Things that people with chronic pain should know

People with chronic pain find that pain is a unique experience. One person may have a different experience dealing with pain than another person, in a similar situation. Pain is more than an unpleasant feeling. It also involves your emotions to events that trigger the pain, such as a car accident or a surgery.

It is hard for a patient, alone, to deal with chronic pain and its related problems such as insomnia and depression. A pain management doctor can help you through this difficult experience. As a patient, you need to take control over your pain, by getting the help that is needed and working with your treatment team to get better.

Understanding chronic pain

Chronic pain outlasts what is considered a normal healing time of three to six months, and can become a disease in itself. It starts in the setting of injury or even without a known trigger. You can understand chronic pain better, by comparing it to acute pain.

Chronic pain vs. acute pain

Acute pain is the short-term pain you feel when you burn your hand, sprain your wrist, or pull a muscle. Your body is warning you to stop a harmful behavior, modify activity to reduce strain on the injured area and seek treatment.

With chronic pain, the nervous system begins to adjust to ongoing pain signals, and the nerves become overactive. This becomes a persistent issue, that can lead to other problems like sleeplessness, depression, or anxiety.

While acute pain acts like a fire alarm that tells you to find and remove the danger, chronic pain acts like a fire alarm that can’t shut off and keeps ringing long after the fire goes out.

Chronic pain and your central nervous system

Early Greeks and Romans believed that the brain plays a role in feeling pain. Although modern science supports this view, we now understand that our pain-sensing system is far more complex than the simple view of the old. The central nervous system (the brain and the spinal cord) is your body’s control center when it comes to pain.

Pain can be either magnified or reduced in the brain and spinal cord, based on a series of relay stations that occur throughout the nervous system’s pain signaling pathway. This process starts when the pain signals in the body get turned on more easily. As a result, a person can become more sensitive and feel moderate to severe pain even with normal stimuli or mild pressure, like a light brush against the skin.

Recognizing chronic pain

Although pain starts at a small level in the brain and spinal cord, it can have a big effect on your life.

Signs of chronic pain:

• Pain lasts over six months
• The amount of pain you feel seems greater than what you would expect
• Sometimes, there is pain without a known cause
• Sleeplessness, anxiety, depression develop

Causes of chronic pain

Chronic pain can start after direct tissue damage, as a result of an illness, or after nerve damage.

Conditions that result in chronic pain:

• Arthritis
• Cancer
• Neck/back radiculopathy (herniated disc presses on a spinal nerve)
• Diabetic neuropathy (hand and foot numbness)
• Myofascial pain syndrome (muscle pain)
• Post-surgical pain syndrome (long-term pain after surgery)
• Phantom limb pain (pain and sensation that a leg or arm is still there after amputation)

Finding the source of pain

Your doctor diagnoses your pain, after a thorough medical history and exam. A description of your pain’s location, duration, and pattern, leads a doctor to the correct diagnosis. Tests such as X-rays, MRIs, CAT scans, may reveal why you are having pain.

Chronic pain treatment

Pain responds best to a treatment that is tailored to your unique symptoms. A balanced approach may include several treatments, for increased healing effect. For example, a pain management doctor may treat you with pain-relief injections, medications, device implants or regenerative therapy.

Pain-relief injections

You may improve with pain-relief injections. The goal is to decrease your pain significantly, without the drowsiness, dizziness, or other unpleasant side effects caused by some oral medications.

Common pain-relief injections:

• Peripheral nerve blocks (nerves are bathed in a medication that numbs the pain)
• Epidural steroid injections (medication is placed close to your spinal cord, often used for neck or back pain)
• Joint injections

Medications

Different medications can work on different types of pain. Medications can treat pain directly or may help with other related problems, such as depression and sleeplessness.

Medications for chronic pain:

• Antidepressant drugs (treat pain, depression)
• Anti-seizure drugs (treat the burning, shooting pain caused by nerve damage in patients with shingles, diabetes)
• Opioids
• Local anesthetics (numb nerve pain)
• Capsaicin (a substance found in hot peppers, that can help with nerve pain)
• Muscle relaxants

Device implant

Implantable devices can be placed in your body for long periods of time (months-years), in order to block pain signals in your spinal cord or in flared-up nerves.

Devices that help with chronic pain:

• Spinal cord stimulators (these devices work on your spinal cord to stop pain signals)
• Peripheral nerve stimulators (these devices work on a painful nerve)
• Pain pump implant (these devices deliver medication directly to the spinal cord, where it stops pain signals)

Regenerative therapy

Regenerative medicine is used to speed up healing, by helping your body form new, healthy cells. It’s often used for joint pain when traditional treatments have failed.

Regenerative therapies include:

• Stem cells
• Platelet-rich plasma (PRP)

Braking the pain cycle

Several everyday habits can help you gain control over your chronic pain:

1. Stay ahead of the pain – take your medications on a schedule
2. Find what increases your pain and try to work around it – for some that means rest, and for others it means greater activity
3. Remain active – people with chronic pain exercise less and have increased risk for cardiovascular problems
4. Avoid stress – the sympathetic (flight or fight) response triggered by stress, can increase pain
5. Get enough sleep – the brain “turns-off” during sleep and gives you a break from pain
6. Stop smoking – smoking slows down blood flow to the tissues, slowing down the removal of toxins from the painful area
7. Maintain a healthy diet – an anti-inflammatory, low sugar, diet may decrease inflammation pain

For complementary treatment approaches, you can visit this NIH chronic pain website.

Outcomes

Under the care of your pain management doctor, chronic pain often improves, or may even disappear. Although chronic pain may return after an injury, such as a fall, it may also return in cycles that are not related to anything you do. Therefore, it is important to seek help early, from your pain doctor, in order to better control your pain and to regain the active lifestyle you deserve.