Article Highlights
- Pain consists of nerve signals that blaze from any part of the body through the nervous system to the brain.
- Chronic pain is persistent pain that keeps recurring, or pain that lasts for 12 weeks or longer.
- Lower back pain is considered the single leading cause of disability worldwide.
- Pain can be mitigated using medications, medical procedures, and lifestyle adaptations.
Overview
There are hundreds of ways you can feel pain, from stubbing your index finger to cutting yourself while slicing vegetables. Like stress, pain is with us from the day we are born, and it remains with us like a faithful companion up to our last day on earth. As newborns, it is the pain of hunger, or of lack of warmth, that instinctively propels us to cry out in search of remedies.
Pain – and chronic pain- is a very personal and subjective experience, each one of us feeling it in our own individual way. And while some of us tolerate pain better than others, it is safe to assume that none of us are particularly enamored with it. Yet pain is vital for our existential safety, for imagine what would happen to you without pain if you dipped your foot into boiling water, or placed a hand on a hot stove. Sudden pain flashes an alert that triggers an instant and reflexive reaction, courtesy of your nervous system, and it prevents you from further injury.
Alternatively, pain can point to a source that needs attention, like a twisted ankle or a burgeoning headache. Or it can be:
- Steady and chronic pain, as with some diseases like fibromyalgia and cancer
- Sharp pain, like when you break a bone or pass a kidney stone
- A constant and throbbing sensation with chronic pain, like when you have a migraine
- Pulsating, such as when you have a raw tooth
- Or acutely incapacitating, such as with symptoms of appendicitis
Here are some of the more clinical descriptions for the pain that you may feel:
- Achy
- Tender
- Dull
- Thud
- Stiff
- Stabbing
- Shooting
- Burning
- Throbbing
And while there is no cure for pain, it can be mitigated through various different means that include lifestyle adaptations, physical therapy, pain medications, medical procedures, and psychotherapy.
What Is Chronic Pain?
Chronic pain is the most widespread reason that sends us to the doctor. It is thought that approximately 1.5 billion people around the world suffer from chronic pain, and more than 100 million people are believed to be living with chronic pain in the U.S., for the most part relying on pain medication for treatment.
Whereas acute pain of the type we have already mentioned warns us of potential injury, chronic pain is pain that keeps recurring, or one that persists for a long period of time. Clinically, it is usually defined as lasting for three months of longer. Lower back pain, for example, can be unremitting and chronic, and like various other types of chronic pain, it is usually resistant to medical interventions. It can generally only be alleviated with medications and other treatment techniques like therapeutic massage, acupuncture, and physical therapy.
What Causes Chronic Pain?
Chronic pain can result from acute pain (e.g. breaking a hip). Or it can come about on its own, when there’s been no injury or obvious cause, for example after an illness. The following are common causes of chronic pain:
- Cancer
- Sciatica, spondylosis, or other forms of nerve compression
- Pain from nerve damage (neuropathy)
- Pain from emotional distress (psychogenic pain)
- MS (multiple sclerosis)
- TMJ (joint dysfunction)
- Post-trauma or post-surgical conditions
- Inflammation
- Lupus
- Migraine
- Arthritis
Pain may also be the result of underlying health conditions, including:
- Chronic fatigue syndrome: severe, sustained weariness often accompanied by pain
- Fibromyalgia: hard to discern generalized pain mostly affecting muscle groups and bones
- Inflammatory bowel disease: chronic inflammation in the gastrointestinal tract
- Interstitial cystitis: a bladder pressure disorder
- Temporomandibular joint dysfunction: painful clicking or locking of the jaw
- Vulvodynia: chronic and difficult to diagnose vulva pain
Types of Chronic Pain
There are various types of chronic pain, as follows:
Nociceptive Pain
This is the most prevalent type of pain and is triggered when nociceptors around the body detect damaging or dangerous stimuli. Nociceptors are sometimes called “pain receptors”, as they play a critical role in how we experience and react to pain. They are sensitive receptors, and, once they detect harmful stimuli, they transmit messages through the nervous system to the brain. They alert the brain that there’s a problem that requires your attention. Nociceptive pain is commonly described as aching or throbbing pain, such as in fibromyalgia, headaches, and arthritis.
