Chronic Pain: Everything you need to know

A dull ache radiates down my leg, barely distracting from the knife-like sensation pulsating in my abdomen. Tears fill my vision because each discomforting twinge is a poignant reminder of the chronic pain overtaking my body. The location, cause, or physical perception of chronic pain varies, but one factor that does not the waiver is the infinite value in chronic pain knowledge. What is chronic pain? What are the symptoms? Treatments? Is there an emotional component? What outside influences affect pain? By reading further, you can become a critical asset in improving the future for patients with chronic pain.

Chronic Pain

What is Chronic Pain?

Pain is designed as a mode of protection. Signals sent from the spinal cord to the brain after trauma stimulate the body’s healing. In a healthy individual, pain sensations decrease as healing increases. Chronic pain, however, does not resolve in the same manner. Chronic pain is pain lasting more than 12 weeks. It occurs when the naturally programmed responses from the nervous system are misinterpreted and fail to stop when healing is technically complete. According to BMC public health, 1 in 5 adults suffers from chronic pain and 1 in 10 are validated through a chronic pain diagnosis annually.

What are the symptoms of chronic pain?

Symptoms of chronic pain are vast. They include:

• Widespread Pain
• Poor Sleep or Insomnia
• Fatigue
• A headache or Migraines
• Mood Swings/Irritability
• Depression
• GI Upset
• Anxiety
• Guilt
• Decreased Sex Drive
• Family/Friendship/Relationship Problems
• Suicidal Thoughts
• Trouble Concentrating
• Memory loss

What causes chronic pain?

You probably never expected that your sprained ankle from fourth-grade soccer practice would cause future repercussions, just like you did not imagine that your broken arm from falling out the tree years ago would be anything more than an amusing grade school story. Those injuries hurt, yes, but they certainly cannot hurt forever. Can they?

An unfortunate misconception is that chronic pain only impacts older people with a medical disability. In the younger population not as prone to disease, chronic pain conditions are often the result of an injury. Still, the causes of chronic pain are variable.

Chronic Pain Causes:

• Arthritis
• Fibromyalgia
• Broken Bones
• Cancer
• Inflammatory Bowel Disease
• Surgery
• Neuropathy
• Headaches or Migraines
• Lyme Disease
• Genetic Conditions (Mitochondrial Disease, Ehlers Danlos Syndrome, Muscular Dystrophies)
• Endometriosis
• Pancreatitis
• Cirrhosis of Liver

What are the different types of chronic pain?

To successfully manage this type of pain, it is imperative for medical professionals to fully grasp the symptoms of their patients. The miscellaneous causes of chronic pain are categorized and the organizational process simplifies receiving the correct chronic pain diagnosis.

Nociceptive Pain

Nociceptive pain stems from inflammation after trauma to a particular area.  The term is derived from nerve cells known as nociceptors, which detect stimuli that cause harm to the body (i.e. extreme temperature, pressure, chemicals). Nociceptors send signals to the central nervous system when trauma occurs. A hallmark of nociceptive pain is that the pain decreases in severity as healing occurs.

Visceral Pain – Nociceptive Pain Category

Visceral pain is one of the three types of nociceptive pain. Visceral pain also involves the nociceptor nerve cells. The cells are limited to pain receptors in the abdomen, pelvis, intestines, and chest when there is damage to internal organs and tissues. Visceral pain is not typically localized and described as aching, burning, or deep pressure.

Examples of visceral pain are acid ingestion, constipation, damage to core muscles, cancer of the pancreas or liver, endometriosis, menstrual pain, prostate damage, and cancer of internal organs.

Somatic Pain – Nociceptive Pain Category

Swelling, force, or vibration of the body’s tissue triggers somatic pain receptors to emit pain signals. Somatic pain is localized and divided into two categories.

Superficial somatic pain is the most common form of somatic pain—the injuries that are near the surface activating pain receptors in the skin, mucus, and mucous membranes. The sensations with superficial pain are burning, itching, and sharp.

Deep somatic pain manifests as a dull ache. It activates pain receptors at deeper locations like bones, joints, tendons, and muscles. Examples of deep somatic pain are headaches, arthritis, joint swelling, bone or skin cancer, bone fracture, strained muscles, damage to the connective tissue through disease or injury, joint injury, and cuts to the skin.

Neuropathic Pain

A consequence of injury or disease, neuropathic pain is characterized as nerve pain from damage sustained to the nervous system.

