial tissues; Deep Somatic pain is initiated by the stimulation of Nociceptors in ligaments, Tendons, Bones, blood vessels, fasciae and Muscles and is a dull, aching, poorly localised pain; visceral pain originates in the viscera (organs) and may be well localised, but it is often extremely difficult to locate and several visceral regions produce referred pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.

Neuropathic Pain is divided into Peripheral, originating in the peripheral nervous system and Central, originating in the brain or spinal cord; Peripheral Neuropathic Pain is often described as burning, tingling, electrical, stabbing or like pins and needles.

Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon; this induces pathological changes that lower the threshold for pain signals to be transmitted; in addition it may generate Nonnociceptive nerve fibers to respond to pain signals; Nonnociceptive nerve fibers may also be able to generate and transmit pain signals; in Chronic Pain this process is difficult to reverse or eradicate once established.

Chronic Pain of different etiologies has been characterised as a disease affecting brain structure and function; Magnetic Resonance Imaging studies have shown abnormal anatomical and functional connectivity, even during rest involving areas related to the processing of pain; also, persistent pain has been shown to cause Grey Matter loss, which is reversible once the pain has resolved.

What is Grey Matter?

Grey Matter, or gray matter, is a major component of the central nervous system, consisting of neuronal cell bodies, Neuropil, Glial Cells and capillaries; the Grey matter contains neural cell bodies, in contrast to white matter, which does not and mostly contains myelinated axon tracts.

The colour difference arises mainly from the whiteness of myelin; in living tissue, grey matter actually has a grey brown colour, which comes from capillary blood vessels and neuronal cell bodies; Grey Matter includes regions of the brain involved in Muscle control, sensory perception such as seeing and hearing, memory, emotion, and speech.


Pain Management:

Complete and sustained remission of many Neuropathies and most Idiopathic Chronic Pain is rarely achieved because it is difficult to treat what you do not fully understand; however, much can be done to reduce thesuffering and to improve the quality of life.

Pain management, also called pain medicine, is that branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain; the typical pain management team includes medical practitioners, pain specialists, clinical psychologists, physiotherapists, occupational therapists and nurse practitioners; acute pain usually resolves with the efforts of one practitioner; however, the management of Chronic Pain frequently requires the coordinated efforts of the treatment team.

Pain is Targeted with the aid of 4 Types of Medication known as:

Peripherally Active Analgesics, which work at the periphery level such as Aspirin.
Centrally Active Analgesics, which are narcotics that bind to the opiate receptors in the brain such as Codeine, Morphine & Heroin.
Local Analgesics, which can be injected into the site of injury or applied topically such as Novocaine.
Indirectly Acting Drugs, which affect non-pain conditions such as emotions that can exacerbate the pain experience.

Psychological Pain Control Methods:

Using medication is not the only way to reduce pain, psychological methods work just as well on some patients and without the side effects of medication, methods such as Biofeedback, which provides biophysiological feedback to the patient about some bodily process the patient is unaware of such as Muscle tension; Systematic Relaxation of the large muscle groups in order to reduce tension, Hypnosis, which uses relaxation, suggestion and distraction to alter the perception of pain.

Acupuncture, an alternative medicine methodology originating in ancient China, is another way of reducing pain; acupuncture is used to treat patients by manipulating thin, solid needles which have been inserted into acupuncture points in the skin; according to traditional Chinese medicine, stimulating these points can correct imbalances in the flow of qi through channels known as meridians; however, scientific research has not found any histological or physiological correlates for qi, meridians and acupuncture points and some contemporary practitioners needle the body without using the traditional theoretical framework.

Chronic Pain Cycle:

Substance Abuse is highly prevalent in some segments of the Chronic Pain population such as those with Chronic Headache, because without the pain relief the Increased pain leads to Anxiety, which leads to Sleeping Problems and Insomnia, which leads to Not Being Able To Cope, which causes tension that leads to Increased Pain; it is a vicious circle.

Chronic Pain may also contribute to a Decreased Physical Activity due to the Fear of exacerbating pain; some investigators have argued that it is this Neuroticism that causes Acute Pain to turn Chronic, but clinical evidence points the other way, to Chronic Pain causing Neuroticism; when long term pain is relieved by Therapeutic Intervention, scores on the Neurotic Triad and Anxiety fall, often to normal levels; self-esteem, often low in Chronic Pain patients, also shows striking improvement once pain has resolved.

Most Chronic Pain patients complain of Cognitive Impairment, such as Forgetfulness, Difficulty with Attention and Difficulty Completing Tasks; objective testing has found that people in Chronic Pain tend to experience Impairment in Attention, Memory, Mental Flexibility, Speed in Executing Structured Tasks, Speed of Response in a Cognitive Task and Verbal Ability.


Chronic Pain Sufferers:

Speak with most doctors and they will say that Chronic Pain is a symptom of an underlying problem and that if you treat the problem the pain will either recede, or go away, but for a staggering number of people, the pain never does go away; it is estimated that a staggering 40% of Britons suffer from some sort of Chronic Pain; 1 in 4 suffer from debilitating lower back pain alone and it is estimated that almost 5% of those who suffer from Chronic Pain have attempted suicide.

Everyone has pain at some time but no one can fully understand the extent and personal cost of having Chronic Pain except the sufferers; as the pain becomes prolonged many sufferers feel hopeless, frustrated and angry and they start to withdraw from the world and a viscous circle of pain and depession begins.

Without the correct treatment, normal pain in muscles and joints can quickly develop into chronic and life long pain; in fact it is estimated that 7 out of 10 mothers of newborns and toddlers develop chronic lower back, hip and shoulder pain due to the physical demands of looking after their children; left untreated, the pain can turn into some form of Arthritis or Fibromyalgia, which is Chronic Pain in the joints and muscles.

