What is chronic pain?
Chronic pain is characterized by pain signals being transmitted and, in many cases, being amplified for weeks, months, and even years.
Chronic pain is usually defined as pain lasting longer than three months. Others characterize it as pain persisting longer than reasonably expected for whatever injury is involved.
What causes chronic pain?
Chronic pain is prevalent and affects about 100 million in the U.S., and is seen more often in women. Chronic pain can be an enigma due to its complicated natural history, vague etiology, and poor response to treatment.
Chronic pain is commonly rooted in musculoskeletal, neurologic, urologic, gastrointestinal, or reproductive disorders. It also has associations with psychological disorders such as major depression, conversion disorder, hypochondriasis, and somatization disorder. Common areas for chronic pain are joints, back, head, neck, shoulders, and the pelvis
The pain can be mild, moderate, or severe. It can be unceasing or sporadic. It can also be mildly irritating to severely disabling.
Symptoms associated with chronic pain include fatigue, difficulty sleeping, suppression of the immune system, avoidance of activity, and disability. Also mood changes such as depression, fear, hopelessness, irritability, stress, and anxiety can be linked to chronic pain.
- Physical therapy: Physical therapy (PT) techniques utilize modalities such as hot or cold therapy, stretching, positioning, massage, traction, ultrasound therapy, manipulation, and transcutaneous electrical nerve stimulation (TENS).
- Acupuncture: Acupuncture is thought of as an alternative therapy for chronic pain. It involves inserting thin needles into the skin at agreed upon strategic locations.
- Nerve blocks: Nerve blocks, especially in a sympathetic nervous system distribution, are effective therapeutic tools. This procedure involves the injection of an anesthetic and a corticosteroid near nerves that are responsible for the chronic pain. This treatment serves to block pain signaling and reduce inflammation.
- Spinal cord stimulation: Spinal cord stimulation is another option and requires the implantation of a stimulator device that emits electrical impulses that override pain signaling. Intrathecal morphine pumps require the implantation of a pump that delivers medication.
- Radiofrequency ablation: Radiofrequency ablation is minimally invasive and uses heat to deal with affected nerve tissue. In this procedure, an electrode is inserted and used to deliver an electrical current to create highly localized heat that causes impairment to or destroys nerve tissue, thus disrupting pain signals.
- Adhesiolysis: Adhesiolysis is another treatment option that is especially helpful for chronic neck and back pain. It involves the use of medications to destroy adhesions, or scar tissue, that may be irritating nerve roots and causing pain.
- Vertebroplasty and kyphoplasty: Vertebroplasty and kyphoplasty help treat chronic back pain attributed to spinal compression fractures. These fractures occur most often in people with osteoporosis (thinning and weakening of bone). Both are safe and effective procedures. Vertebroplasty requires the injection of special cement into the affected areas of the spine, which restores and strengthens the spinal column.
- Steroid injections: Steroid injections, cervical and epidural, can also provide long-term relief of pain in some. They may be repeated for a total of no greater than three times in a period of 12 months.
Medications are a cornerstone of treating chronic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) that have been used for the treatment of chronic pain include ibuprofen (Advil, Motrin), naproxen sodium (Naprosyn, Anaprox), diclofenac (Voltaren, Cataflam XR), indomethacin (Indocin), and ketoprofen. These medications act to reduce inflammation, thereby reducing pain.