CHRONIC PAIN

BACKGROUND

Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer.

Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, there may also be no clear cause. Other health problems, such as fatigue, sleep disturbance, decreased appetite, and mood changes, often accompany chronic pain. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and stamina. This difficulty in carrying out important and enjoyable activities can lead to disability and despair.

DISEASE OCCURRENCE IN POPULATION:

In less developed countries in South East Asia the prevalence rates varied from 5.2% in India, 8.8% in Pakistan to 43.2% in Thailand.

In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men.

RISK FACTORS:

There are three major categories of risk factors for chronic pain:

• Biological risk factors that stem from your physical characteristics as well as your medical history
• Psychological risk factors linked to your mood and personality
• Lifestyle risk factors

LIVING WITH CHRONIC PAIN: BIOLOGICAL RISK FACTORS:

These are the leading physical factors that could put you at risk for chronic pain:

• Old age: As people grow older and as their bodies age, they tend to need more ways to manage pain.
• Genetics: Some chronic pain conditions like migraines have been linked to genetics. Studies also have found genetic conditions that can make you more sensitive to pain and require more chronic pain management.
• Race: African-Americans and Hispanics appear to be at greater risk for chronic pain, studies have shown.
• Obesity: People who carry a lot of extra weight often develop chronic pain due to their poor health. Obesity also can exacerbate medical conditions that require pain management.
• Previous injury: People who have recovered from a traumatic injury run a greater risk for future chronic pain, the main pain neurotransmitter is released in greater quantities in people who had previous pain problems or previous longstanding psychiatric disorder.

Living With Chronic Pain: Psychological Risk Factors

These factors can also increase your risk of living with chronic pain:

• Childhood trauma: People who experienced parental neglect or physical or sexual abuse as children are more likely to have chronic pain. "These childhood factors play a large role in later developing a chronic pain problem,”
• Mood disorders: People with depression or anxiety disorders have a greater risk of chronic pain. Many brain areas and neurotransmitters that handle pain signals also manage mood.

Living With Chronic Pain: Lifestyle Risk Factors

The way you live your life can put you at risk for chronic pain:

• Having a high-risk job: People with jobs that require heavy lifting or strenuous physical activity are at greater risk for developing chronic pain.
• Stress: Chronic pain has been linked to both chronic stress and post-traumatic stress disorder.
• Smoking: Smokers are at greater risk for developing medical conditions that lead to the need for chronic pain management. They also are less likely to respond to pain management therapies.

SIGN AND SYMPTOMS

The symptoms of chronic pain include:

• Pain that does not go away as expected after an illness or injury.
• Pain that may be described as shooting, burning, aching, or electrical.
• Discomfort, soreness, tightness, or stiffness.

Pain can lead to other problems, such as:

• Fatigue, which can cause impatience and a loss of motivation.
• Sleeplessness, often because the pain keeps you awake during the night.
• Withdrawal from activity and an increased need to rest.
• A weakened immune system, leading to frequent infections or illness.
• Depression, which is common and can make your pain worse.
• Other mood changes, such as hopelessness, fear, irritability, anxiety, and stress.
• Disability, which may include not being able to go to work or school or perform other daily activities

DIAGNOSTIC TEST:

Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision.  So, health professionals rely on the patient’s own description of the type, timing, and location of pain. Defining pain as sharp or dull, constant or on-and-off, or burning or aching may give the best clues to the cause of the pain. These descriptions are part of what is called the pain history, taken during the start of the evaluation of a patient with pain.

Since chronic pain may occur in a variety of locations in the body and for many different reasons, patients and their health professionals need to work together to identify the causes and symptoms of that pain and how it can be relieved.

Although technology can help health professionals form a diagnosis, the best treatment plans are tailored to the person, with input from healthcare team members, who each have different training backgrounds and understand chronic pain. The person with pain and his or her loved ones also must be actively involved in the treatment.

To see if there's an injury or identifiable condition causing your chronic pain, the doctor will need to run diagnostic tests. For the imaging tests (x-rays, MRIs), you may have to go to an imaging centre to have these done; the results will be sent back to your doctor, who will interpret them for you.

