CHRONIC PAIN: WHAT IT IS AND HOW PROPER TESTING HELPS
Chronic Pain in the US
Table of Contents
What Is Pain?
What is Chronic Pain?
The Effects of Chronic Pain on Physical and Mental Health
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.
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Acute Pain vs. Chronic Pain
Chronic Pain vs. Chronic Pain Syndrome
What Causes Chronic Pain?
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 (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 (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.10
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.11
Sciatica causes mild to sharp burning pain that travels from the lower back to the buttocks. Unlike acute sciatic, 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.
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.12 Scientists do not know how an injury can lead to persistent pain. Nonetheless, they believe several factors may increase the risk. These include pre-injury depression, anxiety, and alcohol use, as well as a history of chronic pain. Those who have sustained multiple injuries may be at a higher risk.
Can Being Overweight Cause Chronic Pain?
Who Suffers from Chronic Pain?
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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.
Blood TestingBlood 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 TestingUrinalysis 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 FluidA 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
X-RaysX-rays are frequently used to diagnose fractures. A specific form of x-ray imaging, the arthrogram, may be used to check painful joint disorders.
MRIAn 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
- Chronic migraine
- Chronic pelvic pain
- Peripheral neuropathy (damage to nerves that lie outside the brain and spinal cord)
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.
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Psychological and Behavioral Treatment
Acceptance and Commitment Therapy (ACT)
Cognitive-Behavioral Therapy (CBT)
Why is Proper Testing Key to Treating Chronic Pain?