Most people live silently with Chronic Pain because they feel that thereís nothing else that they can do besides take possibly harmful prescription drugs just to get through a normal day and their quality of life, relationships and work suffer and they simply canít do the things that they used to be able to do, or just want to do with suffering from pain.

Sleepless Nights Due To Pain:

Aches and pains can cause anyone a sleepless night now and again; it doesn't take much, a pulled muscle from over exercising, or a morning spent re-arranging furniture; the next thing you know, you're lying in bed at 2am staring at the ceiling, aching and hoping for sleep; whilst most aches and pains from these types of exertion fade away with time, painful and sleepless nights can be the norm for people living with Chronic Pain; over half of Chronic Pain sufferers say that they don't sleep well and wake up feeling like they've not been to bed.

Living with long term Chronic Pain is a challenge; it not only affects your sleep, but like a stone thrown in a pond, the pain causes ripples throughout your everydaylife as well, it can affect your mood, mobility, self-confidence, relationships and social life; during a normal night's sleep, you should go through the light sleep, deep sleep and REM, Rapid Eye Movement, sleep cycles, which are normally repeated at least 3 times a night and getting enough deep sleep and REM sleep are essential if you are to feel refreshed by the morning.

The problem is that Chronic Pain interferes with this sleep cycle; a sudden severe pain can make you bolt upright from a sound sleep, but even less severe pain can cause micro-arousals; these are periods when your pain interferes with the sleep cycles, forcing you into the light sleep stage and even though you may not become conscious and won't remember waking up, you will not benefit from the deep sleep and REM sleep cycles, making you feel tired and as if you haven't been to bed.

The main pains that interfere with your sleep are back pain, TMJ pain, which is pain in the TemporoMandibular joint of the Jaw; aArthritis; fFibromyalgia, which can cause pain throughout the body's Muscles, Ligaments and Tendons; Neuropathy or nerve pain; premenstrual cramps; acute injuries; surgery and serious diseases such as Cancer.

It's not just the intensity of the pain that can make it difficult to sleep, variable pain, where it is worse some times than others, is often the most likely to cause sleeplessness; if you have constant pain for months, even years, you learn to live with it, to a point, but if the pain level varies and if it's unpredictable, there is no way you can get used to it and it can seriously interfere with sleep.

Is There Any Treatment?

Because of the mind and body links associated with Chronic Pain, effective treatment requires addressing Psychological as well as Physical aspects of the condition and forms of treatment include Acupuncture, Behaviour Modification, Biofeedback, Brain Stimulation, Deep Injections, Local Electrical Stimulation, Medications, Placebos, Psychotherapy as well as Surgery.

Clinical investigators have tested Chronic Pain patients and found that they often have lower than normal levels of Endorphins in their Spinal Fluid; investigations of Acupuncture include wiring the needles to stimulate nerve endings electrically (Electroacupuncture), which some researchers believe activates Endorphin systems; other experiments with Acupuncture have shown that there are higher levels of Endorphins in Cerebrospinal Fluid following Acupuncture.

Endorphins, The Natural Pain and Stress Fighters:

Endorphins are amongst the brain chemicals known as neurotransmitters, which function to transmit electrical signals within the nervous system; at least 20 types of endorphins have been demonstrated in humans and can be found in the pituitary gland, other parts of the brain and distributed throughout the nervous system.

Exercise, Pain and Stress are the most Common Factors leading to the Release of Endorphins:

Endorphins interact with the opiate receptors in the brain to reduce our perception of pain and act similarly to drugs such as morphine and codeine; in contrast to the opiate drugs, however, activation of the opiate receptors by the body's endorphins does not lead to addiction or dependence.

In addition to a decreased feelings of pain, the secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones and enhancement of the immune response; with high endorphin levels, we feel less pain and fewer negative effects of stress.

Endorphins have been suggested as modulators of the so called Runner's High that athletes achieve with prolonged exercise; whilst the role of endorphins and other compounds as potential triggers of this euphoric response have been debated extensively by doctors and scientists, it is at least well known that the body does produce endorphins in response to prolonged, continuous exercise; however, endorphin release varies amongst individuals, which means that two people who exercise at the same level or suffer the same degree of pain will not necessarily produce similar levels of endorphins.

Certain foods, such as chocolate or chili peppers, can also lead to enhanced secretion of endorphins; in the case of chili peppers, the spicier the pepper, the more endorphins are secreted; the release of endorphins upon ingestion of chocolate likely explains the comforting feelings that many people associate with this food and the craving for chocolate in times of stress.

Even if you don't participate in strenuous athletics, you can try various activities to increase your body's endorphin levels; studies of acupuncture and massage therapy have shown that both of these techniques can stimulate endorphin secretion and believe it, or not, sex is also a potent trigger for endorphin release; finally, the practice of meditation can increase the amount of endorphins released in your body.

Having Sex Not Only Releases Endorphins, It Burns Calories As Well:

You may already know that sex burns calories, or at least you may assume it, but do you know just how many calories it does burn? Obviously it also depends on how strenous the sex is and how healthy you are, but having sex can burn around 5 or 6 calories per minute, which adds up to around 300 calories per hour, that's the equivalent of a brisk jog, so it's worth having long slow sex; to further put that into perspective, that's approximately 3 times as many calories per hour as you would burn by just standing or sitting.

Apart from the pleasure of having sex, one of the reasons that you feel so good and happy after sex is because sex releases large amounts of endorphins and endorphins are natures best antidepressant, and best of all our bodies produce an endless amount of them, an endorphin rush can also keep you in an elated mood for quite some time; it is likely that you will feel on a high for several hours after having good sex and the endorphin rush that sex creates will also relieve pain and stress as well as helping you to sleep better.


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