Examples of neuropathic pain include diabetes, cancer, stroke, phantom limb pain, amputation, and cytomegalovirus.

Mood Disorders and Chronic Pain

Mind and body interplay is undoubtedly evident in this type of pain. The painful sensations are physical, but a psychological component is introduced as pain signals in the brain communicate with the entire body. Nevertheless, scientists are currently questioning the origin of chronic pain and mood disorders—do mood disorders result in chronic pain or is it vice versa?

Medical professionals struggling to find a cause of chronic pain automatically resort to an unconfirmed psychological diagnosis. Patients and doctor relationships are strained by the “Which comes first? The Chicken or the egg?” analogies. All fitting physical conditions should be ruled out and psychological concerns addressed. Chronic pain always has an effect on the mind, so there is the potential for secondary mood disorders.

Depression and Anxiety

Studies indicate that chronic pain conditions induce depression in 85% of patients. Scientists support the hypothesis of chronic pain leading to depression because the conditions share sensory pathways. The sections of the brain essential to controlling moods, like the thalamus, hippocampus, and amygdala, are simultaneously involved with injury sensory pathways. Those same pathways undergo changes from injury and stress exposure. Chronic pain patients are in a constant state of vulnerability, as their pathways are overloaded by the burden of continuous pain.

Situational circumstances of chronic pain also influence comorbid mood disorders. A chronic pain diagnosis contributes to extra stress: appointments distract time from family, medical costs overwhelm the bank, and cash flow dwindles with sick days off from work. Establishing trust with medical professionals raises concern: “What if they don’t believe me?” Receiving the correct diagnosis is imperative for symptom management. Perhaps the most significant anxiety for chronic pain patients is fear of the future. The carefree lives they used to lead have been altered and the future is a teeter-totter bouncing with uncertainty.

Social Isolation and Chronic Pain

Social isolation exacerbates the emotional effects of this type of pain. From personal experience, at the beginning of my diagnosis, I could not lead the same lifestyle as before. I lost many people who I once thought were true friends. My diagnosis was a reminder they are not forever invincible. They too are susceptible to illness at any stage. In a state of immaturity, the easiest recourse was to push aside such a possibility, ignoring me.

Laying the blame does not help. I am equally accountable. Chronic pain patients struggle to feel understood, but experiencing the exact pain of another is impossible. Even the closest friends and family can adopt the role of strangers. As a result, chronic pain patients withdraw from the world around them in misunderstanding. The regression of social interactions hinders mental wellbeing and fuels depression. Learning techniques to respectfully expressing your emotions with your loved ones is key to overcoming the social effects of this pain.

Obsessive Compulsive Disorder and Chronic Pain

Obsessive Compulsive Disorder (OCD) is a chronic anxiety disorder with two prominent features. The first is obsessive thoughts and the second involves compulsive behaviors. Intrusive thoughts drive the mechanisms of OCD. The subsequent repetitive behaviors are an outlet for anxiety, as they repress the urge to engage in the behavior until the thoughts return.

This type of pain increases the likelihood of OCD because patients engage in avoidance behaviors. Those with chronic pain are accustomed to high pain levels and they do not wish to add to that burden. OCD manifests to spare them from more pain. For example, obsessive thoughts of contamination and the hand-washing compulsions are the top OCD habits featured in chronic pain research. Patients fear the germs that exacerbate their pain condition and they seek to eliminate the chance of becoming sicker, despite the obsessive behaviors required.

Brain Fog and Chronic Pain

Brain fog is prevalent in chronic pain cases and is a layman’s term for concentration impairment. Prior to chronic pain, patients describe themselves as intelligent, thirsting for knowledge, and always eager for a new challenge. Suddenly, casual conversation is obscured in the midst of a dense fog. Speaking is a strenuous demand. A cloudy opaqueness traps your words in a strand of incomprehensible murmurs and you long for your former train of thought unshrouded by chronic pain.

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It is no surprise that issues with memory recall, poor concentration, and difficulty speaking are chronic pain symptoms. The human brain requires rest for optimal function, but the discomfort of chronic pain prevents the formation of consistent sleeping habits. People with chronic pain do not fall asleep with ease, nor do they maintain REM sleep cycles to rejuvenate thinking. Recent MRI studies reveal that in someone with this type of pain, the frontal brain region responsible for emotion is seldom inactive. Neurons are exhausted with little opportunity for recharge.

Increased Risk of Dementia and Chronic Pain

“I hope I am not like that when I am old...”

