Diagnosing and Treating Chronic Pain

Chronic pain is an affliction that affects millions of people worldwide, and it often leads to other health problems such as weight gain and mental illness. In some cases, the causes of chronic pain are clear, for example, cancer patients often endure severe chronic pain caused by the illness from which they are suffering. However, in many cases the causes are unclear or sometimes impossible to determine, and unless a definitive diagnosis can be made treatment strategies may be imprecise. With the burden of chronic pain causing many lost work days and having a substantial economic effect, not to mention the personal suffering it causes, there is a growing interest in finding better diagnostic techniques and treatments for the condition.

Defining chronic pain

The definition is simple – pain that continues beyond the acute and subsequent healing stages. For example, a straightforward fracture to a bone would normally cause intense acute pain, followed by six to eight weeks of gradually reducing pain as the injury heals. This is the intended outcome of the body’s pain response; severe pain on injury to alert the brain to deal with the damage, then a period of reduced pain as the body heals, sufficient to make sure you take care of the affected part until healing is complete. This is a pain working for you, even though it may not feel like it at the time! If it didn’t hurt when you damaged yourself, you might carry on with your broken bone, leading to possible infection and serious complications, and at the least improper healing of the fracture that could impair your future mobility. If it didn’t hurt as it was healing, you might be tempted to start using the affected part too soon, leading to further damage and delaying proper healing. If you experience pain that lasts longer than these useful stages that help you protect yourself, then the pain has become chronic. It is no longer serving a purpose that is helpful to you; it is just making your life difficult.

What kinds of conditions typically cause chronic pain?

There are many conditions that can cause chronic pain, which can be loosely classified into one of several groups:

1. Arthritis: Osteoarthritis, caused by deterioration of the surfaces between joints, typically leading to the gnarled fingers and painful hips and knees of your senior years. Rheumatoid arthritis(RA), which can strike at a much younger age and is an auto-immune disease, which means the body is responding to something it perceives to be a threat but is not. This leads to your internal systems mistakenly attacking your own body. RA results in reduced mobility and painful joints all over the body and can be very debilitating.
2. Nervous system: As your nerve endings carry pain signals from the affected part of your body to the brain, any kind of malfunction can cause problems with chronic pain. Examples include peripheral neuropathy, where people experience pain in their extremities because of faulty nerve signals; complex regional pain syndrome, which manifests itself as nerve pain with an undefined cause; fibromyalgia, a condition that causes pain throughout the body; and chronic back and neck pain, often following injury or damage but persisting long after the initial incident.

These are the most widely reported presentations of chronic pain, but there are many other conditions that have a chronic pain component or are associated with chronic pain, so doctors can have a difficult time getting to the root of the problem.

Diagnosing chronic pain

This is an ongoing problem, although diagnostic techniques are being developed and tested continually. Many of the common causes of chronic pain are difficult to attribute to a specific cause, and in the first instance, other possible reasons for the presence of ongoing pain need to be eliminated. If you have pain in any part of your torso, this can involve numerous tests and scans to check the condition of all your internal organs and systems, which can be a time-consuming process. If nothing can be identified after assessment of your internal organs, then there are further tests that can be done for some of the conditions that could be causing the pain.

These include ultrasound, which produces images showing the blood flow in the affected area, electrodiagnostic testing, that test the nerve functions of limbs and face using electrical stimulation, musculoskeletal ultrasonography, which uses ultrasound images to look for causes of muscle, tendon and ligament pain, and thermology, which uses an electronic infrared imaging device to measure the body’s skin temperature and find irregularities that could indicate where the source of the pain is located. It’s also likely that you would be asked to perform certain physical activities so that clinicians can assess your gait, posture, and range of movement.

Treating chronic pain

Reaching a conclusion as to the cause of the pain will enable the most effective treatment to be administered. In many cases, chronic pain is treated with strong painkillers, including opioids. These drugs act in a similar way to morphine, on which they are based, and there is currently an ongoing debate about the overuse and abuse of opioids across the world. They can be very effective in helping patients with chronic pain conditions, but their use does not address the cause of the pain, and if it’s possible to act on the cause the treatment will be far more effective and long-lasting. Acupuncture has been used for millennia in the treatment of pain conditions and can be very effective when correctly administered.

There are a variety of injectable treatments available that are being continually refined to improve their effectiveness, such as nerve blocks that deaden the nerve endings for a short while; steroids; platelet and stem cell injections that aim to stimulate the body to regenerate its tissues; and Botox treatments that weaken or paralyse afflicted overactive muscle tissues. Another treatment that is increasing in popularity is cannabidiol oil, which is extracted from the hemp plant. It can be bought from regulated suppliers like Wellspring CBD, and although it is related to marijuana, it has no psychoactive properties. In an increasing number of places, the use of marijuana for certifiable medical purposes has been decriminalized, so this could be an option, but you would still be subject to the psychoactive effects if you are using marijuana buds or leaves.

Rehabilitation

In many cases, patients need physical and occupational therapies to help them relearn how to use their bodies. When you are experiencing pain, the instinct is to hunch over and protect the affected area. When this becomes habitual, it can lead to poor posture, imbalance, and stiffness, that far from helping the situation will be making the pain worse. Added to this is the problem of muscle deterioration and weakness caused by inactivity – after all, if it hurts to walk, you’ll probably avoid walking when you don’t have to. The problem here is that if your body becomes weak, it is harder to undertake physical activities, and it hurts more when you do move.

The increase in pain levels makes you want to do less and less, but this will be far more harmful than being active. It’s hard to believe when you are in pain, but what you feel when pain becomes chronic is no longer warning you that an area needs protecting; it is like a record stuck in a groove playing the same notes over and over again when there is nothing that needs protecting anymore. By maintaining correct posture, learning to relax your body effectively, and building up your fitness, you will be helping your body to cope far better with the areas of pain. It’s also important to learn ways to manage your pain in your normal life, using aids that can help you with painful or awkward tasks such as unscrewing lids. You can also learn how to bend, stretch and reach for things correctly to avoid extra strain and help you to be independent.

Psychology

The frame of mind you have will be highly influential in your ability to cope with chronic pain. It’s not uncommon for chronic pain sufferers to slip into a depression, which is perfectly understandable when you are suffering what can be an agonizing pain on a constant basis. Understanding why you have the pain is a good start to managing it more effectively because knowledge is power. If you know for a fact that the pain you feel is not doing anything constructive for you, it’s easier to learn to manage it when it does hurt. You can learn not to panic and tense your muscles in anticipation of pain, and thus reduce the physical responses that increase the pain you feel. It’s also a positive experience to feel that you are able to act to help yourself and improve your quality of life, rather than having your existence dominated by your pain.

Simple, accurate diagnoses and a cure for chronic pain are not available as yet, but treatments are improving all the time, and there are a much wider acceptance and understanding of the effects of chronic pain. With research being carried out into the function of pain, physiology, and the causes of pain conditions, the development of treatments continues to advance in the right direction.