Chronic Pain

Just about everyone gets aches or pains at some point. But for some people, pain is a constant presence in their lives.

Normally, we experience pain as a result of a specific injury. The sensation lets us know something has happened, so we can take appropriate action.

But chronic pain is different. Chronic pain lasts. The National Institute of Neurological Disorders and Stroke (NINDS) says that for someone with chronic pain, pain signals keep firing in the nervous system (Read about "The Brain" "Nervous System") for weeks, months, or even years. The pain may start with a specific incident, such as a sprain. (Read about "Sprains") Or there may be an underlying condition or disease such as arthritis or a so-called slipped disc that causes chronic pain. (Read about "Arthritis and Rheumatic Diseases" "Back Pain" "The Spine") Pain complaints such as headache (Read about "Headaches"), low back pain, arthritis pain or neurogenic pain, which results from damage to the peripheral nerves (Read about "Peripheral Neuropathy") or to the central nervous system itself, are especially common as we get older. Pain can be caused by diseases and conditions such as chronic fatigue syndrome, sickle cell disease or post-polio syndrome. (Read about "Chronic Fatigue Syndrome" "Sickle Cell Disease" "Post-Polio Syndrome") Pain can also result from cancer or cancer treatments. (Read about "Cancer: What It Is" "Cancer Treatments")

In addition, some people suffer chronic pain without having experienced any apparent past injury and many of these people spend years trying to pinpoint the source of their pain. If you or someone you love is experiencing chronic pain, it's important to see a doctor to rule out specific underlying causes that require immediate medical treatment.

Treating chronic pain

Because the causes of chronic pain are so varied, there is no single treatment that can work for everyone. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says treatment options that may be useful for chronic pain include:

• Medications - For some types of pain, pain relievers such as acetaminophen may be effective. If pain is caused by inflammation, aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be helpful. If chronic pain is severe, stronger prescription medications may be needed. The National Cancer Institute (NCI) says many people may be concerned about losing control or getting addicted to pain medication; however NCI says that correct use and careful monitoring of medications can reduce this risk substantially. Talk with your doctor and remember to take precautions to avoid potential interactions. (Read about "Medicine Safety") A caution about "over-the-counter" pain relievers such as acetaminophen and ibuprofen; you should not take them for more then a week without consulting a doctor. They can have serious side effects such as gastric bleeding and liver damage. (Read about "Gastrointestinal Bleeding" "The Liver")
• Heat and cold - The use of either heat or cold for pain depends on the specific cause of the pain and should be discussed with your doctor or physical therapist. Moist heat options include such things as a warm bath or shower; dry heat options include such things as a heating pad. Make sure you take all necessary precautions to avoid burning or otherwise hurting your skin, and if you have poor circulation, do not use cold packs.
• Transcutaneous electrical nerve stimulation or TENS - A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some types of pain. NIAMS says that TENS seems to work by blocking pain messages to the brain and by modifying pain perception. (Read about "The Brain" "Nervous System")
• Massage - Massage therapy, using light strokes may increase blood flow and bring warmth to a stressed area. However, make sure you discuss this options with your doctor first and use only a highly qualified therapist who has experience working with people who have chronic pain. (Read about massage in "CAM Therapies")

For some forms of chronic pain, such as back conditions, surgery may be the best option. Some patients have also benefited from psychotherapy, therapy, biofeedback (Read about biofeedback in "CAM Therapies") and behavior modification. This is not to say that the pain these people felt was "all in their head," just that certain alternative therapies can be useful in coping with this condition.

Although chronic pain remains a difficult problem to tackle, research continues into possible causes and better treatments. For example, the National Institutes of Health say that some researchers have found that people with chronic pain often have lower-than-normal levels of endorphins in their spinal fluid. Investigators are also studying the effect of stress on the experience of chronic pain. (Read about "Stress") The important thing is that you shouldn't ignore pain. See a doctor as soon as possible.

Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy Syndrome

A specific type of chronic pain is called complex regional pain syndrome (CRPS). It is also known as reflex sympathetic dystrophy syndrome. NINDS says the key symptom of CRPS is continuous, intense pain out of proportion to the severity of the injury, which gets worse rather than better over time. CRPS most often affects one of the arms, legs, hands or feet. Often the pain spreads to include the entire arm or leg. Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating and swelling.

Doctors aren't sure what causes CRPS, according to NINDS. In some cases, the sympathetic nervous system plays an important role in sustaining the pain. Another theory is that CRPS is caused by a triggering of the immune response (Read about "Immune System"), which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area.

Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. NINDS says doctors may prescribe any number of things to relieve the pain such as:

• topical analgesics
• antidepressants (Read about "Depressive Illnesses")
• corticosteroids
• opioids

There is a warning concerning corticosteroids however. The National Institutes of Health say anyone using corticosteroids should talk to their doctors about taking supplemental calcium (Read about "Calcium") and vitamin D to reduce the risk of osteoporosis. (Read about "Vitamins & Minerals" "Osteoporosis")

However, no single drug or combination of drugs has yet produced consistent long-lasting improvement in symptoms, according to NINDS. Other treatments may include:

• physical therapy (Read about "Rehabilitation")
• sympathetic nerve block
• spinal cord stimulation
• intrathecal drug pumps to deliver opioids and local anesthetic agents via the spinal cord

The prognosis for CRPS varies from person to person. Spontaneous remission from symptoms occurs in certain individuals. Others can have unremitting pain and crippling, irreversible changes in spite of treatment.

Related Information:

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