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Health Library : Physical Medicine and Rehabilitation

 

Chronic Pain

What is pain?

Pain is an unpleasant feeling that lets you know that something may be wrong. It is one of the body's warning signals that indicates a problem that needs attention. Pain starts in receptor nerve cells located beneath the skin and in organs throughout the body. When there is an illness, injury, or other type of problem, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the message to the brain. Pain medications work by reducing or blocking these messages before they reach the brain.

Pain can be anything from a slight nuisance, such as a mild headache, to something excruciating and emergent, such as the chest pain that accompanies a heart attack, or pain of kidney stones. Pain can be acute, meaning new, subacute, lasting for a few weeks or months, and chronic, when it lasts for more than three months.

Chronic pain has been said to be the most costly health problem in U.S. Increased medical expenses, lost income, lost productivity, compensation payments, and legal charges are some of the negative economic consequences of chronic pain. Consider the following:

  • Low back pain is one of the most significant health problems. Back pain is the most frequent cause of activity limitation in people younger than 45 years old.
  • Cancer pain affects the majority of patients in intermediate or advanced stages of cancer.
  • Arthritis pain affects nearly 50 million Americans each year.
  • Headaches, according to the National Institute of Neurological Disorders and Stroke, affect millions of U.S. adults. The three most common types of chronic headaches are migraines, cluster headaches, and tension headaches.
  • Other pain disorders, such as the neuralgias and neuropathies that affect nerves throughout the body, pain due to damage to the central nervous system (the brain and spinal cord), as well as pain where no physical cause can be found--psychogenic pain--increase the total number of reported cases.

What are the different types of pain?

Two types of pain include the following:

  • Acute pain. This pain may come from inflammation, tissue damage, injury, illness, or recent surgery and is of short duration, usually lasting less than a week or two. It usually ends after the underlying cause is treated or has been resolved.
  • Chronic pain. Pain that persists for months or even years.

What is chronic pain?

Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be intermittent or continuous. It may affect people to the point that they cannot work, eat properly, participate in physical activity, or enjoy life.

Chronic pain is considered a major medical condition that can and should be treated.

What causes chronic pain?

There are many causes of chronic pain. It may have started from an illness or accident, from which a person has long since recovered, but pain remained. Or there may be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic pain in the absence of any past injury or evidence of illness.

What is the "terrible triad?"

When pain becomes such a problem that it interferes with life's work and normal activities, a person may become the victim of a vicious circle. Pain may cause a person to become preoccupied with the pain, depressed, and irritable. Depression and irritability often leads to insomnia and weariness, leading to more irritability, depression, and pain. This state is called the "terrible triad" of suffering, sleeplessness, and sadness. The urge to stop the pain can make some people drug-dependent, and may drive others to have repeated surgeries, or resort to questionable treatments. The situation can often be as hard on the family as it is on the person suffering with the pain.

Treatment for chronic pain

Chronic pain involves all aspects of a person's life; therefore, the most effective treatment includes not only relief of symptoms, but also other types of support. A multidisciplinary approach to pain management can often provide the needed interventions to help manage the pain. Pain management programs are usually conducted on an outpatient basis. Many skilled professionals are part of the pain management rehabilitation team, including any or all of the following:

  • Neurologists/neurosurgeons
  • Orthopaedists/orthopaedic surgeons
  • Anesthesiologists
  • Oncologists
  • Physiatrists
  • Nurses
  • Physical therapists
  • Occupational therapists
  • Psychologists/psychiatrists
  • Social workers
  • Case managers
  • Vocational counselors

Special pain programs are located in many hospitals, rehabilitation facilities, and pain clinics.

The pain management rehabilitation program

The pain management rehabilitation program is designed to meet the needs of the individual patient, depending on the specific type of pain, disease, or condition. Active involvement of the patient and family is vital to the success of the program.

The goal of pain management programs is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life--physically, emotionally and socially. Pain management techniques assist in reducing the suffering experienced by a person with chronic pain.

In order to help reach these goals, pain management programs may include the following:

  • Medical management of chronic pain, including medication management:
    • Over-the-counter (OTC) medications may include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and/or acetaminophen.
    • Prescription pain medications may be needed to provide stronger pain relief than aspirin, including narcotics. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse and may have unpleasant side effects.
    • Prescription antidepressants can benefit some patients because these medications can increase the supply of a naturally produced neurotransmitter, serotonin. Serotonin has been found to be an important part of a pain-controlling pathway in the brain.
  • Heat and cold treatments to reduce the stiffness and pain, especially with joint disorders such as arthritis
  • Physical and occupational therapy interventions, such as massage and whirlpool treatments
  • Exercise to reduce spasticity, joint contractures, joint inflammations, spinal alignment problems, or muscle atrophy (weakening and shrinking) to prevent further problems
  • Local electrical stimulation involving application(s) of brief pulses of electricity to nerve endings under the skin to provide pain relief in some chronic pain patients
  • Nerve blocks and regional anesthesia
  • Emotional and psychological support for pain, which may include the following:
    • Psychotherapy and group therapy
    • Stress management
    • Relaxation training
    • Meditation
    • Hypnosis
    • Biofeedback
    • Behavior modification
    • Assertiveness training

    The philosophy common to all of these varied psychological approaches is the belief that patients can do something on their own to control their pain, including changing attitudes, the perception of being a victim, feelings, or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to pain.
  • Patient and family education and counseling
  • Alternative medicine and therapy treatments, as appropriate

In addition, treatment may include:

  • Surgery. Surgery may be considered for chronic pain. Surgery can bring release from pain, but may also destroy other sensations as well, or become the source of new pain. Relief is not necessarily permanent, and pain may return. There are a variety of operations to relieve pain. Consult your doctor for more information.
  • Acupuncture. Acupuncture is a 2000-year-old Chinese technique of inserting fine needles under the skin at selected points in the body, and has shown some promise in the treatment of chronic pain. Needles are manipulated by the practitioner to produce pain relief.

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