Before the age of sixty, the early onset of dementia is discussed as a joke. However, dementia is no laughing matter.

Dementia is a serious medical condition impacting the deterioration of brain cells. Symptoms are comprised of confusion, memory loss, hallucinations, a decline in social skills, paranoia, psychosis, and trouble with simple tasks. Worrying about getting old is not the sole cause of early onset of dementia. Chronic pain is an additional risk factor.

UC San Fransisco performed a comprehensive study linking chronic pain to the early onset of dementia. A series of memories tests reflects a marked interference with memory function. The energy that normally preserves memory development with age is zapped from the hormonal and brain pathways in chronic pain patients.

Fibromyalgia and Chronic Pain

10 million people in the United States have fibromyalgia—the most common chronic pain condition. Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, and the infamous brain fog its sufferers have nicknamed “fibrofog.”

Although Fibromyalgia is fairly common, seldom does it stand alone. There are a host of comorbid diagnoses. Tension headaches, irritable bowel syndrome, and interstitial cystitis are a few examples. It is almost as if the pain of Fibromyalgia is a symptom of another underlying disorder (i.e. autoimmune diseases, genetic syndromes, osteoarthritis, etc.).

Chronic Pain/Fibromyalgia Tender Point

Fibromyalgia is diagnosed based on tender points, which examines the soft tissues in the body. A physician conducts the Tender Point Exam by pressing down on the symmetrical tender points scattered across the body. Suspected Fibro patients mark the areas they feel pain.

Fibromyalgia Tender Points:

• Front lower sides of your neck
• Upper chest
• Inner elbows
• Just above inner knees
• Back of your head
• Top of the shoulders
• Upper back (at shoulder blades)
• Upper buttock
• Hips

What treatments are there for chronic pain?

Treatment for chronic pain is geared towards the underlying cause. Chances are, a quick fix is not a guarantee. Unless treatments are tailored to the individual, chronic pain can be difficult to control.

Physical Therapy Exercise

Deconditioning is a frequent complication of chronic pain and a huge deterrent in the routine of daily functioning. Physical therapy is a chronic pain treatment meant to restore strength. Physical therapists are specialized in identifying areas that contribute to pain. They observe a patient’s movements to pinpoint areas of weakness. Through strengthening exercises, low impact aerobic training, stretching, and aquatic exercises, muscles are strengthened to improve flexibility and enhance blood flow—both of which are conducive to chronic pain symptoms.

Medications (Medications (NSAIDs, Opioids, PCA, Antidepressants)

There is a range of medications to combat chronic pain. The most easily accessible are over the counter medications:

• Tylenol (acetaminophen)
• Non-Steroidal Anti-inflammatory Drugs such as aspirin, Advil, or Aleve (ibuprofen, naproxen)

When over the counter medications are ineffective, a doctor can prescribe long-term prescription medications obtained from a pharmacy:

• Non-Steroidal Anti-inflammatory Drugs – Celebrex (celecoxib)
• Antidepressants – Cymbalta, Elavil (duloxetine, amitriptyline)
• Muscle Relaxants – Amrix (cyclobenzaprine)
• Anti-anxiety – Valium (diazepam)

Stronger prescription painkillers are occasionally used to treat episodes of acute pain in chronic pain patients or to manage severe baseline pain unresponsive to alternative treatments. While not ideal for long-term use due to their extensive side effect profiles, examples of stronger prescription painkillers are:

• Oxycodone (OxyContinm Roxicodone, Percocet)
• Hydrocodone (Vicodin, Norco, Lortab)
• Morphine
• Hydromorphone (Dilaudid and Exalgo)
• Fentanyl
• Codeine
• Methadone (Dolophine and Methadose)

Medications to treat chronic pain are available in a number of forms. Whether pills, liquid oral suspensions, intravenous infusions, or lotions and topical options, discuss with your physician to establish what form is best for you.

Thermotherapy

As a chronic pain suffer, it sometimes feels as if I am forever at the mercy of others. Physical therapists, doctors, and pharmacists are not always with immediate reach. I have to schedule appointments well in advance and once handed a script, my wait for relief is prolonged at the local pharmacy. However, there resources accessible from home that can take the edge off of the pain, like thermotherapy!

Thermotherapy is a fancy name for heat therapy. Heat is effective for treating this type of pain like muscle pain, fibromyalgia, neuropathic pain, muscle spasms, and joint swelling and stiffness residual from injury. Applying heat improves chronic pain because it encourages the circulation of blood to the damaged area.

