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Chronic Pain
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Resource Description: 
The National Pain Foundation is a non-profit organization. Much of the information on this site is presented in an interactive way to encourage patients to take an active role in the management of their chronic pain. The My Pain section includes a Personal Inventory section to help pain patients identify the information they need to manage their pain in the most understandable way.
This site is primarily for medical professionals, but includes information on research programs of interest to pain sufferers.
The American Chronic Pain Association (ACPA) was founded in 1980. Its roots are from one small support group that grew to many. The site includes an article on "Ten Steps From Patient to Person" and a catalog of ACPA self-help materials. ACPA support groups are active across the country.
American Pain Foundation is an independent nonprofit organization. The site includes a pain information library, online forum, resource locator and a wealth of how-to information and resources.
The CFIDS Association of America is dedicated to conquering chronic fatigue and immune dysfunction syndrome (CFIDS), also known as chronic fatigue syndrome (CFS), myalgic encephalomyelitis (M.E.) and many other names. The site includes a comprehensive section for youth and a wealth of information for adults.
This site includes and "Ask the Pain Doctors" section, pain assessment tools, and a comprehensive pain library in addition to standard information about chronic pain.
The National Fibromyalgia Association (NFA) is a nonprofit organization. The site includes coping strategies, information about disability, nutrition and diet and more.
Episode number: 
312

It's a shocking statistic.  More than 50 million Americans suffer chronic pain severe enough to interfere with their performance of daily activities.  That means they are either partially or completely disabled.

Pain comes in many forms and the terms patients use to describe pain are often different because it is subjective.  No two people experience pain alike.  It can range from mild and tolerable to severe and intolerable.  It can be sharp or aching, throbbing or burning.

Chronic pain is continuous pain that persists for more than 3 months, and beyond the time of normal healing. It can last for months or years – and, as horrible as it sounds, even for a lifetime.  It can interfere with an individual's sleep, productivity, and quality of life. 

The cause of chronic pain can be the result of an initial acute injury, such as a sprain, or disease such as a serious infection.  It can occur as a consequence of a chronic condition, like arthritis. However, a cause is not always evident. 

Although most pain can be relieved or greatly eased with proper pain management, most pain goes untreated, under treated, or improperly treated.  In fact, only an estimated 1 in 4 of those with chronic pain receive proper treatment meaning millions of people suffer needlessly, unaware of effective pain management options.
People with chronic pain can be helped, and while the issue hasn't received the attention it deserves in the past, the environment is changing.  A U.S. government Congressional Mandate has declared 2000 - 2010 as the Decade of Pain Control and Research.  Many health care professionals are now recognizing that pain is complex and multidimensional and that patients with chronic pain require careful evaluation and a varied treatment strategy. 


Quick Facts

  • Over 50 million Americans experience chronic pain that interferes with daily living activities and nearly 25 million Americans xperience acute pain each year due to injuries or surgery.

  • 1 in 3 American adults lose more than 20 hours of sleep each month due to pain.

  • Lost workdays due to pain add up to over 50 million a year.

  • Chronic pain accounts for more than 80 percent of all physician visits.

  • Pain costs the nation an estimated $70 billion a year in medical claims, disability payments and lost productivity.

  • Headache and lower back pain are the most common types of pain in the U.S.
    • Over 25 million Americans suffer from migraines; 9 out of 10 Americans have non-migraine headaches each year
    • Over 26 million Americans between the ages of 20 and 64 experience frequent back pain.

  • According to the American Pain Foundation, pain is the number one complaint of older Americans and one in five older Americans regularly use painkillers.

  • Research indicates that men and women respond differently to pain.

  • The cause of chronic pain is not always evident.

  • Medical and technological advances have made pain more manageable today than ever before.

  • Only an estimated 1 in 4 of those with chronic pain receive proper treatment meaning millions of people suffer needlessly, unaware of effective pain-management options.

Ask Your Doctor

This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.

  • Have you treated others with the type of pain I have?

  • Do you think I need more evaluation to determine what is causing my pain and whether there is any effective treatment?

  • Do I need to see a specialist for my pain?

  • What are the options for treating my pain?

