Chronic pain is a significant problem in Canada, affecting almost 20% of the population. It is usually defined as pain that lasts longer than normal (usually 3 to 6 months) for an illness or injury and can be caused by medical problems such as cancer, diabetes, arthritis, disc herniations, and fibromyalgia. Treating chronic pain remains one of the most challenging issues of medicine today. Unfortunately, there is no single cause of chronic pain, which can make assessment, diagnosis, and treatment difficult.
Chronic pain is classified based on the source of the pain. Neuropathic pain is caused by damage to nerves, the brain, or spinal cord. Nociceptive pain is caused by continued tissue damage due to certain medical conditions (e.g., cancer, arthritis, lupus). Some types of chronic pain are a combination of both of these, while for other types of pain, no cause can be found. Nociceptive pain usually responds well to traditional pain medications, but neuropathic pain does not respond as well. However, neuropathic pain does respond to other medications such as certain antidepressants and antiseizure medications.
Chronic pain often has a physical component, but psychological factors are also involved. Factors which perpetuate pain and disability include physical deconditioning (e.g., loss of muscle tone and strength) and the inappropriate use of medications. Other equally important factors that potentially compound the problem are an inability to deal with stress, depression, and anxiety. Chronic pain also brings about changes (in both the brain and spinal cord) in the way pain signals are processed. As the vicious cycle of pain and disability deepens, irritability, anxiety, frustration, and depression can worsen, as do problems with memory and concentration. Chronic pain can also lead to social withdrawal and isolation.
Early recognition of chronic pain is essential. The longer the pain persists, the more resistant it becomes to treatment.
In many cases, typical treatments for acute pain, such as rest, immobilization, painkillers, and opioids, simply worsen chronic pain and escalate the cycle of increasing pain. Chronic pain is a complicated, multifaceted illness that affects every aspect of a person's life including family, work, and everyone around them. As a result, no single medical specialty can adequately address the needs of someone suffering from chronic pain.
In fact, the only effective way to treat chronic pain is through an integrated, multidisciplinary approach where all the physical, emotional, and psychosocial issues of the person and their family can be addressed. The earlier treatment of persistent pain begins, the easier and faster it can be resolved.
At a minimum, a good interdisciplinary team should include:
- a doctor experienced in pain management
- a health care professional for counselling (e.g., psychologist, psychiatrist)
- a physical therapist or rehabilitation specialist to assess physical conditioning requirements
- nurses knowledgeable about managing chronic pain
Pain relievers may help some forms of chronic pain, but are ineffective for some people. Other methods are usually needed to adequately control pain. These can include:
- physical activity
- muscle strengthening
- reduce inappropriate medications
- treat symptoms of anxiety and depression
- develop coping skills
- establish social support systems
- take personal responsibility for recovery
- learn relapse prevention skills
Once chronic pain sufferers recover their physical function, emotional well-being, and social life, it is important to keep practicing any new behaviours, sometimes with the help of a support group. Without alternate ways of finding comfort, relapse of chronic pain can occur.