We often associate pain with some direct cause. It could be from a sports injury, or toothache, perhaps an accident which has resulted in a broken limb. For most of these there is a standard action and recovery process, with no pain once healed.
For many though, pain is something for which there is no simple “cause and effect” making it more difficult to fix the problem. Pain is a constant factor in the lives of many. The 2006 National Disability Survey Ireland (CSO, 2008), stated that pain was one of the most common disability types reported. 50% of individuals reported pain as the main cause of their disability. 20% stated the pain disability was caused by an accident or injury. 13% of Irish population and 27% of Irish households are affected by chronic pain
What is Chronic Pain
Chronic Pain can be defined as pain which has lasted longer than what would be considered as “normal” healing time, perhaps as part of recovery from illness or injury; generally, more than 3 months. Chronic Pain may be attributable to an event such as an accident, developing from acute pain. In some cases, especially in relation to sports injury in contact sports, the underlying chronic pain may appear sometime after an event.
Surveys show that in Ireland, 35% of reported Chronic Pain was arthritis related. It may be site specific, (e.g. Back, Knee, Wrist) however 80% of sufferers in Ireland report that their pain relates to more than one site.
Types of Chronic Pain
Nociceptive pain is the type of pain which results from physical injury or damage to body tissue. This may be due to a fracture, injury or burn, or following surgical treatment such as following an operation. It can present as a sharp or stabbing type of pain, or as an ache. The pain can also be described as ‘gripping’ in nature. Lower back pain is the common form of this pain; 40% of all pain in Ireland is back pain. However, pain may also result from conditions such as osteoarthritis and osteoporosis.
Neuropathic pain is caused by damage of the nerves, spinal cord, or brain. Typical effects are felt as a burning or tingling type of pain. This type of pain can often be spontaneous, and can be felt as sudden shocks. Neuropathic pain can also be felt as hypersensitivity to touch or cold. Causes of neuropathic pain include nerve compression such as carpal tunnel syndrome and nerve damage for example from peripheral neuropathy due to diabetes or post-herpetic neuralgia following shingles (herpes zoster) infection.
Psychogenic pain is physical pain that arises from psychological factors, and is much less common as a stand-alone condition. Psychological factors and symptoms of psychogenic pain often complicate pain related disabilities although the pain has a physical cause, the psychological factors exacerbate or enhance the pain to be more severe than found in most individuals with a similar physical cause of pain. There can be a cyclic effect known as chronic pain syndrome. This arises when an individual with physical pain becomes increasingly anxious about their pain. These psychological factors then increase the perception that the pain is more severe, which then causes increased anxiety and the cycle repeats. Treatment plans for this type of pain should include a mental health component, however, it should be recognised that although psychogenic pain has psychological roots, the pain that is experienced by the individual is real and has can have profound physical effects.
Causes of Chronic Pain
The cause of chronic pain is often difficult to determine with often many aspects to consider. It is this indeterminate nature which can present the biggest obstacle to health professionals to establishing proper diagnosis of the condition.
A general classification of the 4 main categories for pain are:
- Musculoskeletal pain
Causes of Musculoskeletal pain include Osteoarthritis; Rheumatoid arthritis; Osteoporosis; Ankylosing spondylitis; Polymyalgia rheumatic; Fractures; Chronic or repetitive overuse; Carpel Tunnel Syndrome and Muscular strains and Mechanical low back pain.
- Headache and/or Migraine
Causes of Headache and/or Migraine include Cluster Headaches; Migraine; Trigeminal neuralgia; Glaucoma; Smoking; Alcohol and Drug or Substance overuse or misuse.
- Neurological (nerve related)
Causes of neurological pain include Diabetic nerve damage (up to 25% of diabetics); Shingles; Multiple Sclerosis; Alcoholism; Thyroid disease and Pernicious anaemia; Infections (e.g., HIV)
- Psychological causes
Psychological causes of pain include Depression; Anxiety; Personality disorders and Sleep disturbances.
The accepted pathway for someone who believes they may have Chronic Pain is to visit their GP in the first instance. The GP or pharmacist will use a standardised “question and answer” style approach to ascertain the exact nature of the problem.
It is important for the patient to provide the GP or other health professional with as much knowledge as they can regarding their symptoms and their impact of daily function. This will enable the health professional to make a better-informed decision as to next steps in terms of appropriate medication and/ or subsequent referral to a pain specialist.
If referred to a pain specialist including consultants across many disciplines esp. Migraine and Arthritis, the best thing a patient can do is to keep a diary, recording experiences, symptoms and any information at all to add value to their first appointment. Waiting times to see specialists are generally long (average currently at 2 years) and all too often, the outcome of the first appointment is to go away, complete a diary and come back; So, with resources extremely limited and waiting times so long, it is vital that people make as much as they can from their first visit.
To be continued…next week I discuss treatment options
Disclaimer: Information given is general; Please ensure you consult with your healthcare professional before making any changes recommended