Chronic Pain

The management of chronic pain

What is chronic pain?

Chronic pain (pain that lasts for more than six months) can be excruciating or it can be mild, it might be debilitating or it may just cause discomfort, and it can be continuous or it may come and go.

Chronic pain might have originated from an earlier initial injury, trauma or infection, or there might be some ongoing reason for your chronic pain. Some people can also suffer from chronic pain without having had any past injury or any evidence of damage to their body.

There is an emotional cost to chronic pain which can also make your pain worse. Stress, anxiety, depression, fatigue and anger all interact in quite complex ways with your chronic pain and may act by decreasing your body’s production of its so-called natural painkillers. Additionally, these negative feelings might increase substances in your body which amplify the sensation of pain, leading to a vicious pain cycle for the chronic-pain sufferer. Even your body’s basic defences can be compromised by chronic pain as there is substantial evidence of unrelenting pain suppressing your immune system.

Your IPSA chronic pain consultation

Taking a detailed medical and lifestyle history from you, your skilled IPSA pain practitioner will work with you, at all times respecting your assessment of the level, intensity and timing of your pain, to develop a suitable pain-management plan. You IPSA pain specialist will carry out your totally confidential consultation in a conducive and professional setting.

What are the symptoms of chronic pain?

Chronic pain symptoms include:

• Pain ranging from mild to severe that does not ‘go away’
• Pain which is described as aching, shooting, electrical or burning
• Feelings of stiffness, tightness, discomfort or soreness

The pain symptom does not exist in isolation and has other problems that are usually associated with it such as:

• Sleeplessness
• Fatigue
• An increased need to rest and withdrawal from activity
• A weakened immune system
• Disability
• Mood changes including fear, hopelessness, depression, anxiety, irritability and stress

The different types of chronic pain

General somatic pain (pain that arises from your ‘outer’ body):

• Pain from your muscles or skin is easily localised by your brain as these types of pain are common. We have all experienced this general somatic pain since we were young when we fell or were hit by an object or person. Usually this type of somatic pain gets better in just a few days.
• However, some people develop somatic pain that stays: for example, chronic back pain or fibromyalgia.
• General somatic pain is usually treated using non-steroidal anti-inflammatory drugs (NSAIDs) (for example, naproxen/ibuprofen and/or paracetamol). Sometimes opioids might be required (for example, codeine or morphine).

Visceral pain (pain that arises from your internal organs):

• Pain that arises in your internal organs is much more difficult for you to locate as your brain has not had much experience in feeling this type of visceral pain. The connections that exist between the pain sensors present in your internal organs and your brain are much less sophisticated than those nerve connections that are coming from your outer body.
• You will no doubt have experienced some form of visceral pain, such as when experiencing acid indigestion or constipation. These kinds of pain are easily treated and they tend to improve quickly using non-prescription medications or they get better on their own without treatment.
• However, pain from an inflammation of your pancreas (chronic pancreatitis) or from an inflammation of your liver (chronic active hepatitis) can last for some time and can also prove difficult to treat.
• Some forms of visceral pain (such as that from gallstones or appendicitis) are able to be treated with surgery. Other types of visceral pain can be treated with non-opioid pain medications, while others require opioids.

Bone pain:

• Pain in your bones from a fracture or bruise is temporary. However, pain from spinal fractures, bone cancer, osteoporosis (a weakening of your bones, often seen in older people), osteomyelitis (which is a type of infection in your bone) and arthritis (which is an inflammation of your joints) can last for a long time.
• Bone pain is both throbbing and gnawing, and if you do suffer from this type of pain, then you might require long-term pain treatment with NSAIDs (like ibuprofen) and opioids. Osteoporosis can be treated using hormonal therapy or bisphosphonates (these help to strengthen your bones).
• Muscle spasms can produce severe pain, often in your back. The use of pain medication alone might not cure this type of pain and so muscle relaxants like baclofen might be required to relax your muscles.

