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Chronic Pain: Johns Hopkins Symptoms and Remedies

Chronic Pain

What Is Chronic Pain

Chronic pain is a syndrome involving either ongoing pain that lasts beyond the resolution of an injury or pain that recurs as a result of a long-standing condition. The common sources of chronic pain are damage or inflammation affecting joints (arthalgia or arthritis), muscles (myalgia or myositis), and/or nerves (neuralgia or neuropathy). Pain syndromes related to joint injury include osteoarthritis, which is the most common cause of chronic joint pain, and rheumatoid arthritis, which occurs when the body's own defense mechanism attacks the joints. Pain related to nerve injury includes postherpetic neuralgia, the vexing pain that may follow shingles; tic douloureux (trigeminal neuralgia), a condition that involves intense facial pain; diabetic neuropathy, which results in painful feet; and phantom limb or post-amputation pain, which may occur following the removal of a limb.

Because the organs inside the body dont have pain fibers like the joints, skin, or muscles, organ damage may be signaled by a chronic, aching, or ill-defined discomfort. This is referred to as visceral pain. Inflammation or cancer of an organ (for example, the liver, kidney, or bowel) can cause chronic visceral pain.

Another type of chronic pain, psychogenic or psychophysiological pain, is not related to an injury or illness. People with psychogenic pain have real dis-comfort, but no source of pain can be identified or the level of discomfort exceeds any possible cause. Fibromyalgia and chronic headache may fall into this pain category.

Chronic pain is an often debilitating condition affecting an estimated 86 million Americans. Along with unrelenting or recurrent pain, sufferers may experience depression, anxiety, and sleep disturbances. Untreated, chronic pain can disrupt family life and interfere with daily functioning. Most chronic pain, however, can be greatly eased with proper pain management-though patients with chronic pain may undergo several different treatment options before finding an approach that provides relief . Pain clinics-centers that provide a multidisciplinary treatment approach-may be the best treatment option for those with inadequately controlled chronic pain.

Symptoms of Chronic Pain

• Persistent, debilitating pain is the common feature of pain syndromes. The location and type of the pain depends on the nature of the injury (when present).
• Depression.
• Anxiety
• Sleep disturbances
• Impaired social functioning

What Causes Chronic Pain

• Pain linked to a muscle, bone, or joint is typically caused by damage or injury to tissue that activates nerve endings called nociceptors, which respond by transmitting pain signals to the brain. Nociceptive pain is usually localized, constant, and often has an aching or throbbing quality. Visceral pain stemming from damage to an internal organ is a subtype of nociceptive pain.
• Neuropathic pain-the type that includes neuralgias, phantom limb pain, and peripheral neuropathies (such as that caused by diabetes)-may also involve tissue damage initially, but the pain persists as a result of an injury or malfunction in the peripheral or central nervous system.
• The cause of psychogenic pain isn't known.

Prevention of Chronic Pain

• Early treatment may help prevent worsening of symptoms.

Diagnosis of Chronic Pain

• Patient history and physical exam are necessary to determine the degree of pain (on a scale of 1 to 10, for instance), to identify a possible source of pain, and to uncover the degree of impairment.
• Chronic pain is diagnosed when pain lasts for at least a month beyond what would be expected from the illness or injury; when pain recurs on and off for at least three months; and when pain accompanies a long-standing condition.
• Imaging studies and blood work can help identify the cause of pain.

How To Treat Chronic Pain

• A number of medical and nondrug therapies are available for treating chronic pain. Patients with chronic pain may be referred to a pain clinic, where clinicians take a multidisciplinary approach, prescribing a variety of methods to meet an individual's pain management needs.
• Over-the-counter pain relievers, which include acetaminophen, and the nonsteroidal anti-inflammatory drugs (NSAIDS) aspirin, ibuprofen, ketoprofen, and naproxen sodium, are commonly used to treat chronic pain. NSAIDS are most useful when pain involves an inflammatory component; if inflammation is not present, acetaminophen is preferred.
• Tricyclic antidepressants may be prescribed to treat the neuropathic pain associated with postherpetic neuralgia, diabetic neuropathy, phantom limb pain, and central pain (which follows a stroke). These anti-depressants are effective even in the absence of depression.
• Anticonvulsant medications, commonly used to treat seizures, may be prescribed for pain associated with trigeminal neuralgia, postherpetic neuralgia, neuroma, diabetic neuropathy, multiple sclerosis, and migraines.
• Antiarrhythmics, medications commonly used to treat heart arrhythmias, may be prescribed to treat diabetic neuropathy and central pain.
• Topical anesthetics and capsaicin may be helpful for patients with diabetic neuropathy, postherpetic neuralgia, or neuroma pain.
• Opioids, such as oxycodone, fentanyl, and morphine, may be prescribed for intractable pain.Because of concerns regarding addiction, ongoing opioid use for the treatment of chronic pain is controversial. Although the potential for abuse exists, it is actually very rare among chronic pain patients who don't have a previous history of addiction. Nevertheless, according to the American Pain Society, opioids should only be used to treat chronic pain if therapy is shown to increase level of functioning. Simple relief from pain may not justify ongoing treatment with opioids.
• Hot and cold applications can provide temporary relief for muscle and joint conditions.
• As adjunct therapy, exercise can help keep the joints and connective tissue strong and limber, improve sleep, and fight depression. Exercise may also reduce the need for pain relievers.
• Electrical stimulation, including transcutaneous electrical stimulation (TENS) and spinal cord stimulation, involves the delivery of brief electrical pulses to the nerve endings to provide pain relief.
• Acupuncture, the insertion of tiny needles into key points of the body, may be beneficial for those with osteoarthritis, headache, and low back pain.
• Cognitive and behavior therapy sessions teach patients skills to cope with pain and may help relieve the anxiety that accompanies chronic pain.
• Stress management techniques, such as relaxation therapy, biofeedback, and self-hypnosis, help patients learn to influence their physical response to pain.