Chronic Pain

What is chronic pain?

Chronic pain is pain that prevents you from being able to do your normal activities without some level of discomfort. Chronic pain may be off and on, or it may be constant. It can be from an injury, illness, or other medical condition, such as arthritis.

How does it occur?

An injury, illness, or condition that causes pain may, in some cases, cause permanent changes to the nervous system. These changes cause the nerves to continue to create the feeling of pain, even though the injury or condition has healed. The body's response to a painful injury or illness can lead to your feeling pain more easily or more intensely than you did before your injury or illness. Physical contacts that didn't cause pain before, such as simple touching, may now cause pain in the area where you are having chronic pain. The area of pain may go beyond the area first affected by the injury or illness.

Chronic pain also occurs with emotional problems. You may have had these emotional problems before the injury or illness, or you may have them because of your physical problems. In either case, if you are anxious or depressed you may feel pain more intensely.

How is it diagnosed?

First your health care provider will check to see that the chronic pain is not caused by a new problem or a new complication of a previous injury or illness. Your provider will examine the painful area.

Your health care provider will ask about the history of the pain. It is very helpful if you keep track of:

• where it hurts
• when it hurts, how long it hurts, and if it is off and on or constant
• what kind of pain it is: for example, if it is sharp, dull, burning, or stabbing, or if it is a feeling of pressure
• how bad it is, for example, on a scale of 1 to 10, with 10 being the worst
• what makes it better and what makes it worse.

An important part of the diagnosis and treatment of chronic pain is determining how much the pain hinders your lifestyle, whether at home, at work, or during recreation.

How is it treated?

The treatment of chronic pain varies, depending on how long it's lasted and how disabling it is. Most chronic pain treatment involves a team of health care providers.

A psychologist, counselor, nurse, or your doctor will check your emotional health. If you have anxiety or depression, these problems need to be treated to help you control the chronic pain. The treatment may include counseling, medicine, or both.

A physical therapist may check your ability to use the painful part of your body. The therapist may help you stretch and strengthen that area. He or she may also use techniques, such as ultrasound, to help reduce the pain. You may have treatment first at the therapist's office or the gym and then be given home exercises to do on your own.

Your physical therapist may recommend a nerve stimulator, called a TENS unit. TENS relieves pain by sending small electrical impulses to your nerves through electrodes placed on the skin. The electrical impulses block pain.

An occupational therapist (OT) specializes in helping people do everyday chores and tasks. Often these are tasks we take for granted, such as dressing, eating, cooking, and going to the bathroom. The OT can help you learn different ways of doing these tasks, so that they are easier and less painful. This may allow you to be more independent and to need less help from others. The OT may recommend bathroom or shower equipment, or a couple of simple tools for the kitchen.

Your health care provider or physical therapist may recommend other treatments such as:

• heat
• cold
• water therapy in swimming pools, hot tubs, or whirlpools
• massage
• acupuncture
• hypnosis
• biofeedback
• meditation.

Your health care provider will probably recommend or prescribe medicine to help with the pain. This may be nonprescription pain medicine or stronger painkillers that need a prescription. Among the nonprescription medicines are acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs such as ibuprofen should be used with caution. They can cause side effects such as bleeding and stomach ulcers.

Narcotics such as hydrocodone, oxycodone, and morphine are sometimes prescribed to manage chronic pain, but only after other medicines and nondrug treatments are tried. Narcotics can be addicting. However, people using these drugs for pain usually do not become dependent on them if they use the drugs as prescribed.

Your health care provider may prescribe medicines usually used to treat epilepsy or depression. Some of these medicines have been shown to decrease chronic pain, even if you don't have epilepsy or depression. Steroids and sedatives are also sometimes used to control chronic pain.

Often, a combination of drug types works best and must be tailored to your particular pain problem.

An important part of treatment is making sure that your family and friends understand that the pain you feel is real and that all these ways to treat the pain are valuable.

There may be other options if you are following your treatment plan and the pain has not gotten any better. In this case, ask your health care provider if injections of medicine into the nerve to numb the pain, or surgery to cut the nerve(s) causing the pain, might be helpful.

You will have regular visits with your health care provider for checks on how well your treatment is working. Some health care providers may ask you to sign a form agreeing to follow all aspects of your treatment plan. Each time you visit, you will report on how well each component of your treatment is working. You will probably also need to grade your pain at each visit, so your health care provider will know whether you are improving.

How long will the effects last?

Your treatment may not get rid of the pain completely. But it should allow you to participate in and enjoy life more than you could before treatment. If you carefully follow all aspects of your treatment program, the pain may gradually go away over many weeks or months.

How can I prevent chronic pain?

The only way to try to prevent chronic pain is to treat pain caused by illness or injury promptly. This might prevent the changes to the nervous system that are thought to cause chronic pain.