CHRONIC PAIN: WHAT IT IS AND HOW PROPER TESTING HELPS
Chronic Pain in the US
Table of Contents
What Is Pain?
- Burning
- Sharp
- Dull
- Intense
- Aching
- Cramping
- Shooting
- Stabbing
What is Chronic Pain?
- Lower back pain
- Cancer pain
- Arthritis pain
- Neurogenic pain (pain due to nerve damage in the brain or other body parts)
- Psychogenic pain (pain due to faulty processing of pain signals by the brain)
- Chronic Fatigue Syndrome: Thich causes extreme fatigue and unexplained pain.
- Endometriosis: This is a painful condition in females, in which the cells that line the inside of the uterus grow outside of the uterus.
- Fibromyalgia: This causes diffuse pain throughout the body.
- Inflammatory Bowel Disease (IBD): This is a long-term disorder that can cause inflammation in any part of the digestive tract.
- Interstitial Cystitis: This causes mild to severe persistent pain in the urinary bladder.
- Temporomandibular Joint Dysfunction: This condition causes severe pain and stiffness in the jaw.
- Vulvodynia: Vulvodynia is a painful condition of females which causes unexplained pain in the areas surrounding the vaginal opening.
The Effects of Chronic Pain on Physical and Mental Health
Long-term pain can seriously affect day-to-day activities, social life, and work performance. It’s common for people with chronic pain to have problems with sleep, appetite, concentration, and mobility.
Moreover, they are more likely to be depressed, anxious, and irritable. Chronic pain causes a threefold increase in the risk of anxiety, and also in the risk of mood disorders such as depression.
What Makes Pain Chronic?
Pain is a complex condition. It has both physiological and psychological components.
When a person sustains an injury, damaged tissues send pain signals to the brain. This is the body’s way of preventing further tissue damage. Pain signals that reach the brain stimulate nerves, causing an unpleasant sensation called pain.
Acute Pain vs. Chronic Pain
- Surgical or dental procedures
- Bone fractures
- Burns
- Cuts
- Labor and childbirth
Chronic Pain vs. Chronic Pain Syndrome
What Causes Chronic Pain?
Fibromyalgia
People with fibromyalgia have unexplained pain in almost every part of their bodies. No one knows what causes fibromyalgia. Nonetheless, scientists think an imbalance of certain brain chemicals may play a critical role. Fibromyalgia can cause tender spots, muscle pain, headaches, long-lasting back pain, or neck pain.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) causes persistent aching that affects more than one joint. Hands, wrists, and knees are the most commonly affected joints. People with RA have other symptoms, such as joint stiffness, swelling, and fever. Like Osteoarthritis, RA has no cure.
Osteoarthritis
Osteoarthritis (OA) causes severe intermittent or persistent aching in the knees, hips, spine, and feet. Other symptoms include joint stiffness, swelling, and limited joint mobility. There is no cure for OA. Thus, people with OA might have some level of pain throughout their lives. According to the CDC, 25% of adults with arthritis (15 million adults) have severe pain in their joints.
Multiple Sclerosis
Multiple sclerosis (MS) is a disease of the brain and the spinal cord. In people with MS, the immune system damages the protective covering of the nerves. As a result, the brain cannot effectively communicate with the body. MS causes pain in the legs, feet, arms, and hands. People with MS report experiencing burning, prickling, or stabbing pain almost every day.
Sciatica
Sciatica causes mild to sharp burning pain that travels from the lower back to the buttocks. Unlike acute sciatica, chronic sciatica persists for three months or longer. The condition is more common in adults aged 40 or older.
Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) causes pain and numbness in the thumb and in the index, middle, or ring fingers. The common causes include repetitive movements of the hand, rheumatoid arthritis, diabetes, and an underactive thyroid gland. Some women may have CTS during pregnancy.
Traumatic Injury
12 to 40% of cases of chronic pain have a history of physical trauma or injury. Likewise, 15% of people hospitalized after serious injury report chronic pain within the first year.
Back Injuries
Combat Injuries
Sports Injuries
Can Being Overweight Cause Chronic Pain?
Who Suffers from Chronic Pain?
Veterans
- About 1 in 5 veterans in primary care have long-term pain
- 1 in 10 have severe persistent pain
Athletes
- Lower back pain
- Leg pain
- Stress fractures (cracks within a bone)
- Tendinitis (swelling of the tendon - a band of fibrous tissues that holds muscles and bones together)
- Diabetes
- Brittle bones
- Recurrent fractures
- Narrowed spinal canal, which presses the nerves that travel through the lower back into the legs
Seniors
- Cancer
- Arthritis and gout
- Heart disease
- Kidney disease
- Damaged nerves
- Stroke
- Shingles
Women
- Arthritis
- Brittle bones
- Migraines
- Irritable bowel syndrome (IBS), which causes mild to severe stomach cramps
How is it Diagnosed?
Diagnosing chronic pain is not easy, as there are no tools to quantify pain. Diagnosis often involves a series of tests and procedures, as well as a review of symptoms and medical history.
- When did you first begin having pain?
- How do you describe your pain? (shooting, burning, cramping, stabbing, dull, or sharp?)
- Have you had an injury in the affected part?
