Managing Chronic Pain: Effective Treatment Options

What Is Chronic Pain?

Pain is described as an unpleasant or uncomfortable feeling which often follows an injury, illness, or its management. Pain is categorized as ‘Chronic pain’ when it lasts longer than the normal healing time, specifically, pain lasting beyond 3-6 months. This could occur anywhere in the body, continuously or it may come and go intermittently. Chronic pain is a serious and complex condition that requires immediate attention. It can disrupt one’s daily activities and can have a significant impact on one’s work, social life, and mental health. It is associated with several complications as well as an increase in morbidity and mortality worldwide. 

Chronic Pain vs Acute Pain

Where Do People Experience Chronic Pain?

Patients may experience chronic pain in one or multiple sites across the body; common sites are the lower back and spine region. Other sites include -

• Upper back/ Shoulders
• Legs and hips
• Neck pain
• Joint pain or arthritis
• Headaches
• Abdomen
• Wrists or feet

The pain may also occur at previous surgical scar sites, beyond the normal healing time, and in the genitals, especially in the testicles amongst men. It can also occur in a specific set of muscles (fibromyalgia) or a bundle of nerves (neurogenic pain).

How Common Is Chronic Pain?

Simply put, chronic pain is quite common all across the globe, with a far-reaching impact on individuals and society. Studies have shown that chronic pain is high in India, with almost 20% of Indians suffering from it, significantly impacting health, employment, and everyday life.  

Causes of Chronic Pain

Chronic pain may or may not have an identifiable underlying cause. The latter is referred to as chronic primary pain. Some common causes of chronic pain are -

Cancer 

Pain may arise due to the primary tumor, its spread, or treatment modalities like surgery, chemotherapy, or radiotherapy.

Other Long-Lasting Illnesses

These include arthritis diseases causing inflammation of the joints like rheumatoid arthritis and osteoarthritis and diseases of muscles like fibromyalgia.

Infections

Several viral infections can cause chronic pain by attacking the nervous system. These include chickenpox or shingles, AIDS, and Hepatitis C infection. COVID-19 is also known to cause chronic pain in some cases in the form of chest pain, headache, muscle pain or myalgia.

Some bacterial infectious causes include Lyme disease, leprosy, and a severe form of syphilis.

Post-Surgery or Trauma 

Chronic pain can develop in old scar tissue due to patient factors like pre-existing chronic diseases or genetic predisposition or due to nerve injuries during surgery.

Neuropathic Pain

This occurs when the nerves which usually carry pain sensations to the brain become more sensitive due to injury or disease or when the brain starts misreading other signals as painful.

Psychosomatic Causes 

This includes pain that cannot be attributed to any disease or injury but is likely due to stress, anxiety, or depression. Scientists have linked this to lower levels of anti-pain hormones in the body called endorphins.

What Does Chronic Pain Feel Like?

Nature of Pain

Chronic pain can be aching, burning, stinging, stiffness, or throbbing. The affected areas may become sensitive or tender to touch or act as trigger points for pain elsewhere in the body.

Detrimental Impact on Mental Health

In the long term, chronic pain is increasingly associated with anxiety, depression, impaired cognition or ability to focus, and stress. Lassitude, loss of appetite, and weight loss may also occur.

The Terrible Triad 

The pain can start interfering with daily work and activity, leading to a vicious cycle of worsening pain, irritability, and anxiety, causing social withdrawal and isolation. This is described as ‘the terrible triad’ of suffering, sadness, and sleeplessness.

Diagnosing Chronic Pain

The first step in managing chronic pain is trying to identify the cause. Since pain is a subjective symptom more often, the root cause diagnosis becomes a little complex. A team of doctors may be needed based on the identified possible source of the pain. They could carry out some diagnostic tests like -

Patient History 

Here the doctor may enquire about the details of pain like its exact site, onset, nature (throbbing, deep-seated, sharp, shooting, etc.), whether it is continuous or it comes and goes, and so on.

Physical Examination 

This involves a thorough clinical examination to look for signs of any underlying cause. A neurological exam may also be conducted.

Blood Tests, Urine Analysis, and other Fluid Samples

These determine the presence of foreign substances or abnormal levels of the body's hormones in response to any underlying disease process or injury.

Imaging

This includes an X-ray, MRI, CT scan, or ultrasound to detect any abnormalities or lesions within the body or as a diagnostic tool.

Psychometric Testing

Since pain cannot be quantified easily, several pain scales have been designed to ascertain the level of discomfort the patient is experiencing so that it can be managed appropriately. These scales can also be useful in assessing the patient’s response and improvement to treatment.

Treatment of Chronic Pain 

Treatment aims to identify and treat the causative factor. If the cause remains uncertain, symptomatic management of the pain and associated effects to ensure a better quality of life becomes the mainstay of management. Multiple modalities are considered to be more effective than a single targeted therapy. The treatment strategies include -

Medical Management

This includes various medications like 

• NSAIDs like acetaminophen and diclofenac for symptomatic pain-relief
• Anti-epileptic drugs are useful for nerve pain
• Muscle relaxants
• Sedatives to help with associated anxiety or insomnia
• Opioids - These are potent pain-relievers but have a high addictive potential

This could also include minimally invasive procedures like trans-cutaneous nerve stimulation (TENS), nerve blocks for pain relief, and steroid injections which serve as anti-inflammatory agents and relieve symptoms.

Lifestyle Modification

Dietary modifications like including anti-inflammatory foods in the diet and reducing fat intake may help ease the pain. It is also imperative to keep the body moving with some form of exercise since prolonged inactivity can do more harm than good. Moreover, exercise releases endorphins in the body, which are the body's natural painkillers.

Therapy

Both physical therapy and psychotherapy have proven effective for chronic pain.

• Physical therapy includes hands-on training of the body to improve its strength, flexibility, and function. 
• Psycho-therapy in the form of cognitive behavioral therapy (CBT) is useful to improve coping and manage other psychological effects like anxiety, depression, and sleeplessness.

Alternative Treatments

The use of alternative medicine to manage chronic pain is on the rise. Massage, chiropractic therapies, use of herbal medicine have also been tried. However, some of the practices still lack concrete evidence. 

Conclusion

While chronic pain may feel like a persistent weight disrupting one's life, it does not have to be dealt with alone. Several treatment options and therapies are available to ensure a better chance at a quality life. 

FAQ

Is There A Cure for Chronic Pain?

Presently, no. The only management option is identifying and treating the cause or providing symptomatic treatment.

What are The Complications of Chronic Pain?

Chronic pain can lead to a decreased quality of life, social isolation, psychiatric disorders, substance-abuse disorders, and especially addiction to opioids. Recently, an increasing association of long-term chronic pain has been seen with dementia. Suicidal tendencies may arise in some long-term cases as well.

What is The Prognosis of Chronic Pain?

The prognosis is quite variable. Chronic pain can commonly be associated with a decreased quality of life, but at the same time, the cause can sometimes be identified and managed effectively.

Are Medications The Most Effective Treatment For Chronic Pain?

Medicine alone is not the best approach to managing chronic pain. A combination of medicine and therapy is known to give better relief.

Can Chronic Pain Be Prevented?

The International Association for the Study of Pain (IASP) recommends some general guidelines to prevent chronic pain, which are -

• Lifestyle changes include daily exercise, a nutritious diet, weight management, and avoiding alcohol and cigarette smoke.
• Maintaining the correct posture at all times
• Stress management
• Seeking prompt help from a healthcare provider whenever needed