Neuropathy (this type of pain arises from the nerves leading from your face, head, trunk or your extremities to your spinal cord):

• At a basic level, all pain does come from your nerves because your nerves actually transmit the painful impulses to your brain. However, some of these painful impulses do not come from your nerve endings (which normally do sense any injury or illness) but from irritation along the length of your nerve instead of at the end of your nerve.
• For example, sciatica is caused when your sciatic nerve (which goes from your spine to your leg) is ‘pinched’. This pinching often occurs near to the lower part of your spine; however, your brain ‘believes’ that the pain has come from your leg’s nerve endings because your sciatic nerve mostly transmits feelings from your leg.
• Other examples of neuropathy-causing illnesses (nerve pain) are infections like shingles that can cause nerve irritation, ruptured spinal discs that pinch nerves or cancers which grow into your nerves and produce irritation. Common diseases that can cause peripheral neuropathy are AIDS and diabetes.
• Nerve pain, which can elicit ‘pins-and-needles’ sensations, can be treated with something called ‘tricyclic antidepressants’. More severe nerve pain can be described as something like a stabbing, sharp and electric feeling. Medicines that are used for seizures, called anticonvulsants, are used to treat this sort of nerve pain.
• Nerve pain can also be due to the loss of a limb where a lost arm (or leg) that feels as if it is still there hurts severely. This is called ‘phantom-limb pain’ or deafferentation. This is often treated using a blood pressure medicine called clonidine that also works by relieving nerve pain.
• Herpes zoster (otherwise known as shingles) produces nerve-ending infection and infection of your skin near to your nerve endings. The local application of a prescription-strength pain medication ointment called capsaicin sometimes helps. Additionally, opioids, tricyclic antidepressants, and/or anti-convulsant medications might be required.

Circulatory problems:

• Poor circulation often causes chronic pain and is usually caused by diabetes, tobacco use or some autoimmune diseases (these are diseases where your body produces antibodies that fight against yourself) like lupus and rheumatoid arthritis.
• The partial blockage of your arteries due to fatty deposits known as plaques also leads to poor circulation. The reason why poor circulation leads to pain is because the part of your body that does not receive adequate blood circulation is deprived of nourishment and oxygen, damaging that part of your body, and thus causing pain.
• Pain arising from poor circulation can be treated with surgery that bypasses clogged arteries using artificial arteries that act by improving your blood circulation. This type of surgery is not always possible, so blood thinners (and/or opioids) might be required for pain control.
• Another fairly common cause for poor circulation is called complex regional pain syndrome (CRPS). This problem involves both nerve transmission and circulation as the painful nerve transmissions make your blood vessels narrow. The narrowing then prevents enough nourishment and oxygen from getting to the affected part of your body. Sometimes, CRPS can be treated with an operation (a surgical sympathectomy) that stops the nerve impulses from narrowing your blood vessels. Usually non-opioid medication (with or without surgery) is required and sometimes opioids are required.

Headaches:

• Headaches (such as cluster or tension headaches and migraines) can be the result of many illnesses and health conditions. They can also result from brain tumours, sinusitis, giant cell arteritis or trigeminal neuralgia.
• Treatment differs for the various types of headaches and the severity of the pain. Sometimes non-opioid medicines can be used. However, opioid therapy is sometimes required.
• Migraines often occur on one side of your head and can be associated with vomiting, nausea, photophobia (when light hurts your eyes), phonophobia (when sound hurts your ears), and something called ‘scintillating scotomata’ (when parallel lines vibrate at the edges of objects, often at the light and dark borders between things). These so-called auras tend to appear prior to the onset of the headache and thus alert you to the migraine coming on. Migraine pain varies from mild to severe in terms of intensity and many specific medications exist for migraine sufferers with triptan drugs being particularly beneficial for some migraine sufferers.
• Cluster headaches occur in groups, often several times each day, and they can last for days up to weeks. These headaches can be severely painful. Oxygen therapy is sometimes helpful for cluster headaches.
• Sinusitis can produce facial pain and is often worse in the morning. Sinus pain might respond well to anti-inflammatory medication and decongestant medication. Sometimes sinus surgery or antibiotic treatment is required.
• Trigeminal neuralgia is a severe peripheral neuropathy (nerve pain) that occurs on one side of the face and head. It has a so-called ‘trigger point’ (usually on the side of your face) which causes intense pain if touched. Anti-convulsants (or anti-seizure medications) are quite often beneficial for this type of nerve pain.

To book your same-day IPSA chronic pain consultation, book online or call your nearest IPSA clinic.