About Chronic Pain

Chronic pain is not in your imagination. Real changes take place in the brain to cause chronic pain. Take a brief look at the causes, diagnosis and treatment of chronic pain.

Acute pain is an uncomfortable sensation, such as a burning stinging or an ache. But it has a purpose. The mug is hot, so you withdraw your hand. Your head hurts, so you rest. A pain that comes on rather suddenly warns you of impending injury or reminds you to take care of yourself. On the other hand, chronic pain has no purpose. Chronic pain could be considered a disease in and of itself.

Pain is considered chronic if it lasts for three months or longer. And, it's not just about physical discomfort. Often emotional pain, like depression or low self-esteem, goes hand-in-hand with chronic pain. Chronic pain can also trigger:

  • Sleep problems
  • Disability
  • Trouble walking

What's going on when you have chronic pain?
Nerve signals keep on firing even after the original cause of pain, such as an injury or infection, is healed. Over time, there are permanent changes in the brain and spinal cord where pain signals begin. These changes make new connections between nerves that can create ongoing painful sensations.

What conditions are associated with chronic pain?
Injury, cancer, arthritis. These are commonly linked with chronic pain. Any disease that damages the nervous system, such as diabetes or multiple sclerosis, can cause neurogenic pain. This is a form of chronic pain that is often described as burning or a pins and needles feeling. There is a long list of other conditions that are associated with chronic pain. Some of these are:

  • Back pain, which could come from arthritis of the spine or spinal stenosis
  • Headaches from migraines, cluster or tension headaches
  • Sciatica: nerve pain that results in pain in the buttocks and down a leg

Fibromyalgia, pain in trigger points located within muscles.

The doctor visit for chronic pain
Be prepared to give details about your pain. Tell your doctor when the pain began, what it feels like, how long it lasts and where it occurs. Point to areas on your body where you have pain. Pain is a unique experience for everyone. Common ways to describe pain may include:

  • Sharp or dull
  • Burning
  • Shooting, as in down an arm or leg
  • Pins and needles

Your doctor may do a neurological examination to figure out if there is a problem that starts in the brain or spinal cord. The exam tests muscle strength, reflexes and sensation. But, no single test can measure the intensity of your pain. Diagnosing the cause of chronic pain is a many-stepped process.

Imaging tests including a CT or MRI may be done to look for diseases of the brain, spinal cord or other parts of the body. Your doctor may do electrodiagnostic procedures, such as:

  • Electromyography (EMG). Thin needles are inserted into a muscle. You contract the muscle and the doctor looks at signals on the EMG machine to determine the muscle's ability to respond to nerves.
  • Nerve conduction studies. Adhesive patches with electrodes are placed on the skin. A small electrical impulse is sent to a nerve and you feel a slight shock. Nerve signal speed is then measured. Abnormal results indicate some kind of nerve damage.

How is chronic pain treated?
Chronic pain is often resistant to a single type of treatment. A combination of medications and therapies often work the best.

  • Drug treatments:
    • Pain relievers. These common stand-bys include aspirin, acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs or NSAIDs such as ibuprofen or naproxen. But sometimes these pain relievers are not enough to control pain. Aspirin should not be taken by anyone under 20 years of age because of the risk of a serious condition called Reye's syndrome. NSAIDs may not be right for you if you have a history of ulcers or kidney or liver disease or take certain other medicines. Ask your doctor what over-the-counter pain reliever is right for you.
    • Opioid drugs. These drugs, such as morphine and codeine, are very strong and can be addicting. If prescribed, they are carefully monitored.
    • Antidepressants and anti-seizure medication. Certain types of these drugs are effective against chronic pain.
  • Non-drug treatments include:
    • Physical therapy. This involves physical techniques, such as manipulation and exercise to help restore your ability to move and perform daily functions.
    • Acupuncture. This treatment is an ancient Chinese healing technique that uses tiny needles inserted under the skin in precise locations.  
    • Biofeedback. This is often used for chronic headache and back pain. In biofeedback you become aware of a bodily function, such as heart rate, skin temperature or  muscle tension through the use of an electronic device. Then you learn to control how your body responds and translate that response to help control pain.
    • Chiropractic care. This is often used for neck or back pain. This is a hands-on approach that uses manipulation to address structural problems that may be contributing to chronic pain.

What is the goal of treatment?
Treatment may not eliminate chronic pain completely. The goal then may be to alleviate the pain enough so that you can live a normal, productive life.