  • Do you ever recommend alternative therapies (acupuncture, massage, hypnosis, herbal remedies), either alone or in combination with prescription medications?

  • What kind of medications work best for this type of pain?

  • Do pain medications cause side effects?

  • Should I take other medication to manage the side effects of my pain therapy?

  • Will I become addicted to pain medication?

  • Can I take nonprescription pain relievers in addition to prescription pain drugs?

  • Besides taking medicine, what else can I do to manage my pain?

  • What level of pain relief I can expect?

  • What can I do to relax and cope with pain? (Pain may feel worse if you are stressed, depressed or anxious.)

  • Where can I go for support?

  • What should I do if I have a pain crisis or emergency?

  • Will following a particular diet make me feel better?

  • Are there any clinical trials of new treatments for chronic pain?

Key Point 1

Identifying the source of pain can be a difficult and long process.  Sometimes pain is not a symptom of a problem; it is the problem. 

We usually think of pain as a bad thing.  But pain is also a good thing when it warns us that something's wrong.  We need the sensation of pain to tell us to take our finger from a hot stove or that we have an infection and should go to a doctor.

When pain is no longer useful as a warning, when it continues past the time of recovery or when it occurs for no discernable reason over an extended time period it becomes chronic pain.  Chronic pain can be a symptom of a problem, or it can be the problem itself – basically a disease like any other.

As with any disease, understanding chronic pain is the first step toward managing it.  Unfortunately, many cases of chronic pain don't correlate to an obvious source.  That makes it challenging – and even frustrating – for doctors to diagnose. 

While testing can be done to attempt to find the cause of pain, there is no lab test, x-ray, or scan to prove the existence or intensity of pain.  Pain is what the patient says it is. But, describing pain in words can be difficult. When you feel pain, your brain is receiving a complex mixture of signals. Pain receptors and nerve pathways differ throughout the body and, consequently, the sensation of pain differs depending on where the message comes from and how it travels.

Each person experiences pain differently.  People with similar problems may feel different levels of pain. They also differ in their ability to tolerate pain and how they respond to pain medication.  There are a number of influences that make the experience vary among individuals, including:

  • Previous experience with pain
  • Physical differences
  • Personality and mood
  • Attitude and expectations

Doctors usually take an extensive medical history and perform both a physical examination and pain assessment to diagnose pain.  They try to determine the intensity of the pain and what's causing the pain by asking questions such as:

  • Where is it?
  • Where does it go?
  • What does it feel like?
  • When did it start?
  • How did it start?
  • What makes it better?
  • What makes it worse?
  • When is it the most bothersome?
  • Does it come and go or remain constant?
  • How bad is this pain compared to other pain that you've had?
  • How does the pain affect your ability to function?
  • What medications or treatments have you tried for the pain?

Doctors also use a variety of pain intensity scales to measure how severely individuals are feeling pain and to monitor the effectiveness of treatments.

Sometimes it takes a long time to get to the bottom of a chronic pain problem.  Both the doctor and the patient have to be persistent and the doctor must provide positive support and interim treatment for the pain and its side effects (such as depression and sleep disorders) for the patient along the way.

    

Key Point 2

Once you know the cause of pain you can predict the treatment that will be most effective in relieving it. 

Sometimes patients are reluctant to undergo a long evaluation and testing process to get to a better understanding of their chronic pain.  However, proper diagnosis is the key to constructive treatment.
 
Sometimes pain is a warning that something's wrong.   When the underlying issue is identified and treated, the pain stops.  Sometimes chronic pain is due to a chronic condition, like arthritis.  In those cases, the disease and the stage it's in will determine the level and type of pain you experience and direct your doctor to specific therapies.  Occasionally, there's no evidence of disease or damage to tissues that doctors can directly link to pain, or pain remains after an original injury appears to be healed.  When the source of pain remains a mystery, treatment may have to be an educated sequence of trial and error. 
  
While there are many treatment options available to treat chronic pain, there's no single plan that works for everyone.  Unfortunately for patients who are often overwhelmed, impatient and perhaps even desperate, there's no magic bullet.  Doctors may need to try   many different kinds of treatments with some patients before they find the right balance between pain relief and their side effects.  The best approach is usually a combination of treatments.

