If you asked a chronic pain sufferer to list a few words that describe what life with constant pain is like, the words “misery” and “torment” would be high on the list.
As many as 90 million Americans suffer from chronic pain; its estimated annual cost in the United States alone is as much as $100 billion in healthcare expenditures and lost productivity. Its toll on quality of life is incalculable.
“Although formerly defined as pain that lasts 6 months or longer, chronic pain is better defined as any pain that lasts longer than 1 month after the injury that precipitates it, pain that occurs over several months, or pain that occurs from an injury, disease, or condition that’s not expected to heal,” says Dr. Russell Portenoy, chairman of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City.
Pain that goes untreated or uncontrolled for long periods of time has a significant impact on everyday life. It affects your ability to get around, to sleep, to work, to play, to have personal and sexual relationships. It causes or contributes to feelings of depression, anger, anxiety, hopelessness, and even thoughts of suicide.
A February 1999 survey conducted for the American Pain Society, the American Academy of Pain Medicine, and Janssen Pharmaceutica reported that more than 40% of patients with moderate to severe chronic pain had yet to find relief.
More than 50% surveyed had been in pain for longer than 5 years and all surveyed described their pain as being a 5 or higher on a scale of 1-10, with 10 being “the worst pain imaginable.” The survey also found that nearly half of the patients had switched physicians at least once and almost a quarter had switched three or more times seeking better pain management.
From Acute Pain to Chronic Pain
Chronic pain often follows the acute pain resulting from injury or disease. For reasons not fully understood, pain messages sent by the nerves after trauma sometimes continue long after the initial source of the pain has healed. Because of this, pain specialists recommend that patients act quickly and aggressively to alleviate acute pain.
Early, aggressive treatment may short-circuit the pain cycle before it becomes an established pattern that is difficult to break. Aggressive treatment of acute injury and pain is always helpful, says Dr. Portenoy, but, “We still don’t really understand which patients go on to suffer from chronic pain and why.”
Two Pain Types
Pain can be divided into two categories: nociceptive and neuropathic. According to Dr. Edgar Ross, director of the Brigham and Women’s Hospital Pain Management Center in Boston, chronic nociceptive pain is the most common–it’s pain from muscle or bone injuries. It is sometimes referred to, more simply, as “mechanical pain” or “pain on movement.” It can last for months or years when damaged tissues don’t heal properly and inflammation becomes chronic. Arthritis pain and most back pain are nociceptive.
Chronic neuropathic pain is caused by damage to the peripheral nerves or by other changes in the peripheral or central nervous system. The nervous system sends pain signals to the brain even when there is no longer any recognizable tissue or nerve damage. This pain can be experienced as stabbing, aching, tingling, or burning, and it can last for months or years.
Although there are now many more treatments for neuropathic pain than there were in the past, successful management of neuropathic pain continues to be a challenge for pain specialists.
Common Chronic Pain Syndromes
Chronic low back pain. This is the most common noncancer-related chronic pain condition seen by pain specialists. Pain specialists also see large numbers of patients suffering from chronic headache, fibromyalgia, and pain from the various neuropathies. It is the single largest cause of lost workdays and lost income due to illness and is responsible for more than a quarter of all workers’ compensation claims. Most cases result from sprains or strains of the muscles and ligaments, while others may be due to disk problems.
Chronic headaches. According to the National Headache Foundation, more than 45 million Americans suffer from chronic, recurring headaches. These headaches include migraines (agonizingly painful, throbbing, vascular headaches) and tension-type headaches (usually characterized by feelings of pressure, tightening, and muscle contraction).
Fibromyalgia. This is a syndrome characterized by pain throughout the body as well as some specific musculoskeletal tenderness. Researchers are still not sure what causes it although theories include nerve dysfunction, muscle abnormalities, and a combination of the two. While anxiety and depression often occur with fibromyalgia, many researchers now think that anxiety and depression are a result of the condition–not the cause.
Here are a few common neuropathic pain syndromes seen by pain specialists:
* Postherpetic neuralgia–pain following a case of shingles.
* Diabetic neuropathy–foot and leg pain and burning associated with diabetes.
* Complex regional pain syndrome (or reflex sympathetic dystrophy)–this usually develops after a tissue or nerve injury and causes continuous pain, abnormally extreme pain reactions, and swelling.
* Trigeminal Neuralgia (also known as tic douloureux)–a disorder of the trigeminal nerve that causes intense, stabbing, electric shock-like pain in the face.
Ironically, according to Dr. Portenoy, the patients who rarely seek treatment from pain specialists are those with the most common pain problem in the United States–chronic pain from joint problems and arthritis.
According to the Arthritis Foundation, nearly 43 million Americans suffer from arthritis. A large percentage of those with arthritis suffer daily pain, stiffness, and difficulty in getting around.
Most chronic pain patients can be helped, according to Dr. Ross. He says that as many as 90% of patients who seek help at pain centers achieve pain reduction and improvement in function. He emphasizes that success in the treatment of chronic pain is defined by the ability of the patient to return to “regular life.” That, he says, is a goal both primary care physicians and pain specialists can help patients achieve.
Article By: Shari Lampert, Medical Writer