Pain Disorders - Chronic Pain

Chronic Pain Statistics

Chronic pain has been said to be the most costly health problem in America. Estimated annual costs, including direct medical expenses, lost income, lost productivity, compensation payments, and legal charges, are close to $50 billion.

> Low back pain - Fifteen percent of the adult US population have had persistent low back pain at some time in their lives. Five million Americans are partially disabled by back problems, and another 2 million are so severely disabled they cannot work. Low back pain accounts for 93 million workdays lost every year and costs over $5 billion in the health care.

> Cancer pain - The majority of patients in intermediate or advanced stages of cancer suffer moderate to severe pain. More than 800,000 new cases of cancer are diagnosed each year in the US, and some 430,000 people die.

> Arthritis pain - Affects 20 million Americans and costs over $4 billion in lost income, productivity, and health care.

> Headache - At least 40 million Americans suffer chronic, recurrent headaches and spend $4 billion a year on medications. Migraine sufferers alone account for 65 million workdays lost annually.

> Other pain disorders like the neuralgias and neuropathies that affect nerves throughout the body, pain due to damage to the central nervous system (the brain and spinal cord), as well as pain where no physical cause can be found -- psychogenic pain -- increase the total number of reported cases.

Source: National Institute of Neurological Disorders
and Stroke

Chronic Pain

What are the different types of pain?
Two primary types of pain are:

acute pain - may be generated by inflammation, tissue damage, injury, illness, or recent surgery and is often characterized by:

pain

redness

increased local temperature

swelling

Acute pain usually ends after the underlying cause is treated or has been resolved.

chronic pain - pain that persists for weeks, months, or even years.

What is chronic pain?
Chronic pain is defined as pain that overwhelms all other symptoms and may become the problem. It may affect people so that often they cannot work, lose their appetites, and physical activity of any kind is exhausting and aggravates the pain.

Chronic pain is considered a major medical condition that can and should be treated accordingly.

What causes chronic pain?
Chronic pain may have started from an initial illness or accident, from which a person has long since recovered, or there may be an ongoing cause of pain, such as arthritis or cancer.

Many people suffer from chronic pain in the absence of any past injury or evidence of illness. The most common type of chronic pain is from an abnormal function in the nervous system. Neuropathic pain refers to pain that can arise when there is abnormal function in the peripheral nervous system.

What is the "terrible triad"?
An individual may become the victim of a vicious circle -- when an individual becomes preoccupied with pain, he/she may become depressed, and irritable. This depression and irritability often leads to insomnia and weariness, which compounds the problem by causing more irritability, depression, and pain. This state is called the "terrible triad" of suffering, sleeplessness, and sadness.

The urge to stop the pain can make some people drug dependent, and may drive others to have repeated surgeries, or resort to questionable treatments.

Treatment for chronic pain:
Chronic pain involves all aspects of a person's life, therefore, the most effective treatment includes not only relief of symptoms, but other types of support. Management of pain may include the involvement of several different specialists, including:

neurologists
neurosurgeons
physical therapists
occupational therapists
anesthesiologists
psychologists
psychiatrists
other health care providers

Special pain programs are located in many hospitals, rehabilitation facilities, and pain clinics.

Specific treatment will be determined by your physician(s) based on:

your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

Medical treatments for chronic pain include:

Over-the-counter (OTC) medications (usually labeled for use for 7 to 10 days):

aspirin

nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, and ketoprofen

acetaminophen

Heat and cold treatments can reduce the stiffness and pain, particularly of arthritis.

Cold packs numb the sore area and are especially good for severe joint pain and swelling.

Heat treatments relax muscles -- dry heat methods, such as a heating pad or heat lamp, or moist heat methods, such as a bath or hydrocollator pack.

Prescription pain medications usually can provide stronger pain relief than aspirin, including the opiate-related compounds. When used wisely, however, they are important recruits in the chemical fight against pain. However, all these drugs have some potential for abuse, and may have unpleasant and even harmful side effects. In combination with other medications or alcohol, some can be dangerous.

Prescription antidepressants can benefit some patients who report that pain relief happens before any uplift in mood, a result that specialists think happens because the antidepressant increases the supply of a naturally produced neurotransmitter, serotonin. Now scientists have evidence that cells using serotonin are also an integral part of a pain-controlling pathway in the brain.

Local electrical stimulation, the application of brief pulses of electricity to nerve endings under the skin can provide pain relief in some chronic pain patients. This procedure is called transcutaneous electrical nerve stimulation (TENS), and is applied to the skin near where the pain is felt.

Brain stimulation is another type of electrical stimulation that is mainly used for controlling pain that is widespread and severe. After the electrodes are surgically implanted in the brain, the patient controls the delivery of electrical stimulations by operating an external transmitter.

Psychological treatment for pain may range from:

psychoanalysis and other forms of psychotherapy

relaxation training

meditation

hypnosis

biofeedback

behavior modification

The philosophy common to all these varied psychological approaches is the belief that patients can do something on their own to control their pain. That something may mean changing attitudes, feelings, or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to the present painful predicament.

Surgery may be considered for chronic pain. Surgery can bring release from pain, but may also destroy other sensations as well, or become the source of new pain. Relief is not necessarily permanent, and pain may return. There are a variety of operations to relieve pain.

Acupuncture, a 2000-year-old Chinese technique of inserting fine needles under the skin at selected points in the body, has shown some promise in the treatment of chronic pain. Needles are manipulated by the practitioner to produce pain relief.

Research is continually being conducted on the brain and nervous system in order to increase the understanding, diagnosis, and treatment of chronic pain.

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