Chronic pain

Chronic pain is typically defined as unrelenting pain that lasts longer than three months or longer than expected after an injury or acute (abrupt or sudden) disease.


Understanding chronic pain
The nervous system senses, communicates and interprets pain. For example, pain tells you to pull your hand away from a hot stove. Chronic pain is different, however. Constant and continual pain signals shoot through the nervous system for weeks, months or even years. There may be no evidence of harm or damage. The pain typically sets in gradually.
Although features of chronic pain can vary from one person to another, the condition often leads to the "terrible triad" -- suffering, sleeplessness and sadness. Pain becomes the focus of life. The person's energy is drained. Relationships suffer, moods change, and restful sleep is interrupted. Bodily functions, such as digestion, urination and bowel movements, may be affected. Eventually, the pain can become overwhelming. The person may try anything to ease the pain, including repeated surgeries.

Some people may begin to depend on medications or seek treatment from questionable sources. Because all aspects of life are affected by chronic pain, it may become difficult to cope with daily life.


Causes/associated factors
Many factors may contribute to chronic pain. For example:
Medical conditions such as arthritis, cancer and migraine headaches are often to blame.

Fibromyalgia (a condition characterized by aches, pain and stiffness in the joints and muscles) and diabetic neuropathy (irritation or damage to nerves from diabetes) may have the same effect.

In the case of shingles (an infection that produces stabbing pain and a rash), pain may continue long after the rash is gone.

Many people live with chronic lower back or facial nerve pain.

Signs/symptoms
People who have chronic pain often have a pattern of pain problems. Again, the pain may develop after an injury but last longer or be more severe than expected. Sleep patterns and moods may be disturbed. In some cases, chronic pain leads to sexual dysfunction. The pain often interferes with job performance and daily living. People who have chronic pain may appear depressed and be unable to imagine a time when pain won't affect their lives.

Diagnosis
Diagnosis is based on careful analysis of your medical history and a thorough physical exam, which may include an evaluation of joints, skin and deep muscles, as well as a search for points on your body that are tender to the touch. To help determine the extent of the problem, the doctor will review your eating and sleeping patterns, moods and daily living activities.

Treatment
Depending on the type of pain, treatment may involve one or more of the following methods.
Medication: Tricyclic antidepressants, typically prescribed for depression, also have an analgesic effect even in people who aren't depressed. The pain relief is often noticed more quickly and at a lower dose than what's needed for the antidepressive effect. Anticonvulsants may help by blocking the spontaneous activity of nerve cells with especially fine fibers, which may ease chronic pain in certain cases. Opioids are usually prescribed for those who have chronic pain caused by cancer.

Psychotherapy: Psychoanalysis (a method of remembering and understanding prior emotional experiences) may help you learn to deal with any psychological issues causing the pain. Individual or group counseling may be recommended.

Relaxation therapy: With relaxation therapy, you learn to relax tense muscles, decrease anxiety levels and improve your outlook.

Hypnosis: Hypnosis increases your susceptibility to suggestion, which may help you deal with chronic pain.

Biofeedback: With biofeedback, you learn to control certain bodily activities (such as heart and breathing rate and muscle tension) through imagery or another form of deep concentration.

Behavior modification: Behavior modification involves changing habits, behaviors and attitudes that may continue the cycle of chronic pain.

Acupuncture: With acupuncture, a practitioner places fine needles along various points of your body to help relieve pain.

Electrical stimulation: With local electrical stimulation, brief pulses of electricity are applied to the skin over the painful area. Transcutaneous nerve stimulation (TENS) involves wearing a battery pack about the size of a beeper that sends a weak electrical current to the skin. This blocks pain impulses in the nerve endings and may help relieve pain.

Brain stimulation: Electrical stimulation in the brain is usually reserved for people who have advanced-stage cancer. An external transmitter beams electronic signals to a receiver under the skin that's connected to a series of electrodes in the brain. You control the amount of electricity used to stimulate the brain to decrease pain.

Placebos: About 35 percent of people given placebo (inactive or "fake") medications, such as sugar pills or saltwater injections, experience pain relief. The placebo tricks the brain into thinking a "real" treatment has been received.

Nerve block: A nerve block is a special medication injected near a nerve to stop sensations of pain.

Surgery: Procedures used to cut the nerve fibers that send messages of pain from the body to the brain or block the connections at junctions in pain pathways in the brain or spinal cord are helpful for some people. Sometimes, destroying nerves can stop chronic pain.

Pain management clinics: At pain clinics, a group of specialists typically reviews your medical history. More tests may also be done. A personalized treatment plan may include psychotherapy, biofeedback, exercise, diet, ice massage, electrical stimulation or the use of various medications to treat pain. The goals of treatment are to decrease the need for pain medication and help you resume more normal activities.

Treatment usually involves more than one visit, with additional follow-up visits to evaluate the treatment's long-term effectiveness.


Complications
When left untreated, chronic pain can have many negative effects.
Your career, appetite, sleep, relationships, physical activity, emotional well-being and overall health can all suffer.

Depression is another common complication of chronic pain. If you have chronic pain and become depressed, remember treatment is available.

Appropriate use of medication for chronic pain is vital. Drug dependence is a risk of certain pain relievers, but this can usually be avoided by the proper choice and dosage of medication.

Pregnancy-specific information
Chronic pain isn't generally considered a pregnancy-related condition. Discuss any specific concerns with your doctor.

Senior-specific information
Older adults face a higher risk of chronic pain because they're more likely to have medical conditions that can result in chronic pain. If you're experiencing pain of any kind, consult your doctor.

Prevention
The best defense against chronic pain is to seek prompt medical attention for any pain that lasts longer than you think it should. Early intervention may help prevent complications that can develop with chronic pain.