Some possible diagnostic tests are:

• Blood test: The doctor may be able to tell if you have certain types of arthritis or an infection based on a blood test. These conditions can lead to chronic pain. A blood test also allows the doctor to check your liver and kidney functions.
• Bone scan: To help your doctor detect spinal problems such as osteoarthritis, sacroiliac joint dysfunction, fractures, or infections (which can all lead to chronic pain), you may have a bone scan. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your blood stream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity—such as an inflammation. A scanner can detect the amount of radiation in all your bones and show the "hot spots" (the areas with more radioactive material) to help your doctor figure out where the problem is.
• CT scan: A CT scan, which stands for computerized axial tomography, shows the bones, but it also shows the soft tissues and nerves.
• EMG: An electromyography (EMG) will test if your muscles are responding well to nerve stimulation.
• MRI: An MRI, which stands for magnetic resonance imaging, shows the bones, but it also shows the soft tissues and nerves. MRIs don't expose you to radiation; they get their image by using magnets.
• X-ray: This gives your doctor a clear picture of your bones.

TREATMENT OPTIONS:

Chronic pain medication can be effective and important for pain management for many people, it isn't the only tool available when it comes to pain treatment, and it shouldn't be the only tool that's used.

MEDICATIONS: There are a lot of medications that are prescribed for pain, opioids (narcotics) and benzodiazepines may not be the best options. Those treatments "have their own problems, and there are no good studies on using opioids for long periods of time for the treatment of chronic pain.

Types of chronic pain medication used include:

• NSAIDs: (non-steroidal anti-inflammatory drugs), including ibuprofen, naproxen, etoricoxib and aspirin
• Acetaminophen:
• Antidepressants: which can improve sleep and alleviate pain
• Anti-seizure medications: which can be effective in treating pain related to nerve damage or injury
• Steroids: like dexamethasone and prednisone, to alleviate inflammation and pain

PHYSICAL THERAPY: is a very important part of any pain management program. Pain can be worsened by exercise that isn't done correctly (or interpreted incorrectly as pain rather than overuse), and a physical therapist can tailor the right exercise regimen for you. Proper exercise slowly builds your tolerance and reduces your pain — you won’t end up overdoing it and giving up because it hurts.

OTHER PAIN MANAGEMENT OPTIONS: A variety of approaches and modalities can help you deal with both the physical and emotional parts of pain:

• TENS (transcutaneous electrical nerve stimulation) therapy
• Meditation
• Relaxation techniques
• Visual imagery, as simple as picturing a peaceful scene, for example
• Biofeedback, which teaches control over muscle tension, temperature, heart rate and more
• Heat therapy like heating pads
• Cold therapy like ice packs, coolant sprays / cream (menthol)
• Manipulation and massage

PRECAUTIONS:

LIVING WITH CHRONIC PAIN DECREASING YOUR RISK:

Becoming more aware of your risk factors can give you an edge in warding off future chronic pain. Preventive steps you can take include:

• Improve your health: Eat right and exercise to reach a healthy weight and become physically fit.
• Quit smoking: There are numerous health benefits to quitting, including the potential to avoid future chronic pain management.
• Manage your stress: Exercise, meditate, or practice another form of stress relief.
• Seek help for mood disorders: If you have depression or anxiety, get help before your mood disorder leads to chronic pain.
• Be smart on the job: Take safety precautions to limit your risk of injury. "That's part of why work safety issues are really important “In construction, people have to wear hard hats because they decrease the risk of head injuries. The same thing may be true for wearing some kind of brace or support when performing a heavy lifting job."

REFERENCES:

• Johannes C, Le T, Zhou X, Johnston J, Dworkin R (Nov 2010). "The Prevalence of Chronic Pain in United States-Adults-Results-of-an-Internet-BasedStudy".JPain. 11 (11):12301239 doi:10.1016/j.jpain.2010.07.002. PMID 20797916
• www.everydayhealth.com/pain­management/know­your­risk­for­chronic­pain.aspx
• www.webmd.com/pain­management/tc/chronic­pain­symptoms
• www.everydayhealth.com/pain­management/know­your­risk­for­chronic­pain.aspx