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Chronic Pain

What is chronic pain?

Pain is official defined as, “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. The definition emphasises the importance of the emotional component as well as any tissue damage/injury.

Chronic pain is quite simply pain that goes on for more than 3 months. It is a common condition that affects around 20% of the adult population, although some research suggests an even greater proportion of the adult population suffers from chronic pain.

Where does chronic pain occur?

Chronic pain can essentially affect any part of the body.

Frequently, chronic pain conditions affect individual body sites within the musculoskeletal system, such as the neck and lower back, as well at major joints such as the knees, hips and shoulders. However, chronic musculoskeletal pain can also be widespread and affect multiple body sites with the condition known as ‘fibromyalgia’ being the most well-known and publicised presentation.

Chronic pain can affect the abdomen, for example, pain is commonly an important symptom in the condition ‘irritable bowel syndrome’ (IBS), and it can also affect the pelvis after major trauma and infection and in long-term gynaecological conditions such as endometriosis.

Types of chronic pain

Chronic pain can be broadly divided in to three types, nociceptive, neuropathic and nociplastic.

The one we all know best is chronic nociceptive pain, which is the type of pain we get after and acute physical injury, such as a muscle strain or ligament sprain. It is also the type of pain that is associated with wear and tear in the joints and arthritis. It occurs when the body’s nerve endings (‘nociceptors’) are stimulated by trauma and inflammation for example.

Another type of pain is chronic neuropathic pain. This type of pain arises from nerves that have been damaged. Chronic neuropathic pain is commonly associated with other neurological symptoms, such as numbness, pins and needles and skin hypersensitivity.

The third type of pain is nociplastic pain, which is pain that arises without clear evidence of actual of potential tissue damage to cause nociceptive pain, or neurological damage to cause neuropathic pain. A good example of nociplastic pain is the chronic widespread pain associated with the condition ‘fibromyalgia’.

 

Can chronic pain occur without a medically demonstrable cause?

Radiological investigations such as X-rays and MRI scans, blood tests and nerve tests can all identify underlying problems that might cause chronic pain, but they can not show pain. There are many patients who suffer from chronic pain without a demonstrable underlying cause and there are many patients who suffer chronic pain that is considered more severe and restricting than their doctor would anticipate on the basis of their scans or test result.  A common example is the patient with severe lower back and leg pains, who has a normal MRI scan, or a scan that only shows medically minor wear and tear in keeping with their age.

Investigations are often necessary because it is important to exclude underlying medical conditions that might benefit from specific treatment targeting the underlying pathology, such as a particular medication, a cortisone injection or surgery. The absence of important demonstrable pathology usually means that treatment can focus on chronic pain as a symptom and the restoration of lost functional capacity.

In these cases, the chronic pain may have been triggered by an initial injury to soft tissues that has gone on to heal without leaving any residual evidence of the damage. It may be that parts of the nervous system are ‘malfunctioning’ and not processing incoming sensory information in a normal way.

We know that emotional factors are important aspects of the experience of chronic pain. People suffering from stress and psychological symptoms, such as anxiety and depression, and those that have experienced significant traumatic events in their lives, including adverse events in their childhood, are at increased risk of developing a chronic pain condition in the absence of any demonstrable important underlying physical pathology.

 

How can chronic pain affect your life?

Living with chronic pain can interfere considerably with the ability to get on with life, not only at home, but also socially and at work.

Chronic pain can become so intrusive, that is makes even the most simple daily tasks difficult. The experience of chronic pain can affect the quality of sleep, personal, social and work relationships, and a patient’s psychological health. The sleep deprivation, breakdown of relationships, social withdrawal and emotional issues such as stress, anxiety and low mood/depression, commonly result in a worsening experience of pain.

Without the input of professionals experienced in treating chronic pain, it often becomes very difficult for the patient to escape from this type of negative cycle.

Does chronic pain cause depression?

Chronic pain can have very important psychological consequences and symptoms such as anxiety and depression are very common in patients experiencing chronic pain. The experience of chronic pain and the associated losses in a patient’s ability to engage in many of the activities they used to enjoy, frequently results in lowered mood and indeed episodes of depression that require treatment their own right.

Will chronic pain ever go away?

There may be a means of relieving the pain, or significantly reducing the severity of the pain. For example, chronic knee pain caused by severe osteoarthritis can commonly be effectively treated with knee replacement surgery.

Where the mechanisms for the chronic pain are more complex, it is commonly much more difficult to take the pain away.  However, a patient’s experience of their pain, and their ability to manage it and engage in important daily activities can be improved considerably through engagement in specialist Chronic Pain Management.

 


For more information about Dr Valentine’s expertise in managing chronic pain, visit Dr Jon Valentine – London Sports Orthopaedics

To arrange an appointment: Tel: 020 7496 3564 / Email: valentine.admin@sportsortho.co.uk.