Treatment options include:

  • Oral medications.  Mild to moderate pain may be managed with non-prescription pain relievers such as acetaminophen, aspirin, and non-steroidal anti-inflammatory drugs like ibuprofen.  More severe pain may be treated by narcotic drugs.  Other drugs that have been effective in treating chronic pain include steroids, antidepressants, and anticonvulsants.
  • Topical drugs.  These are anesthetics that are applied directly to the skin to numb the pain.
  • Therapeutic exercise.  Exercise can strengthen weak muscles, mobilize stiff joints and increase range of motion.
  • Heat and cold therapy.  Warmth can relieve pain by relaxing muscles. Cold relieves pain by reducing inflammation.
  • Cognitive behavioral therapy.  CBT employs a range of relaxation techniques that help to relieve pain or improve the ability to tolerate it.
  • Psychotherapy.  The primary goals for psychotherapy are to treat depression and anxiety caused by chronic pain and help patients develop and use coping skills.
  • Complementary/Alternative Approaches.  These include acupuncture, acupressure, therapeutic massage and chiropractic care.
  • Hypnosis. Not everyone can be hypnotized but studies have shown that 15 to 20% of people who can be hypnotized report dramatic relief of pain as a result.
  • Neurostimulation therapy.  The stimulation of nerves through a low electrical current has proven effective in relieving some chronic pain. Techniques include transcutaneous electrical nerve stimulation (TENS), spinal cord stimulation (SCS), and peripheral nerve stimulation (PNS).
  • Anesthesiologic approaches.  These include nerve blocks, epidural steroid injections, spinal infusions and trigger point injections.
  • Surgical approaches.  Surgical options include implantation of a small pump that continuously delivers pain-relieving medication and surgery to interrupt the pathways that send pain signals to the brain. 
    

Key Point 3

The medical goal of pain treatment is to restore function in the patient's life; it is not necessarily to completely eliminate pain. 

The ideal goal for the chronic pain sufferer would be to get complete pain relief.  In many cases, that goal just isn't realistic.  For instance:

  • Disease progression may cause an accompanying progression in pain 
  • When an injury remains unresolved, changes in the body may take place making the body more vulnerable to pain
  • People with chronic pain often have lower than normal levels of painkilling endorphins and, hence, a heightened sensitivity to pain
  • A "wind-up phenomenon" may come into play where nerve fibers transmitting painful impulses to the brain become "trained" to deliver pain signals better and, at the same time, the brain becomes more sensitive to pain

When it's impossible to eliminate pain, the goal has to be to provide as much pain relief as possible and improve everyday functioning.

Here are steps you can take:

  • Find a doctor who has expertise in treating chronic pain.  If your doctor isn't able to provide effective treatment, ask about a referral to a pain management clinic.  Not every patient needs to be seen in a pain clinic; but every patient who has pain should at least consider it.

  • Work with your doctor to set realistic expectations.  You and your doctor need to develop a partnership for the long haul.

  • Make sure your doctor treats your emotional and social needs as well as your physical needs.  Because chronic pain continues for a long period of time, it can cause a whole host of issues that can prevent people from leading full and meaningful lives.  Sleep deprivation and too much stress can aggravate pain. Depression can lower your ability to cope with pain.  

  • Learn as much as possible about your condition and how recommended treatments can affect it. Also consider how well those treatments fit your lifestyle. You and your doctor should work together to choose a plan that's right for you.

  • Be patient.  It takes time to figure out which treatment or combination of treatments will work best.  Taking control of pain can be hard work.

  • Be persistent.  Your need for pain control may change over time. Regular monitoring of your condition and how treatments are working is essential to getting the best outcome.

  • Join a support group. Support groups allow people to share ideas, strategies, struggles, and successes. Talking with people who understand what you're going through will help you feel less alone.

  • Settle for nothing less than respectful care and being listened to by all your healthcare providers.
    Many patients who have been treated for chronic pain find that they're able work, socialize and enjoy family life again.  Chronic pain may be unavoidable, but it doesn't need to control your life.

Medline Plus

Medline Description: 

Conduct an off-site search for Chronic Pain information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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