Chronic pain is a big problem for a lot of people. More people than most realize, I think. It is also a frequently misunderstood problem and those of us experiencing chronic pain can face attitudes ranging from pity to disbelief to (sometimes) understanding.
When discussing pain, it is important to realize that there are different kinds of pain. The cause of the pain determines appropriate treatment. The American Chronic Pain Association website offers a wealth of information on various causes of pain and treatment options. It’s a great resource to check out. I’ll give a quick overview here, but that site covers things in much greater detail.
Generally speaking, chronic pain is pain that persists 3 to 6 months or more. The pain may be from an injury or an ongoing process. It may be from muscles, nerves, bones, or visceral organs. Determining the cause helps with choosing an appropriate treatment. In some cases, the causative factor can be treated and the pain relieved. In many cases some level of pain persists despite the best treatment and pain medications or other treatments are necessary in order to stay functional. Most times there are multiple sources of pain. For example in my case, I have old injuries to a couple of joints, osteoarthritis in those joints plus several others, cardiac pain, and frequent migraine and tension headaches. Examples of other causes of chronic pain are diabetic neuropathy, fibromyalgia, back or neck degenerative disc disease, peripheral vascular disease. This is by no means a comprehensive list.
Joint pain is a common complaint as people age or in younger people with injuries or an ongoing inflammatory process like rheumatoid arthritis. Often physical therapy can help with joint pain by strengthening the muscles which support the joints and improving flexibility. Sometimes a surgical intervention may be called for to correct a joint abnormality. In my case, I had to have surgery on my knee for an injury which tore the meniscal cartilage and ruptured two ligaments. I had another surgery on my ankle to help arthritis pain caused by joint instability. That actually reduced my pain to a much more easily tolerated level for several years. Steroid injections to joints or visco-supplementation (injecting a synthetic synovial fluid into the joint capsule) can relieve or reduce pain. Heat and/or ice is useful and an inexpensive treatment that can be done at home any time. Finally medications are a big stand-by, especially anti-inflammatories such as the NSAIDS (ibuprofen, naproxen, etc.) or even steroids (prednisone, medrol, etc.). For those unable to use NSAIDS due to stomach or bleeding problems, kidney problems, high blood pressure, or cardiovascular issues, or those with severe pain, opiates may be necessary. Topical medications are also commonly used. These include counter-irritants such as camphor, menthol, or capsaicin (found in Tiger Balm, Icy Hot, Ben Gay), salicylates (aspirin-like compounds), and NSAIDS (topical ketoprofen or diclofenac).
Nerve pain can be a more difficult problem to cope with. This type of pain may be caused by damage to a nerve from an injury or surgery, peripheral neuropathy related to diabetes or some vitamin deficiencies, pressure on a nerve by bone spurs or neighboring structures such as bulging discs or inflamed tissues. The pain is typically perceived as burning or tingling and maybe shooting. Treatment may require surgery to free trapped nerves or reduce pressure. Keeping diabetes under control helps diabetic neuropathy. Treating vitamin deficiencies may relieve the pain if that is the problem. If medication is needed, typically medications originally developed to treat seizures are used. These include Neurontin, Depakote, Dilantin, Tegretol, Lyrica. Certain antidepressants are used at low doses such as amitriptyline, nortriptyline, or trazodone. Injections of steroids or local anesthetics may be used also in some cases.
Visceral pain originates inside the body in the internal organs. Examples include that burning pain in the stomach and chest from gastro-esophageal reflux (GERD), chest pain from cardiac ischemia, abdominal and back pain from gallbladder problems or kidney stones. The key to all of these is treating the underlying pathology in the organ if possible. That may mean acid reducing medicine and diet changes for GERD, for example. Cardiac ischemia requires revascularization by stenting blocked vessels or bypass and nitrates or other cardiac medications.
There are also pain syndromes such as fibromyalgia and reflex sympathetic dystrophy. These require specialized treatment which may include physical therapy, aquatherapy, injections, or oral medications. Tramadol has been found to be especially helpful for fibromyalgia pain. Sometimes Tylenol or NSAIDS are used. Medications for neuropathic pain such as Lyrica are used as well.
This is not meant to be a comprehensive review. There are many possible treatments I have not been able to cover yet. Next time I’ll talk more about the use of opiate medications and common misconceptions and attitudes encountered by those with chronic pain.