Neuropathic Pain
This type of pain is associated with damage to the neurons in the body. It can happen when nerves are not functioning optimally and they transmit incorrect pain signals to the central nervous system and brain. The type of pain generated is often described as shooting pain. Examples might include:
- Phantom limb pain (following an amputation)
- Sciatica (irritation in the sciatic nerve)
- Diabetic neuropathy (damage to the peripheral nervous system)
- Post-mastectomy pain (pain disorder following breast cancer surgery)
Somatic Pain
This is often referred to as “tissue pain”, or “skin pain”, or “muscle pain”, since those are the areas where sensory nerves detect the pain. This is what you feel when for example you cut your skin, stretch a muscle, or fall and hurt yourself.
Visceral Pain
This is also a type of nociceptive pain, referring to pain spotted by sensitive nerves in internal organs (such as in the thoracic, pelvic, or abdominal viscera organs). It is frequently described as generalized pain caused by firmness around the organs, and it is also known to radiate to other areas, making it hard to accurately locate and diagnose. An example is pain in the heart that is felt in the left arm and neck.
Psychogenic Pain
Some pain disorders are associated with psychological issues such as strong emotions, fears, depression, distress, and obsessive thought patterns or behaviors. When severe enough, they can cause pain that is accompanied by fatigue and muscle aches. Psychogenic pain symptoms can include:
- Headache
- Muscle pain
- Back pain
- Knee and joint pain
- Stomach pain
- And other pains
Treatment for psychogenic pain includes various medications, including opioids, antidepressants, as well as psychotherapy.
Idiopathic Pain
This is also referred to as pain of unknown origin as it has no identifiable cause. While the roots of this type of pain are not detectable, it is nevertheless real and prevalent among people who had a prior pain disorder such as fibromyalgia or cancer.
An example of persistent idiopathic pain would be facial pain in the form of burning pain in the face with no identifiable nerve or tissue damage.
Managing Pain with Medications
There are almost more drug medications for pain, both over the counter and prescription drugs, than there are types or causes of pain. Here is a brief description of medications doctors may prescribe to patients for pain:
NSAIDS
Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to patients to alleviate the symptoms of pain. These are pain suppressant drugs that function by way of a chemical process in which they block the effects of Cox 1 and Cox 2. Those are special enzymes that help produce prostaglandins, which in turn cause inflammation that results in pain. Examples are Celebrex, Motrin, Advil (ibuprofen), Indocin and several other medications. Long-term use of NSAIDS may cause gastrointestinal ulcers, and may slightly raise the risk of heart attack.
ANTIDEPRESSANTS
Some medications found to be effective for chronic pain are drugs developed to treat other conditions. These are called adjuvant analgesics. Antidepressants, for example, are effective treatments for pain caused by arthritis, nerve damage and neuropathy, tension headaches, migraines, facial pain, fibromyalgia, low back pain, and pelvic pain. It is not fully understood how these drugs help with pain, but they may increase neurotransmitters in the spinal cord that reduce pain signals. It is important to note that antidepressants don’t work right away – they may take a few weeks to help. There are several different types of anti-depressants, but it has been found that tricyclic antidepressants are most effective for pain. Examples include Amitriptyline, Imipramine (Tofranil), Clomipramine (Anafranil), Doxepin, Nortriptyline (Pamelor), and Desipramine (Norpramin). However other classes of antidepressants (e.g. SNRIs, SSRIs) have fewer side effects and may also be used to relieve chronic pain.
ANTI-ANXIETY SSRIs
Selective Serotonin Reuptake Inhibitors (SSRIs), are a relatively new class of anti-depressant and anti-anxiety medication, usually prescribed in pain management techniques together with psychotherapy. SSRIs are commonly used drugs for the treatment of Generalized Anxiety Disorder (GAD) as well as various other anxiety and phobia disorders, but they can also be helpful for pain. SSRIs generally don’t work as well as tricyclic antidepressants for pain management, but they often produce fewer side effects.
Examples of common SSRIs include Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox), Escitalopram oxalate (Lexapro), and Citalopram (Celexa).
ANTI-SEIZURE MEDICATIONS
The Food and Drug Administration (FDA) has approved only a few anti-seizure drugs, or anticonvulsants, for the treatment of chronic pain. While the main purpose of anticonvulsants is to prevent seizures, they also seem to be effective at treating certain kinds of chronic pain. In particular, they may be helpful for neuropathic pain, such as peripheral neuropathy, and chronic headaches like migraines. Commonly used anti-seizure medications for pain treatment include Carbamazepine (Tegretol) for trigeminal neuralgia, diabetic neuropathy pain and postherpic neuralgia, Gabapentin (Neurontin) for postherpetic neuralgia, or shingles pain, and diabetic neuropathy, and Pregabalin (Lyrica) for postherpic neuralgia and diabetic neuropathy.