- Does any activity relieve your pain or make it worse?
- Do you have a history of mental illness, such as depression or anxiety?
- Where do you rate your pain on a scale of 0 to 10?
- Where do you rate your pain on a scale of 0 to 10?
Athletes
Blood Testing
Blood tests are useful in the diagnosis of infections and inflammation. People with infection/inflammatory disorder have high levels of white blood cells, and also of inflammatory substances such as the C-reactive protein (CRP).A blood test can also help determine if there is the presence of rheumatoid arthritis (RA), gout, or cancer. If RA is present, the blood analysis will show positive results for specific proteins called rheumatoid factors.
Urine Testing
Urinalysis is most commonly used to check if a patient has gout. Gout is a type of arthritis that causes high blood levels of uric acid.A doctor may also order a urine test for a patient who uses a narcotic painkiller to relieve chronic pain.
Testing Spinal and Brain Fluid
A doctor inserts a needle into the lower back and collects a sample of cerebrospinal fluid (CSF). CSF is a clear liquid that protects the brain and spinal cord.A CSF analysis helps diagnose disorders of the central nervous system and some types of cancer.
Musculoskeletal and Neurological Exams
Imaging
- Identify fractures or inflammatory changes in the bone
- Obtain details of a bone and surrounding structures
- Tell the difference between cancerous growths, infections, or fractures
- Identify nerve damage
X-Rays
X-rays are frequently used to diagnose fractures. A specific form of x-ray imaging, the arthrogram, may be used to check painful joint disorders.MRI
An MRI scan uses a strong magnetic field and radio waves to create detailed images of internal organs. MRI helps diagnose the following conditions.- Chronic low back pain
- Fibromyalgia
- Osteoarthritis
- Chronic migraine
- Chronic pelvic pain
- Peripheral neuropathy (damage to nerves that lie outside the brain and spinal cord)
Electrodiagnostic Procedures
Electromyography (EMG)
An EMG helps diagnose disorders of muscles and nerves. It records electrical activity in the muscles. Thus it helps find out how electrical signals pass from nerves to muscles.A patient may need an EMG if they have numbness, muscle weakness, tics, or muscle pain. Electromyography may be used to identify some conditions that can cause chronic pain, such as:
- Carpal tunnel syndrome
- Amyotrophic lateral sclerosis (ALS)
- Radiculopathy (pinched nerves in the spine)
- Muscular dystrophy (a genetic disorder that causes a gradual loss of muscle mass)
Nerve Conduction Study (NCS)
A nerve conduction study measures the speed with which electrical signals pass through a nerve. NCS is a valuable tool to identify:
- Carpal tunnel syndrome
- Herniated disk disease, which causes low back pain
- Abnormalities in the sciatic nerve
To confirm a diagnosis, a doctor may order both EMG and NCS at the same time.
Pain Management
- Improve mobility as much as possible
- Maintain quality of life with the lowest possible dose of medication
- Reduce the risk of pain-related psychiatric problems such as depression and anxiety
Pain Relievers
Non-Opioids
Opioids
Anticonvulsants
Muscle Relaxants
Corticosteroids
Antirheumatic Agents
Antidepressants
Alternative Treatments
- Massage: This treatment may help relieve pain associated with RA and fibromyalgia
- Acupuncture: This treatment may work for pain due to osteoarthritis and fibromyalgia
- Meditation: Limited studies suggest that mindfulness meditation improves pain perception and may reduce depressive symptoms
- Hypnosis: Hypnosis may be useful in treating cancer pain and back pain
Psychological and Behavioral Treatment
Acceptance and Commitment Therapy (ACT)
Cognitive-Behavioral Therapy (CBT)
- Cancer
- Chronic migraines
- Fibromyalgia
- HIV/AIDS
- Irritable bowel syndrome
- Multiple sclerosis
- Osteoarthritis
- Rheumatoid arthritis
- Spinal cord injury
Why is Proper Testing Key to Treating Chronic Pain?
- Designing the most effective treatment plan
- Improving the quality of life
- Preventing potentially life-threatening complications
- Reducing the cost of diagnosis and treatment
Resources
- https://nccih.nih.gov/research/results/spotlight/Prevalence-Profile-High-Impact-Chronic-Pain
- https://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/2351-notes.pdf
- https://www.theatlantic.com/health/archive/2017/12/america-experiences-more-pain-than-other-countries/548822/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562413/
- https://nccih.nih.gov/news/press/02122019
- https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Pain
- https://www.health.harvard.edu/mind-and-mood/depression-and-pain
- https://www.hsph.harvard.edu/news/hsph-in-the-news/suicide-rates-chronic-pain/
- https://www.uspharmacist.com/article/trends-in-chronic-pain
- https://www.cdc.gov/arthritis/pain/index.htm
- https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain
- https://academic.oup.com/painmedicine/article/14/3/336/1858823
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676152/
- https://bestpractice.bmj.com/topics/en-us/694
- https://www.apa.org/pubs/journals/releases/amp-a0035794.pdf
- https://effectivehealthcare.ahrq.gov/products/opioids-chronic-pain/protocol
- https://www.frontiersin.org/articles/10.3389/fphar.2018.01229/full