Examples of thermotherapy therapy are heating packs, electric heating pads, microwavable rice bags, paraffin wax treatment, and heat wraps.

Chronic Pain Treatment

Cryotherapy

Cryotherapy is the process of icing painful injuries. Ice is an analgesic. It does not heal the injury, but it has pain relieving properties. Ice is preferred for recent injuries with swelling or for overuse injuries like tennis elbow, sprained joints, and rheumatoid arthritis flares.

Examples of cryotherapy are cold compresses, chemical cold packs, and the faithful frozen vegetable packs.

TENS Therapy

TENS therapy stands for transcutaneous electrical nerve stimulation. The device delivering the therapy is known as a TENS unit, which is attached to electrodes placed on the surface of the skin. Electrical pulses travel from the TENS battery pack, through the wires, and to the nerve fibers of the painful area. A TENS unit can be safely used at home with a medical doctor’s permission and in-depth demonstration.

Tips to Deal With Chronic Pain

Ironically, I have dealt with it secondary to Ehlers Danlos Syndrome for numerous years, but I am no expert. Navigating life with chronic pain is an arduous feat for the most seasoned of veterans. Regardless, I have picked up on tips and tricks along my chronic pain journey.

Support

This type of pain is lonely, yet there are others willing to reach out and help if you allow them. Self-isolation is not fair when it deprives you of healing fellowship, nor is it fair to others who miss out on the opportunity to connect with a wonderful person such as yourself!

Those currently in your life who do not have firsthand experience with chronic pain or illness are still capable of offering support. If you decide that you need someone who lives with chronic pain for an increased understanding, there are online groups. Nobody should feel obligated to face chronic pain alone.

Distractions

This pain is comparable to repeatedly enduring the stages of grief. An important facet of coping with chronic pain is allowing yourself to mourn your lost health. Wallowing in your chronic pain indefinitely is not necessarily helpful. Listen and heed to the warnings your body is giving you through the pain, as they prevent further injury, but it is equally as imperative not to remain hyper-focused on every ache, pain, or stabbing malady. It is less grueling immersed in a book or laughing over an interesting television show. Distractions are a path on the road to acceptance and healing.

Set Small, Reasonable Goals

Chronic pain is a spectrum. Some patients suffer severe disability, while others manage day-to-day with pain that is well controlled. Either way, the diagnosis has introduced a shift of lifestyle to varying extents.

I became discouraged when it prevented me from excelling in the tasks I previously did without effort. My self-worth was like a rug being pulled rapidly from under my feet, as I ran head-on towards undertakings larger than what I could safely endure. Going to bed at night, I’d add on to the to-do list from the day before.

Accomplishments with chronic pain look different than a compilation of healthy aspirations, and that is okay! Failure was necessary to determine my boundaries. New limits gradually emerged and I set small and reasonable goals. Instead of goals with infinite possibilities between them and lacking direction, I set attainable objectives. As I finally crossed the bullets from my list, I dozed to sleep with a satisfied smile. Chronic pain will not steal my joy—there is hope through its every trial.

Do you have this type of pain? Leave your comment below. 

References

Koenig, J., Oelkers-Ax, R., Parzer, P., Haffner, J., Brunner, R., Resch, F., & Kaess, M. (2015). The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study. Child & Adolescent Psychiatry & Mental Health, 9(1), 1–9. https://doi-org.ezproxy.ngu.edu/10.1186/s13034-015-0069-0

Hara, Y. (July 5, 2017). Does Chronic Pain Increase Dementia Risk? Retrieved from https://www.alzdiscovery.org/cognitive-vitality/blog/does-chronic-pain-increase-dementia-risk

Larson EB. (2016). Evaluation of cognitive impairment of dementia. Retrieved from https://www.uptodate.com/home.

Mehraban, A., Shams, J., Moamenzade, S., Samimi, S. M., Rafiee, S., & Zademohamadi, F. (2014). The High Prevalence of Obsessive-Compulsive Disorder in Patients with Chronic Pain. Iranian Journal of Psychiatry, 9(4), 203–208.

Rehan, K. (N.d.). Fibromyalgia Tender Points – Why They’re Not The Same as Trigger Points. Retrieved from https://www.spineuniverse.com/conditions/fibromyalgia/fibromyalgia-tender-points

Sheng, J., Liu, S., Cui, R., Zhang, X., & Wang, Y. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plasticity, 1–10.

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.