CORTICOSTEROIDS
Corticosteroid drugs reduce spontaneous discharge in an injured nerve, which can alleviate neuropathic pain. Prednisone or prednisolone are often used for pain relief although the most commonly prescribed corticosteroid for pain is Dexamethasone. However, corticosteroids can have a number of side effects (including high blood pressure, memory and mood problems, and weight gain), so check with your doctor to see whether the benefits might outweigh the risks.
PRESCRIPTION OPIOIDS
When used appropriately, opioids (such as Percocet or Dilaudid) can be very effective for the treatment of some types of chronic pain. They may be less effective for certain types of pain, however, such as nerve pain. For pain that is consistent and lasts throughout the day and night, physicians may recommend a long acting opioid. Potential side effects of opioids can include constipation, drowsiness, and nausea. Additionally, you should be aware that opioids can be addictive, and the United States is currently facing a growing opioid overdose-related epidemic. The CDC suggests that opioids can be an effective solution for pain management in the short term, but we do not know enough about the long-term benefits considering the potential risks for abuse and overdose.
Treating Chronic Pain Without Medications
For various reasons, including the risk of opioid addiction and overdose mentioned above or other drug side effects, individuals may wish to pursue a non-pharmacological form of pain management. Or they may wish to combine medication with other alternative treatments. There are several options individuals with chronic pain might find helpful:
COGNITIVE-BEHAVIORAL THERAPY (CBT)
Contingency Management and Cognitive Behavioral Therapy (CBT) are behavioral pain management treatments designed to help modify the person’s expectations and behaviors related to pain, to increase skills in coping with various life stressors, to help restore normal brain function, and to improve overall health. Psychotherapy treatments such as cognitive-behavioral therapy (CBT) have shown relatively good results, especially when applied in concert with medication.
PHYSICAL THERAPY
When applied correctly, physical therapy can be a highly beneficial part of a pain management program. Physical therapists have at their disposal various possible treatments and techniques such as electrical stimulation, muscle-release techniques, heat, ultrasound, to aid your back muscles and soft tissues for pain relief. Physical therapy typically aims at boosting flexibility and improving posture by strengthening back and abdominal muscles. By providing pain relief and enhancing flexibility, this pain management technique has also been known to improve overall health.
EXERCISE
If you have back or joint pain, there will be times when all you want to do is lie in bed all day. However, research has shown that exercise (when applied in the appropriate frequency, duration, and intensity) can significantly improve pain and pain-related symptoms. Physical activity also improves general health, reduces disease risk, and helps slow the progression of chronic illnesses such as heart disease, type 2 diabetes, and obesity. While there is not a specific criteria on the amount of physical activity that is beneficial for chronic pain, the research suggests that frequent movement is better than being sedentary or inactive. Physical activity should be tailored to the abilities and needs of the individual with chronic pain.
OTHER PAIN-RELIEVING OPTIONS
Here is a short list of other options that might be necessary or helpful to mitigate pain:
- Surgery
- Cortisone injections
- Stretching
- Chiropractic care
- Massage and manipulation
- Losing weight (if overweight)
- Acupuncture
- Yoga, meditation and other relaxation techniques
- Cold and hot therapy
Final Thoughts
We aren’t ever guaranteed lives without pain, and we can usually tolerate a little pain and still function relatively well. But when pain becomes debilitating and interferes with our ability to be happy and carry on with our daily lives, then the pain needs to be addressed.
Multimodal therapy, or treatment that involves multiple types of intervention, may be most effective for the management of chronic pain. You may want to incoporate physical activity, medication, cognitive behavioral therapy, and psychoeducation in your pain management plan. The more knowledgeable and informed you are about your pain and your treatment options, the better off you will be.
References
- https://www.mayoclinic.org/pain-medications/art-20045647
- https://www.verywellhealth.com/anti-seizure-medications-for-chronic-pain-2564494
- https://www.asra.com/page/46/treatment-options-for-chronic-pain
- https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf
- https://www.mayoclinic.org/steroids/art-20045692
- https://stanfordhealthcare.org/medical-conditions/pain/pain/treatments/non-pharmacological-pain-management.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534717/